A novel microbubble construct for intracardiac or intravascular MR manometry: a theoretical study

It has been demonstrated that gas-filled microbubble contrast agents, based on their volume changes, can serve as pressure probes in an MR field. It was recently reported that such an MR-based pressure measurement with microbubbles at 1.5 T must make use of microbubbles that have a volumetric magnetic susceptibility difference with the blood of at least 34 ppm in SI units. In this work, we show through analytical approximations and numerical simulations that such a microbubble formulation can be achieved by coating typical lipid-shelled microbubbles with particles of high dipole moment. Through finite-element simulations we demonstrate that the effective volumetric magnetic susceptibility of a coated microbubble is dependent on the radius, the shell volume fraction and the magnetic susceptibility of the particulates on the shell. Our calculations suggest that a suitable microbubble formulation which will be MR-sensitive to small pressure changes at 1.5 T must be 2-3 microm in radius and be uniformly coated with single-domain magnetic nanoparticles, such as magnetite, at shell volume fractions below 5%.     

A Delphi study to determine the European core curriculum for Master programmes in genetic counselling

Genetic counsellors have been working in some European countries for at least 30 years. Although there are great disparities between the numbers, education, practice and acceptance of these professionals across Europe, it is evident that genetic counsellors and genetic nurses in Europe are working autonomously within teams to deliver patient care. The aim of this study was to use the Delphi research method to develop a core curriculum to guide the educational preparation of these professionals in Europe. The Delphi method enables the researcher to utilise the views and opinions of a group of recognised experts in the field of study; this study consisted of four phases. Phases 1 and 4 consisted of expert workshops, whereas data were collected in phases 2 and 3 (n=35) via online surveys. All participants in the study were considered experts in the field of genetic counselling. The topics considered essential for genetic counsellor training have been organised under the following headings: (1) counselling; (2) psychological issues; (3) medical genetics; (4) human genetics; (5) ethics, law and sociology; (6) professional practice; and (7) education and research. Each topic includes the knowledge, skills and attitudes required to enable genetic counsellors to develop competence. In addition, it was considered by the experts that clinical practice should comprise 50% of the educational programme. The core Master programme curriculum will enable current courses to be assessed and inform the design of future educational programmes for European genetic counsellors.     

神经症优化治疗方案的特尔菲法研究

目的:探讨不同类型神经症治疗的最优治疗方案。方法:采用文献法初步筛选出神经症已有明确疗效的全部药物和心理治疗方案,在此基础上采用专家咨询法(Delphi法),选择来自我国20家精神专科三级医院的20名精神科临床专家,进行两轮专家咨询,最终筛选出公认的神经症最优治疗方案。结果:神经症的最优治疗方案分别是强迫症为帕罗西汀联合认知行为治疗,社交焦虑障碍为帕罗西汀联合综合性心理治疗和帕罗西汀联合认知行为治疗,惊恐障碍为选择性5-羟色胺再摄取抑制剂(Selective Seroto-nin Reuptake Inhibitors,SSRI)类合并苯二氮卓艹类联合认知行为治疗和帕罗西汀联合认知行为治疗,广泛性焦虑障碍为帕罗西汀联合认知行为治疗和SSRI类合并苯二氮卓艹类联合认知行为治疗。结论:专家咨询法成功筛选出了强迫症、社交焦虑障碍、惊恐障碍和广泛性焦虑障碍四类神经症的最优治疗方案。     

Assessment of heritability for personality,based on a short-form of the Eysenck personality inventory: A study of 12,898 twin pairs

The influence of genetic factors for two personality dimensions was analyzed using data from 12,898 unselected twin pairs of the Swedish Twin Registry. The heritability index was 0.50 (men) and 0.58 (women) for psychosocial instability. Corresponding figures for psychosocial extraversion were 0.54 and 0.66. Thus, about half the phenotypic variation may be attributed to genetic factors.     

广泛性焦虑障碍认知行为治疗技术专家共识的德尔菲法研究

目的:使用德尔菲法(Delphi法)研究国内广泛性焦虑障碍(GAD)的认知行为治疗(CBT)技术的使用情况,为进一步规范CBT技术奠定基础.方法:复习国外关于广泛性焦虑障碍的认知行为治疗的随机对照研究文献,筛选出35个认知行为治疗技术并制定专家咨询表,发放给31名认知行为治疗专家,进行两轮咨询,最后对这些技术进行排序.结果:综合秩次排前4位的依次为,建立治疗关系、心理教育、资料收集与评估和放松练习;而国外常用的技术,如苏格拉底提问、担忧暴露排在第26位和第22位;思维阻止在可操作性维度、使用频率维度和对治疗的贡献维度上的变异系数(CV)分别为0.25、0.36和0.31.结论:在广泛性焦虑障碍的治疗中,专家达成共识的技术为建立治疗关系、心理教育、资料收集与评估和放松练习,而思维阻止是否剔除有待进一步研究.     

Identifying the research priorities for schema therapy: A Delphi consensus study

Despite the popularity of schema therapy, there exist several important gaps in research on the schema therapy model and its effectiveness. The number of gaps makes it difficult to determine the research areas of the highest strategic priority to advance schema therapy. The objective of this study was to establish consensus among schema therapy clinicians and researchers on the priority areas for future schema therapy research. A panel of experts in schema therapy (43 clinicians and 13 researchers) participated in a Delphi consensus study. The research areas rated were developed by interviewing the founder of schema therapy, Jeffrey Young, conducting a focus group with the executive board of the International Society for Schema Therapy and screening recent reviews on schema therapy for recommendations for future research. The panel rated 81 research areas in terms of priority across three rounds. Nineteen research areas were rated by 75% of the panel as ‘Very high priority’ or ‘High priority’. These priorities reflected four broad themes: (1) schema therapy constructs and measures, (2) the theoretical assumptions underlying schema therapy, (3) schema therapy and theory in relation to different contexts and outcomes and (4) schema therapy effectiveness and mechanisms of change. The findings are important for establishing a clear research agenda for the future of schema therapy.     

Developing a Framework for Ankle Function: A Delphi Study

Context:

Addressing clinical outcomes is paramount to providing effective health care, yet there is no consensus regarding the appropriate outcomes to address after ankle injuries. Compounding the problem is the repetitive nature of lateral ankle sprains, referred to as functional (FAI) or chronic (CAI) ankle instability. Although they are commonly used terms in practice and research, FAI and CAI are inconsistently defined and assessed.

Objective:

To establish definitions of a healthy/normal/noninjured ankle, FAI, and CAI, as well as their characteristics and assessment techniques.

Design:

Delphi study.

Setting:

Telephone interviews and electronic surveys.

Patients or Other Participants:

Sixteen experts representing the fields of ankle function and treatment, ankle research, and outcomes assessment and research were selected as panelists.

Data Collection and Analysis:

A telephone interview produced feedback regarding the definition of, functional characteristics of, and assessment techniques for a healthy/normal/noninjured ankle, an unhealthy/acutely injured ankle, and FAI/CAI. Those data were compiled, reduced, and returned through electronic surveys and were either included by reaching consensus (80% agreement) or excluded.

Results:

The definitions of a healthy/normal/noninjured ankle and FAI reached consensus. Experts did not agree on a definition of CAI. Eleven functional characteristics of a healthy/normal/noninjured ankle, 32 functional characteristics of an unhealthy/acutely injured ankle, and 13 characteristics of FAI were agreed upon.

Conclusions:

Although a consensus was reached regarding the definitions and functional characteristics of a healthy/normal/noninjured ankle and FAI, the experts could only agree on 1 characteristic to include in the FAI definition. Several experts did, however, provide additional comments that reinforced the differences in the interpretation of those concepts. Although the experts could not agree on the definition of CAI, its characteristics, or the preferred use of the terms FAI and CAI, our findings provide progress toward establishing consistency in those concepts.Key Words: outcomes, ankle sprains, ankle instability

Key Points

• A working definition of a healthy/noninjured ankle was established, along with the functional characteristics of and assessment techniques for healthy and unhealthy ankles.
• Although a consensus was reached regarding the definition of functional ankle instability, disagreements emerged in the experts'' comments. The definition that achieved consensus is very similar to the original Freeman definition.
• Consensus was not reached regarding the definition of chronic ankle instability.
• Future researchers should compare the experts'' responses with feedback from patients who sustained ankle injuries and with ankle-outcome instruments.

The National Athletic Trainers'' Association Research & Education Foundation has identified outcomes assessment as a professional priority.¹ There is no more vivid example of the barriers to the consistent assessment of outcomes than in the treatment of ankle and foot injuries. Specifically, lateral ankle sprains (LAS) continue to represent the single most common athletic injury² and have the highest reinjury rate among all injuries,^2–4 yet outcomes that substantiate their treatment are limited. Further complicating outcomes assessment after LAS is the repetitive nature of ankle sprains, which has led to the identification of a phenomenon called chronic or functional ankle instability (CAI or FAI, respectively).^5–7 Although a common entity in practice and research, FAI is inconsistently defined and assessed.^8–10 Despite widespread support for its existence, there is currently no consensus regarding the definition of FAI^8–10 or the characteristics of those who have it. Researchers classify the existence of FAI inconsistently, and clinicians diagnose it arbitrarily. To substantiate the existence and relevance of any injury or condition, it must be definable and have a measurable effect on function. Neither of those is true regarding FAI, which has resulted in discrepancies in the research, making cross-study comparisons impossible, and the true effect of FAI remains largely unknown. The lack of standard outcomes and the inconsistencies in the identification of repetitive LAS have further complicated the reporting of ankle-injury outcomes. Therefore, athletic trainers are unable to address 1 of the most important issues identified in their profession (ie, outcomes) for the most common injury, LAS, of the patients in their care.Following the model from the World Health Organization (WHO),¹¹ the first steps toward outcomes assessment after LAS are to (1) develop a framework of a healthy/normal/noninjured ankle, (2) establish a clear definition for the recurring ankle-sprain phenomenon, or FAI, and (3) identify the functional outcomes that should be assessed after LAS.¹¹ A common approach to this type of problem is to gather input from a panel of content experts in an effort to establish consensus regarding a certain topic. Therefore, we used the Delphi method to determine the definitions of a healthy/normal/noninjured ankle, FAI, and CAI, along with their characteristics and assessment techniques.     

Prioritization of future genetics education for general practitioners: a Delphi study

PurposeGeneral practitioners (GPs) are increasingly expected to deliver genetics services in daily patient care. Education in primary care genetics is considered suboptimal and in urgent need of revision and innovation. The aim of this study was to prioritize topics for genetics education for general practice.MethodsA Delphi consensus procedure consisting of three rounds was conducted. A purposively selected heterogeneous panel (n = 18) of experts, comprising six practicing GPs who were also engaged in research, five GP trainers, four clinical genetics professionals, and three representatives of patient organizations, participated. Educational needs regarding genetics in general practice in terms of knowledge, skills, and attitudes were rated and ranked in a top-10 list.ResultsThe entire panel completed all three rounds. Kendall's coefficient of concordance indicated significant agreement regarding the top 10 genetic education needs (P < 0.001). “Recognizing signals that are potentially indicative of a hereditary component of a disease” was rated highest, followed by “Evaluating indications for referral to a clinical genetics centre” and “Knowledge of the possibilities and limitations of genetic tests.”ConclusionsThe priorities resulting from this study can inform the development of educational modules, including input for case-based education, to improve GP performance in genetic patient care.     

A novel construct as a cell carrier for tissue engineering

A 3D scaffold, in the form of a foam, with the top surface carrying a micropattern, was constructed from biodegradable polyesters poly(3-hydroxybutyric acid-co-3-hydroxyvaleric acid) (PHBV) and poly(L-lactide-co-D,L-lactide) (P(L/DL)LA) to serve as a substitute for the extracellular matrix (ECM) of tissues with more than one cell type. The construct was tested in vitro for engineering of such tissues using fibroblasts (3T3) and epithelial cells (retinal pigment epithelial cells, D407). The patterned surface was seeded with D407 cells and the foam was seeded with 3T3 cells to represent a tissue with two different cell types. To improve cell adhesion, the construct was treated with fibronectin. The cells were seeded on the construct in a sequence allowing each type time for adhesion. Cell proliferation, studied by MTS assay, was significantly higher than that of tissue culture polystyrene control by day 14. Scanning electron and fluorescence microscopy showed that the foam side of the construct was highly porous and the pores were interconnected and this allowed cell mobility and proliferation. Immunostaining showed collagen deposition, indicating the secretion of the new ECM by the cells. On the film side of the construct D407 cells formed piles in the grooves and covered the surface completely. It was concluded that the 3D P(L/DL)LA-PHBV construct with one micropatterned surface has a serious potential for use as a tissue engineering carrier in the reconstruction of complex tissues with layered organization and different types of cells in each region.     

A novel construct as a cell carrier for tissue engineering

A 3D scaffold, in the form of a foam, with the top surface carrying a micropattern, was constructed from biodegradable polyesters poly(3-hydroxybutyric acid-co-3-hydroxyvaleric acid) (PHBV) and poly(L-lactide-co-D,L-lactide) (P(L/DL)LA) to serve as a substitute for the extracellular matrix (ECM) of tissues with more than one cell type. The construct was tested in vitro for engineering of such tissues using fibroblasts (3T3) and epithelial cells (retinal pigment epithelial cells, D407). The patterned surface was seeded with D407 cells and the foam was seeded with 3T3 cells to represent a tissue with two different cell types. To improve cell adhesion, the construct was treated with fibronectin. The cells were seeded on the construct in a sequence allowing each type time for adhesion. Cell proliferation, studied by MTS assay, was significantly higher than that of tissue culture polystyrene control by day 14. Scanning electron and fluorescence microscopy showed that the foam side of the construct was highly porous and the pores were interconnected and this allowed cell mobility and proliferation. Immunostaining showed collagen deposition, indicating the secretion of the new ECM by the cells. On the film side of the construct D407 cells formed piles in the grooves and covered the surface completely. It was concluded that the 3D P(L/DL)LA-PHBV construct with one micropatterned surface has a serious potential for use as a tissue engineering carrier in the reconstruction of complex tissues with layered organization and different types of cells in each region.     

A roadmap to rumination: A review of the definition,assessment, and conceptualization of this multifaceted construct

Rumination has been widely studied and is a crucial component in the study of cognitive vulnerabilities to depression. However, rumination means different things in the context of different theories, and has not been uniformly defined or measured. This article aims to review models of rumination, as well as the various ways in which it is assessed. The models are compared and contrasted with respect to several important dimensions of rumination. Guidelines to consider in the selection of a model and measure of rumination are presented, and suggestions for the conceptualization of rumination are offered. In addition, rumination's relation to other similar constructs is evaluated. Finally, future directions for the study of ruminative phenomena are presented. It is hoped that this article will be a useful guide to those interested in studying the multi-faceted construct of rumination.     

Quality issues concerning genetic counselling for presymptomatic testing: a European Delphi study

Genetic counselling for presymptomatic testing is complex, bringing both ethical and practical questions. There are protocols for counselling but a scarcity of literature regarding quality assessment of such counselling practice. Generic quality assessment tools for genetic services are not specific to presymptomatic testing (PST). Therefore, the aim of this study was to identify aspects of effective counselling practice in PST for late-onset neurological disorders. We used the Delphi method to ascertain the views of relevant European experts in genetic counselling practice, ascertained via published literature and nomination by practitioners. Ethical approval was obtained. Questionnaires were sent electronically to a list of 45 experts, (Medical Doctors, Geneticists, Genetic Counsellors and Genetic Nurses), who each contributed to one to three rounds. In the first round, we provided a list of relevant indicators of quality of practice from a literature review. Experts were requested to evaluate topics in four domains: (a) professional standards; (b) service standards; (c) the consultant''s perspective; and (d) protocol standards. We then removed items receiving less than 65% approval and added new issues suggested by experts. The second round was performed for the refinement of issues and the last round was aimed at achieving final consensus on high-standard indicators of quality, for inclusion in the assessment tool. The most relevant indicators were related to (1) consultant-centred practice and (2) advanced counselling and interpersonal skills of professionals. Defined high-standard indicators can be used for the development of a new tool for quality assessment of PST counselling practice.     

A sensitive isotope modification of the mixed haemadsorption test applicable to the study of prozone effects

Investigations of surface antigens of animal cells require sensitive and quantitative in vitro methods. A modification of the mixed haemadsorption technique (MHT) suitable for such purposes is presented. The indicator cells have been labelled with chromium-51. During studies of experimental conditions, including reproducibility and sensitivity, the technique was used in four model systems including histocompatibility (H-2, HL-A), species, organ and blood group antigens. Isotope labelling of the indicator cells has rendered the test more sensitive and in addition some qualitative properties of antigen—antibody interaction have been studied. The test procedure is simple and fast.     

Employee competence and performance-based assessment: A college of American pathologists Q-probes study of larboratory personnel in 522 institutions

OBJECTIVE: To survey employee competence assessment practices in departments of pathology and laboratory medicine and provide suggestions for improvement. DESIGN: A 3-part study consisting of a questionnaire about current competence assessment practices, an evaluation of compliance with stated competence assessment practices using personnel records of 30 employees, and a written appraisal of competence of 5 specimen-processing staff members per institution. SETTING: A total of 522 institutions participating in the College of American Pathologists 1996 Q-Probes program. MAIN OUTCOME MEASURES: Institutional competence assessment practices, compliance of each institution with their own practices, and determination of competence of specimen-processing personnel. RESULTS: Of the participating institutions, 89.8% had a written competence plan and 98.1% reported reviewing employee competence at least yearly. General competence was reviewed by direct observations (87.5%), review of test or quality control results (77.4%), review of instrument preventive maintenance (60.0%), written testing (52.2%), and/or other methods (20.8%). In 8.6% of institutions, employees who failed competence assessment were not allowed to continue their usual work. On review of records of 14 029 employees for adherence to the laboratory's general competence plan, adherence was 89.7% for direct observations, 85.8% for review of quality control and test results, 78.0% for review of instrument records, and 74.0% for written testing. Employee failure rate ranged from 0.9% to 6.4%, depending on the competence evaluated. Adherence to an institution's plan was 90.4% for new employees, 93.1% for computer skills, 95.8% for laboratory safety, and 92.1% for continuing education. When a written competence assessment was given to 2853 specimen-processing staff members, 90.0% responded satisfactorily. CONCLUSIONS: Opportunities for improvement in employee competence assessment are numerous, and we provide several specific suggestions.     

A computerized volumetric segmentation method applicable to multi-centre MRI data to support computer-aided breast tissue analysis,density assessment and lesion localization

Density assessment and lesion localization in breast MRI require accurate segmentation of breast tissues. A fast, computerized algorithm for volumetric breast segmentation, suitable for multi-centre data, has been developed, employing 3D bias-corrected fuzzy c-means clustering and morphological operations. The full breast extent is determined on T1-weighted images without prior information concerning breast anatomy. Left and right breasts are identified separately using automatic detection of the midsternum. Statistical analysis of breast volumes from eighty-two women scanned in a UK multi-centre study of MRI screening shows that the segmentation algorithm performs well when compared with manually corrected segmentation, with high relative overlap (RO), high true-positive volume fraction (TPVF) and low false-positive volume fraction (FPVF), and has an overall performance of RO 0.94 ± 0.05, TPVF 0.97 ± 0.03 and FPVF 0.04 ± 0.06, respectively (training: 0.93 ± 0.05, 0.97 ± 0.03 and 0.04 ± 0.06; test: 0.94 ± 0.05, 0.98 ± 0.02 and 0.05 ± 0.07).     

Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi study

Infections are identified as the most common preventable cause of death in pediatric oncology patients. Assessing and stratifying risk of infections are essential to prevent infection in these patients. To date, no tool can fulfill this demand in China. This study aimed to develop a nursing work-based and Chinese-specific tool for pediatric nurses to assess risk of infection in oncology patients. This research was a modified Delphi study. Based on a literature review, a 37-item questionnaire rating on a 0–5 scale was developed. Twenty-four experts from 8 hospitals in 6 provinces of China were consulted for three rounds. Consensus for each item in the first round was defined as: the rating mean was > 3 and the coefficient of variation (CV) was < 0.5. Consensus for each item in the second round was defined as CV < 0.3. Consensus among experts was defined as: P value of Kendall's coefficient of concordance (W) < 0.05. After three rounds of consultation, a two-part tool was developed: the Immune Status Scale (ISS) and the Checklist of Risk Factors of Infection (CRFI). There were 5 items in the ISS and 14 in the CRFI. Based on the ISS score, nurses could stratify children into the low-risk and high-risk groups. For high-risk children, nurses should screen risk factors of infection every day by the CRFI, and twice weekly for low-risk children. Further study is needed to verify this tool's efficacy.