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Exposure to adversity (e.g., poverty, bereavement) is a robust predictor of disruptions in psychological functioning. However, people vary greatly in their responses to adversity; some experience severe long-term disruptions, others experience minimal disruptions or even improvements. We refer to the latter outcomes—faring better than expected given adversity—as psychological resilience. Understanding what processes explain resilience has critical theoretical and practical implications. Yet, psychology's understanding of resilience is incomplete, for two reasons: ( a) We lack conceptual clarity, and ( b) two major approaches to resilience—the stress and coping approach and the emotion and emotion-regulation approach—have limitations and are relatively isolated from one another. To address these two obstacles,we first discuss conceptual questions about resilience. Next, we offer an integrative affect-regulation framework that capitalizes on complementary strengths of both approaches. This framework advances our understanding of resilience by integrating existing findings, highlighting gaps in knowledge, and guiding future research.

Objectives The current study investigated the hypothesis that the relationship between flow states and well-being is mediated by nondual experiences. Past empirical and theoretical work suggests flow states share similarities with nondual experiences. The current study expanded upon previous work by examining the relationships between flow, nondual experiences, emotion, and well-being. Methods Students enrolled in various artistic classes (N = 104) were surveyed once a week for four weeks. Participants reported on their experiences of flow, nonduality, emotion, and psychological and subjective well-being. Results Higher scores on measures of both flow (b = 7.03, SE = 0.82, p < .001) and nondual experiences (b = 0.17, SE = 0.02, p < .001) predicted increased positive emotion immediately after class. Nondual experiences partially mediated this relationship, such that when accounting for nondual experiences, the relationship between flow and positive emotion was significantly decreased (b = 4.30, SE = 0.45, p < .001). Longitudinally, nondual experience also mediated the relationship between flow and satisfaction with life (Sobel t = 1.94, SE = 1.06, p = .05). However, while flow predicted increased psychological well-being (b = 0.32, SE = 0.14, p = .02) after the four weeks, nondual experience did not (b = −0.003, SE = 0.002, p = .13). Conclusions These findings suggest that flow states may facilitate some features of nonduality and share similarities with meditative states. Additionally, the link between flow and well-being may be explained by its similarities to meditative states, and that creative activities could be useful in fostering well-being.

Experimental investigations of emotion regulation have shown that reappraisal (changing interpretations to change emotions) and distraction (directing attention to change emotions) are effective for regulating the experience of both negative and positive affect, while suppression (changing the outward expression of emotion) has been consistently shown to be ineffective. It is unknown, however, whether this pattern of effects generalizes to the context of daily stressors-a common part of daily life in which effective emotion regulation should be particularly beneficial. In addition, little is known about how frequently different strategies are deployed in response to daily stressors. The present investigation used daily diary methodology in two separate samples of adults (N = 174) to examine the use of these three emotion regulation strategies and their relationships with both negative and positive affect in response to daily stressors. Results revealed that reappraisal was negatively associated with negative affect and positively associated with positive affect, although the effect sizes for positive affect were larger than those for negative affect, suggesting that reappraisal may be particularly important for increasing positive affect in response to daily stressors. Distraction was consistently positively associated with negative affect, while suppression was not consistently associated with either negative or positive affect, suggesting that these two strategies may not be associated with emotional relief in the face of stressors. In terms of frequency of use, suppression was endorsed at higher rates than reappraisal and distraction, suggesting that individuals' use of emotion regulation strategies may not align with their effectiveness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognitive reappraisal is a common form of emotion regulation that often centers on reframing how one thinks about an emotional situation so that one feels better. Given its demonstrated widespread benefits, two conclusions have been drawn about reappraisal: People can use it easily, and people should use it frequently. We critically examine these conclusions and highlight two fundamental drawbacks of reappraisal: First, people are often unable to use reappraisal successfully, and second, even when successful, using reappraisal to feel better is not always functional. To synthesize current research and inspire future research, we present a conceptual framework that systematically considers these drawbacks and how they may be influenced by individual-centered factors (e.g., the individual’s skill) and situation-centered factors (e.g., a stressor’s intensity) to shape outcomes across time. We then summarize the current literature and highlight the importance of considering reappraisal’s costs and benefits in future research.

Evidence to date has established a preference for successful individuals whose achievements are attributed to natural talent (“naturals”) rather than focused effort (“strivers”). Across six studies, we discovered a reversal of the bias depending on contextual and personal factors. Strivers, rather than naturals, are favored when evaluating ordinary people. This preference is particularly strong among perceivers who have experience in the performance domain, and it replicates across different domains and participant populations. Strivers are also preferred as cooperative partners and are expected to perform better on novel, unrelated tasks. The direction of the preference for naturals versus strivers can be traced to a combination of the perceiver's experience and the target's professional status. Specifically, a naturalness bias was only present among experienced perceivers evaluating professional targets. On the other hand, a more implicit form of the naturalness bias was observed in attributions made about the target's achievement, such that strivers were assumed to have natural talent more than naturals were assumed to have worked diligently.

Background Techniques in breast reconstruction have significantly advanced the possibility to create more natural and aesthetically appealing breasts. Despite thorough preoperative planning and vigilant operative technique, symmetry remains a concern for select patients who have undergone autologous breast reconstruction. Although symmetry procedures of the contralateral breast have been well described in the literature, little has been published regarding secondary revision in the autologous reconstructed breast, leaving uncertainty as to the appropriate timing and technique for revision procedures that will not hinder the viability of the flap. In this article, we provide an effective, reproducible and safe method of mastopexy after autologous breast reconstruction. Methods A retrospective review of all patients undergoing autologous breast reconstruction by a single surgeon between 2007 and 2014 was performed. Patients who underwent mastopexy after autologous breast reconstruction were included. Patient characteristics, type of reconstruction, staging of procedures, secondary operations, and complications were recorded. Results Ten patients with asymmetric autologous breast reconstruction underwent flap mastopexy in 1 or both breasts. Indications for mastopexy included asymmetry resulting from immediate loss of autologous flaps, unilateral fat necrosis, scarring after mastectomy flap necrosis, excess ptosis, and volume asymmetries. No flap loss, fat necrosis, or nipple loss occurred after flap mastopexy. Conclusions The autologous mastopexy technique is a useful option in secondary refinement procedures for breast reconstruction. It provides a reliable and predictable method to adjust the inframammary fold, increase projection, and address excess ptosis. It has a low complication rate and can be safely and reliably performed as early as 3 months after initial reconstruction.

BackgroundIntraperitoneal (IP) administration of ceftazidime is recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) from Pseudomonas. Patients with PDAP may also need IP heparin to overcome problems with drainage of turbid peritoneal dialysis (PD) fluids and blockage of catheters with fibrin. Physico-chemical stability of ceftazidime and heparin, and biological stability of heparin in many types of PD solutions is unknown. Therefore, we investigated the stability of ceftazidime and heparin in 4 types of PD solutions.MethodsA total of 12 PD bags (3 for each type of solution) containing ceftazidime and heparin were prepared and stored at 4°C for 120 hours, and then at 25°C for 6 hours, and finally at 37°C for 12 hours. An aliquot was withdrawn after predefined time points and analyzed for the concentration of ceftazidime and heparin using high-performance liquid-chromatography (HPLC). Samples were assessed for pH, color changes, particle content, and anticoagulant activity of heparin.ResultsCeftazidime and heparin retained more than 91% of their initial concentration when stored at 4°C for 120 hours followed by storage at 25°C for 6 hours and then at 37°C for 12 hours. Heparin retained more than 95% of its initial activity throughout the study period. Particle formation was not detected at any time under the storage conditions. The pH and color remained essentially unchanged throughout the study.ConclusionsCeftazidime-heparin admixture retains its stability over long periods of storage at different temperatures, allowing its potential use for PDAP treatment in outpatient and remote settings.

Characterization of graphite particles (dust) produced by the rotational abrasion that would occur in a shifting pebble bed reactor is of interest for purposes of maintenance, safety, and operation...

Stressful life events (SLEs) are frequently associated with a range of deleterious mental and physical health outcomes. However, some individuals exhibit resilience, defined as maintained or even improved health in the wake of SLEs. How and why might this be the case? Given that SLEs give rise to negative emotions, which in turn contribute to mental and physical illness, promising answers to questions about resilience lie in research on people's ability to manage their emotions, or, emotion regulation. This essay focuses on emerging empirical evidence that suggests that two seemingly opposite emotion regulation strategies, cognitive reappraisal and emotional acceptance, are particularly effective for managing negative emotions, which, in turn, may confer resilience. By integrating theory with extant empirical evidence, we offer a model that aims to reconcile how these two strategies—one that involves minimizing emotions (cognitive reappraisal) and the other that involves engaging with emotions (emotional acceptance)—are each associated with resilience. Specifically, we propose that these strategies are not contradictory, but rather complementary. We additionally discuss broader implications for the links among stress, emotion regulation, and health, as well as key issues for future research at the intersection of social and clinical psychology, medicine, and public health. Keywords: stress; emotion regulation; mental and physical health; cognitive reappraisal; acceptance

Characterization of graphite particles (dust) produced by abrasion that would occur in a pebble bed reactor is of interest for reasons of safety, operation, and maintenance. To better understand th...

This article provides a preliminary evaluation of a campus sleep health program for undergraduate university students. In this study, 5 focus groups with 38 undergraduates assessed perceptions about sleep in relationship to college experiences. Additionally, 35 undergraduate students participated in campus sleep improvement workshops, and completed a brief self-report survey before and after the workshop. Results showed five themes emerged from focus groups: (a) Sleep and its impact on academics, (b) Understanding of the importance of sleep, (c) Procrastination and its impact on sleep, (d) Stress, and (e) Sleep and extracurricular/social activities. Based on self-report surveys, there was no improvement in perceived sleep importance, but perceived sleep confidence of undergraduate student-participants increased significantly after the workshop. The sleep health program for undergraduates showed promising results, and should be evaluated using a larger, more rigorous design in future studies.

Two emotion regulation strategies-cognitive reappraisal and acceptance-are both associated with beneficial psychological health outcomes over time. However, it remains unclear whether these 2 strategies are associated with differential consequences for emotion, physiology, or perceived cognitive costs in the short-term. The present study used a within-subjects design to examine the effects of reappraisal (reframing one's thoughts) and acceptance (accepting feelings without trying to control or judge them) on the subjective experience of negative emotions, positive emotions, and physiological responses during and following recovery from sad film clips shown in the laboratory. Participants also reported on perceived regulatory effort, difficulty, and success after deploying each emotion regulation strategy. In 2 samples of participants (N = 142), reappraisal (vs. acceptance) was associated with larger decreases in negative and larger increases in positive emotions, both during the film clips and recovery period. However, acceptance was perceived as less difficult to deploy than reappraisal, and was associated with a smaller dampening of skin conductance level (indicating more successful regulation) during the film clips in 1 sample. These results suggest that reappraisal and acceptance may exert differential short-term effects: Whereas reappraisal is more effective for changing subjective experiences in the short term, acceptance may be less difficult to deploy and be more effective at changing one's physiological response. Thus, these 2 strategies may both be considered "effective" for different reasons. (PsycINFO Database Record

Carrying a short allele in the serotonin transporter polymorphism (5-HTTLPR) while experiencing stressful environments is linked to elevated risk for depression. What might offset this risky combination of genes and environment? We hypothesized that individual-level factors may play a protective role. Specifically, we examined whether individuals' ability to decrease their stress responses via effective emotion regulation may be an important moderating factor and addressed this hypothesis in a socioeconomically diverse sample of 205 children aged 9-15 years. At-risk children (short-allele carriers in high-stress contexts) exhibited more depressive symptoms than other groups. Importantly, at-risk children who used effective emotion regulation did not exhibit increased depressive symptoms. These results have important implications for the basic science of understanding risk and resilience: in addition to genes and environment, individuals' agentic ability to self-regulate may need to be considered as a critical third factor. Given that emotion regulation is learnable, these results also have strong public-health implications. (PsycINFO Database Record (c) 2014 APA, all rights reserved). Language: en

High cardiac vagal control (as measured by respiratory sinus arrhythmia; RSA) is associated with lower depression. Recent theories argue that people's responsiveness to social resources is a key mechanism in this association. This argument implies two hypotheses: first, high RSA should be related to decreased depressive symptoms only when social resources (social support) are available; second, utilization of available social resources (social engagement) should serve as a mechanism for the positive effects of RSA. To test these hypotheses, we measured RSA in 131 adults. Participants reported their social support, social engagement, and depressive symptoms. Six months later, they again reported their depressive symptoms. Participants with higher RSA reported fewer depressive symptoms six months later, but only under conditions of high social support. The interaction between RSA and social support in predicting depressive symptoms was fully mediated by social engagement. These findings provide crucial support for the idea that cardiac vagal control contributes to decreased depressive symptoms via social processes. Implications for biological sensitivity to context and differential susceptibility theories as well as for the prevention and treatment of depression are discussed.

Emotion regulation is central to psychological health, and several emotion-regulation strategies have been identified as beneficial. However, new theorizing suggests the benefits of emotion regulation should depend on its context. One important contextual moderator might be socioeconomic status (SES), because SES powerfully shapes people's ecology: lower SES affords less control over one's environment and thus, the ability to self-regulate should be particularly important. Accordingly, effectively regulating one's emotions (e.g., using cognitive reappraisal) could be more beneficial in lower (vs. higher) SES contexts. Three studies (N = 429) tested whether SES moderates the link between cognitive reappraisal ability (CRA; measured with surveys and in the laboratory) and depression. Each study and a meta-analysis of the 3 studies revealed that CRA was associated with less depression for lower SES but not higher SES individuals. Thus, CRA may be uniquely beneficial in lower SES contexts. More broadly, the effects of emotion regulation depend upon the ecology within which it is used. (PsycINFO Database Record

Graphite particle generation by interpebble abrasion and by abrasion of pebbles with the containment vessel during operation of a pebble bed reactor is an issue of interest in the safety analysis of this class of very high temperature reactor. To understand particle generation, we have constructed an apparatus to generate graphite particles from preformed graphite hemispheres under rotational/spinning abrasive loading. We have initially used commercial-grade graphites in our experiments and have generated size distributions for the abraded particles, determined particle shapes, and measured the particle surface areas, pore volumes, and pore volume distributions of particles produced during abrasion of graphite surfaces under different conditions. The size distributions were studied using an Aerodynamic Particle Sizer™ and a Scanning Mobility Particle Sizer.™ Most of the particles observed were in the range from 18.1 to 600 nm in diameter. The scanning electron micrographs showed that the particles tend to...

Mindfulness-based cognitive therapy (MBCT) has been shown to be an effective treatment for mood and anxiety disorders. Little is known, however, about the specific psychological skills that may improve with MBCT. The present study investigated the relationship between history of MBCT and emotion regulation ability. Specifically, we examined cognitive reappraisal ability (CRA) in a sample of individuals with a history of MBCT compared with two control groups: a group without a history of any type of therapy and a group with a history of cognitive behavioral therapy (CBT). Groups were matched on key variables including age, sex, education, working memory, emotional reactivity, and life stress. CRA was measured using a standardized laboratory challenge. Results indicated that participants with a history of MBCT demonstrated higher CRA than both the no-therapy control group and the CBT control group. These results suggest that, by guiding people to accept thoughts and feelings without judgment and to focus on the present moment, MBCT may lay the foundation for increased CRA.

As techniques for breast reconstruction with autologous abdominal tissue have evolved, free transverse rectus abdominis myocutaneous flaps have persevered because of their superior reliability and minimal donor-site morbidity compared with muscle-sparing techniques. Further refinements are described in this article to maximize abdominal flap perfusion and ensure primary closure of the rectus fascia. It has been well documented that incorporating both the lateral and medial perforators provides maximal perfusion to all zones of the lower abdominal transverse skin flap. However, dissection and harvest of both sets of perforators requires disruption and/or sacrifice of abdominal wall tissues. The technique presented here was designed to use both the lateral and medial row perforators, and to minimize abdominal wall disruption. Deep inferior epigastric artery medial and lateral row perforators are selected for their diameter, proximity, and transverse orientation to each other. A transverse ellipse of fascia is incised to incorporate both perforators. The fascial incision is then extended inferiorly in a T configuration to allow for adequate exposure and harvest of the vascular pedicle and/or rectus abdominis, and primary closure. Limiting perforator selection to one row of inferior epigastric arteries diminishes perfusion to the abdominal flap. Furthermore, perforator and inferior epigastric artery dissection often results in fascial defects that are not amenable to primary closure. However, maximal abdominal flap perfusion and minimal donor-site morbidity can be achieved with the transverse dual-perforator fascia-sparing free transverse rectus abdominis myocutaneous flap technique and can be performed in most patients.

It is now clear that positive emotion leads to enhanced psychological functioning. What is less clear, however, is just why this is so. Drawing on a social-functional perspective, we argue that positive emotional behavior that accurately signals to others the individual's internal state will enhance social connectedness. Positive emotional behavior that does not accurately signal a person's experience--such as a smile that is not felt--may impede social connectedness and, in turn, psychological functioning. This perspective suggests that (a) the degree to which experience and behavior are dissociated during positive emotional episodes, over and above level of positive behavior, should predict worse psychological functioning and (b) the effect of dissociation should be mediated by social connectedness. To test these hypotheses, we conducted a short-term prospective longitudinal study, with a baseline assessment of depressive symptoms and well-being at Time 1. Six months later, at Time 2, we used a novel within-individual laboratory paradigm to measure the degree to which positive emotional behavior was dissociated from (vs. coherent with) a participant's positive emotional experience. We also assessed level of positive behavior and experience. Then, another 6 months later, we assessed social connectedness as a mediator and depressive symptoms and well-being as outcomes at Time 3. Even when controlling for baseline functioning and for level of positive emotion behavior and experience, we found that greater positive experience-behavior dissociation at Time 2 predicted higher levels of depressive symptoms and lower levels of well-being at Time 3. As predicted, these associations were mediated by social connectedness.

The PAX study was a naturalistic, prospective survey evaluating treatment expectations and satisfaction in a typical French migraine population.A total of 1710 patients were recruited by 489 general practitioners across France. Despite a high drop-out rate (due to one or more deviations from protocol and/or missing data), the analysable per-protocol population (PPP) patients (n = 615) remained representative with regard to the overall migraine population. Patients ranked expectations according to four criteria at baseline, and were asked to report satisfaction for each criterion at baseline and for six consecutive attacks. The highest-ranked treatment expectation was rapid relief of headache, followed by pain-free response, relief of associated symptoms, and ability to carry on present activity, respectively.At inclusion,50% of patients were using non-specific medications (analgesics, NSAIDs), and 30% reported global satisfaction with treatment. At the end of the survey,75% of patients were using specific medications (predominantly triptans), and global treatment satisfaction increased to 83%, independent of treatment expectation rankings at baseline.These survey results suggest that satisfaction with acute migraine treatment increases when specific medications are prescribed, irrespective of which treatment expectation is considered most important at baseline. This emphasizes the need for improvements in the management of migraine, to ensure that optimal treatment is being provided with regard to pharmacological intervention.

Spirochetes of the genus Leptospira cause leptospirosis in humans and animals worldwide. Proteins exposed on the bacterial cell surface are implicated in the pathogenesis of leptospirosis. However, the biological role of the majority of these proteins is unknown; this is principally due to the lack of genetic systems for investigating Leptospira and the absence of any structural information on leptospiral antigens. To address this, we have determined the 2.0-A-resolution structure of the lipoprotein LipL32, the most abundant outer-membrane and surface protein present exclusively in pathogenic Leptospira species. The extracellular domain of LipL32 revealed a compact, globular, "jelly-roll" fold from which projected an unusual extended beta-hairpin that served as a principal mediator of the observed crystallographic dimer. Two acid-rich patches were also identified as potential binding sites for positively charged ligands, such as laminin, to which LipL32 has a propensity to bind. Although LipL32 shared no significant sequence identity to any known protein, it possessed structural homology to the adhesins that bind components of the extracellular matrix, suggesting that LipL32 functions in an analogous manner. Moreover, the structure provides a framework for understanding the immunological role of this major surface lipoprotein.

Introduction Intraperitoneal tigecycline is a potential option for the treatment of peritoneal dialysis (PD)-associated peritonitis caused by microorganisms resistant to commonly used antibiotics. However, the stability of tigecycline must be assessed in the PD solution before evaluating its safety and therapeutic efficacy in PD-associated peritonitis. The objective of this study was to investigate the stability of tigecycline in 3 types of PD solutions at different temperatures for various time points. Methods A total of 27 PD bags (9 PD bags for each type of PD solution; 1.5% glucose, 7.5% icodextrin, and 1.5% glucose pH neutral) containing 2 μg/mL of tigecycline were prepared and stored at either 4, 25, or 37°C. An aliquot was withdrawn immediately before (0 hour) and after pre-defined time points. Each sample was analyzed in duplicate for the concentration of tigecycline using a stability-indicating high-performance liquid chromatography (HPLC) technique. Samples were also assessed for pH, color changes, and evidence of precipitation immediately after preparation and on each day of analysis. Results Tigecycline in all 3 types of PD solutions retained more than 90% of its initial concentration for at least 216, 72, and 8 hours at 4, 25, and 37°C, respectively. There was no evidence of precipitation at any time under the tested storage conditions. The pH and color of tigecycline admixed PD solutions stored at 4, 25, and 37°C remained essentially unchanged for 336, 96, and 48 hours respectively. Conclusion The results obtained from the study provide a platform for future clinical studies aiming to determine the safety and therapeutic efficacy of intraperitoneally administered tigecycline for the treatment of PD-associated peritonitis.

Galectins are an evolutionarily conserved family of proteins that translate glycan recognition into cellular effects. Galectin-11 is a unique member of the galectin family that is only expressed in ruminants such as sheep, goat and cattle and that plays a critical role in several important biological processes, such as reproduction and parasite-mediated innate immune responses. Currently, these two areas are of major importance for the sustainability of ruminant livestock production. Despite the emerging biological significance of galectin-11, no structural information is available. It is expected that structural studies will unravel the functional mechanisms of galectin-11 activity. Here, the expression, purification and crystallization of the ruminant-specific galectin-11 from domestic sheep and the collection of X-ray data to 2.0 Å resolution are reported.

We reported previously the results of a 6-month controlled trial in which the use of a commercially available electronic prescribing system with integrated clinical decision support and evidence-based message capability was associated with significantly lower primary care drug costs. The original study focused on new prescriptions, defined as claims for a medication that the patient had not received in the previous 12 months. The main objectives of this follow-up report were to (a) determine if the 6-month savings on new prescriptions were sustained during 12 months of follow-up, (b) evaluate the impact of the computerized decision support system (CDSS) on all pharmacy claims and per-member-per-month (PMPM) expenditures, and (c) evaluate the prescribing behaviors within 8 high-cost therapeutic categories that were frequently targeted by the electronic messages to prescribers to help verify that the drug cost savings were due to the recommendations in the electronic prescribing system.Two database queries were performed to identify additional pharmacy claims data for all Network Health Plan patients who were cared for by the 38 primary care clinicians (32 physicians, 4 nurse practitioners, and 2 physician assistants) included in our original 6-month study. This follow-up analysis (a) identified all new prescription claims for the 2 groups of clinicians throughout the 12-month follow-up period (June 2002 through May 2003) and (b) assessed all pharmacy claims during the same 12-month period to provide more complete savings estimates and to examine between-group differences in PMPM expenditures.During 12 months of follow-up, clinicians using the electronic prescribing system continued to have lower prescription costs than the controls. Clinicians using the electronic prescribing system had average costs for 26,674 new prescriptions that were dollar 4.12 lower (95% confidence interval, dollar 1.53-dollar 6.71; P=0.003) and PMPM expenditures that were dollar 0.57 lower than expected based on the changes observed for 24,507 new prescriptions written by clinicians in the control group. The average drug cost savings on new prescriptions were dollar 482 per prescriber per month (PPPM), based upon prescription cost and dollar 465 PPPM based upon PMPM analysis. When all pharmacy claims (156,429) were analyzed, the intervention group.s average prescription cost was dollar 2.57 lower and their PMPM expenditures were dollar 1.07 lower than expected based on the changes observed in the control group. The average drug cost savings on all pharmacy claims were dollar 863 PPPM based on average prescription cost and dollar 873 PPPM based on PMPM analysis. The proportion of prescriptions for highcost drugs that were the target of the CDSS messages to prescribers was a relative 17.5% lower among the intervention group (35.8%) compared with the control group (43.4%; P=0.03).An electronic prescribing system with integrated decision support shifted prescribing behavior away from high-cost therapies and significantly lowered prescription drug costs. The savings associated with altered prescribing behavior offset the monthly subscription cost of the system.

Although newer, heavily promoted medications are commonly prescribed, published evidence and consensus guidelines often support the use of less expensive alternatives. This study was designed to evaluate the impact on prescription costs of a computerized decision support system (CDSS) that provides evidence-based recommendations to clinicians during the electronic prescribing process.A retrospective cohort study was performed using a pharmacy claims database. Clinicians using the CDSS were matched with a control group by pharmacy billed amount, number of patients treated, and number of new prescriptions filled during a 6-month baseline period in which neither group used the system. The primary outcome measure was the difference in prescription costs between the 2 groups after implementation of the CDSS in the intervention group.Clinicians who received evidence-based messages had significantly lower prescription costs than those in the control group. The average cost per new prescription was 4.16 dollars lower (P = .02) in the intervention group, and the average cost for new and refilled prescriptions was 4.99 dollars lower (P = .01). The 6-month savings from new prescriptions and their refills are estimated to be 3,450 dollars (95% CI, 1,030-5,863 dollars) per clinician.Providing electronic, evidence-based decision support during the prescribing process can shift prescribing decisions toward more evidence-based care and significantly decrease primary care prescription costs.

Kalisch et al. propose that positive reappraisal constitutes a resilience mechanism for highly stressed individuals. Both empirical and theoretical accounts suggest that this claim is too simplistic – the relationship between reappraisal and resilience depends on context. Indeed, there may be contexts in which reappraisal leads to harm, not resilience. Future research should examine multiple regulatory processes as well as context.

BACKGROUND: A substantial proportion of patients with gastro-oesophageal reflux disease (GERD) have only a partial response to proton pump inhibitor (PPI) therapy. Prokinetic drugs may improve reflux symptoms by enhancing oesophageal motility and gastric emptying. AIM: To evaluate the effect of revexepride, a novel prokinetic 5-hydroxytryptamine type 4 (5-HT4 ) receptor agonist, compared with placebo, in patients with GERD who have a partial response to PPIs. METHODS: A phase 2b, double-blind, parallel-group study was conducted, in which patients were randomised to one of three revexepride treatment groups (0.1, 0.5 and 2.0 mg three times daily) or placebo (1:1:1:1 ratio). Daily e-diary data captured patients' symptoms over an 8-week treatment period. The primary efficacy outcome was the weekly percentage of regurgitation-free days in the second half of the study (weeks 5-8). RESULTS: In total, 480 patients were randomised and 477 received treatment (mean age 47.9 years; 61% women). The mean percentage of regurgitation-free days increased from baseline (range, 15.0-18.8%) to week 8 (62.3-70.5%) in all four study arms; however, there were no statistically significant differences in this change between placebo and the three treatment arms. No dose-dependent relationship in treatment effect was observed for any of the study endpoints. The incidence of treatment-emergent adverse events (TEAEs) was revexepride dose-dependent. Only one serious TEAE occurred and none resulted in death. CONCLUSIONS: Revexepride was no more effective than placebo in controlling regurgitation in patients with GERD symptoms partially responsive to PPIs. Revexepride was well tolerated. ClinicalTrials.gov Identifier: NCT01472939. ispartof: Alimentary Pharmacology & Therapeutics vol:41 issue:7 pages:649-661 ispartof: location:England status: published

Intentionally hurting one’s own body (deliberate self-harm; DSH) is theorized to be associated with high negative emotional reactivity and poor emotion regulation ability. However, little research has assessed the relationship between these potential risk factors and DSH using laboratory measures. Therefore, we conducted two studies using laboratory measures of negative emotional reactivity and emotion regulation ability. Study 1 assessed self-reported negative emotions during a sad film clip (Reactivity) and during a sad film clip for which participants were instructed to use reappraisal (Regulation). Those with a history of DSH were compared to two control groups without a history of DSH matched on key demographics: one healthy group low in depression and anxiety symptoms and one group matched to the DSH group on depression and anxiety symptoms. Study 2 extended Study 1 by assessing neural responding to negative images (Reactivity) and negative images for which participants were instructed to use reappraisal (Regulation). Those with a history of DSH were compared to a control group matched to the DSH group on demographics, depression, and anxiety symptoms. Compared to control groups, participants with a history of DSH did not exhibit greater negative emotional reactivity but did exhibit lower ability to regulate emotion with reappraisal (greater self-reported negative emotions in Study 1 and greater amygdala activation in Study 2 during regulation). These results suggest that poor emotion regulation ability, but not necessarily greater negative emotional reactivity, is a correlate of and may be a risk factor for DSH, even when controlling for mood disorder symptoms.

The selection of antimicrobial agents in the hospital setting is still a largely manual task and, therefore, fraught with the potential for error. This includes the choice of agents, dosage regimens, and monitoring for response and toxicity. The authors describe current and future strategies to use information technology to improve the process of antimicrobial selection and to avoid dosing errors and contraindicated drug combinations. The possible role of decision support in preventing the emergence of resistance is also discussed.

The limited ranges of the wild progenitors of many of the primary European domestic species point to their origins further east in Anatolia or the fertile crescent. The wild ox (Bos primigenius), however, ranged widely and it is unknown whether it was domesticated within Europe as one feature of a local contribution to the farming economy. Here we examine mitochondrial DNA control-region sequence variation from 392 extant animals sampled from Europe, Africa and the Near East, and compare this with data from four extinct British wild oxen. The ancient sequences cluster tightly in a phylogenetic analysis and are clearly distinct from modern cattle. Network analysis of modern Bos taurus identifies four star-like clusters of haplotypes, with intra-cluster diversities that approximate to that expected from the time depth of domestic history. Notably, one of these clusters predominates in Europe and is one of three encountered at substantial frequency in the Near East. In contrast, African diversity is almost exclusively composed of a separate haplogroup, which is encountered only rarely elsewhere. These data provide strong support for a derived Near-Eastern origin for European cattle.