Search

Microglia are the resident macrophages of the central nervous system (CNS), implicated in developmental processes, homeostasis, and responses to injury. Derived from the yolk sac during development, microglia self-renew, self-regulate their numbers during homeostatic conditions, and show a robust proliferative capacity even in adulthood. Together with monocyte-derived macrophages (MDM), microglia coordinate the regeneration of CNS myelin around axons, termed remyelination. Gene expression analyses and experimental modelling have identified pro-remyelination roles for microglia/MDM in clearance of myelin debris, secretion of growth factors, and remodelling of the extracellular matrix. Further investigations into the molecular mechanisms controlling these regenerative functions will reveal novel therapeutic strategies to enhance remyelination, by harnessing the beneficial effects of the innate immune response to injury. [ABSTRACT FROM AUTHOR]

Objective Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others. Methods Theory building among researchers with experience and expertise in clinician–patient communication, using an iterative cycle of discussions. Results We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model ‘collaborative deliberation.’ The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration. Conclusions We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the exploratory use of short decision support tools for patients, called Option Grids. Option Grids are summary tables, using one side of paper to enable rapid comparisons of options, using questions that patients frequently ask (FAQs) and designed for face-to-face clinical encounters. To date, most evidence about ‘patient decision aids’ has been based on tools with high content levels, designed for patients to use independently, either before or after visits. Methods: We studied the use of Option Grids in a quality improvement project, collecting field notes and conducting interviews with clinical teams. Results: In the ‘Making Good Decisions in Collaboration’ (MAGIC) program, clinicians found that using Option Grids made it easier to explain the existence of options and reported a ‘handover’ effect, where patient involvement in decision making was enhanced. Conclusion: Option Grids made options more visible and clinicians found it easier to undertake shared decision making when these tools were available. Used in a collaborative way, they enhance patients’ confidence and voice, increasing their involvement in collaborative dialogs. Practice implications: Further work to confirm these preliminary findings is required, to measure processes and to assess whether these tools have similar impact in other clinical settings. [Copyright &y& Elsevier]

The passive corrosion properties of a series of Ni–Cr–Mo alloys were investigated. The alloys studied were C22, C2000, C276, C4 and 625. Potentiostatic experiments at potentials within the passive range were obtained as a function of temperature (25–85 °C) for each alloy. Each specimen was subsequently analyzed by time-of-flight secondary ion mass spectrometry (TOF SIMS) and X-ray photoelectron spectroscopy (XPS). Results indicated that much lower passive dissolution currents, and a much slower attainment of steady-state conditions, were observed on those alloys with >20 wt.% Cr content. These alloys also consistently showed only a minor temperature dependence of the passive current. The surface analyses showed that the high-Cr alloys were able to build thicker oxides with a layered structure consisting of an inner Cr–Ni oxide layer and an outer Mo/Cr oxide. By contrast, such a high-Cr content inner layer and structured elemental distribution were not achieved with alloys having a lower bulk Cr content.For low potentials (200 mV), when Cr dissolution can only occur as Cr(III), additional alloying elements, specifically Mo and W, exert little influence on passive current densities. At 500 mV, a potential at which Cr(VI) release appears to start, the presence of Mo, and especially W, in the outer regions of the oxide suppresses passive dissolution. This may be due to the low dissolution rate of the W-containing surface oxide layer, but some influence of W on the defect density within the oxide cannot be ruled out. The observed temperature dependence for high-Cr alloys (C22, C2000) reflects the lack of steady state and cannot be interpreted as an accurate activation energy. [Copyright &y& Elsevier]

Objective: Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice.Methods: Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed.Results: Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited.Conclusion: A more complex picture was observed compared with previous portrayals in current theoretical models.Practice Iimplications: The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice. [ABSTRACT FROM AUTHOR]