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1.  Cis and trans RET signaling control the survival and central projection growth of rapidly adapting mechanoreceptors 
eLife  null;4:e06828.
RET can be activated in cis or trans by its co-receptors and ligands in vitro, but the physiological roles of trans signaling are unclear. Rapidly adapting (RA) mechanoreceptors in dorsal root ganglia (DRGs) express Ret and the co-receptor Gfrα2 and depend on Ret for survival and central projection growth. Here, we show that Ret and Gfrα2 null mice display comparable early central projection deficits, but Gfrα2 null RA mechanoreceptors recover later. Loss of Gfrα1, the co-receptor implicated in activating RET in trans, causes no significant central projection or cell survival deficit, but Gfrα1;Gfrα2 double nulls phenocopy Ret nulls. Finally, we demonstrate that GFRα1 produced by neighboring DRG neurons activates RET in RA mechanoreceptors. Taken together, our results suggest that trans and cis RET signaling could function in the same developmental process and that the availability of both forms of activation likely enhances but not diversifies outcomes of RET signaling.
eLife digest
During development, cells send and receive numerous signaling molecules. In order to trigger a biological response, such signaling molecules must first bind to a specific receptor protein, often located on the cell surface. These receptor proteins can either work alone or with partner proteins called co-receptors. When the co-receptor is produced by the same cell as the receptor, it is called cis signaling. When the co-receptor is produced by other cells, it is called trans signaling.
RET is one such receptor that is important for the development of the nervous system and many other biological processes. It interacts with a particular family of signaling molecules, the glial cell line-derived neurotrophic factor (GDNF) family ligands, which first bind to a co-receptor, GFRα, before binding to RET. These co-receptors can come from the same cell as RET, or from a different cell.
Previous studies have indicated that RET can receive both cis and trans signals using cultured cells, but it was not clear whether both types of signal occur during normal development and contribute to the same biological processes. Fleming, Vysochan et al. investigated this question by analyzing the roles of RET signaling in a type of mouse neuron that is involved in sensing touch. RET is important for the survival and development of these neurons, which express both RET and its co-receptor GFRa2. Another RET co-receptor, GFRa1, is produced by other cells that are next to the cell bodies and projections of these touch-sensing neurons.
To investigate the roles of different GFRa co-receptors further, Fleming, Vysochan et al. generated a variety of mouse mutants, including mice with mutations in one or both types of co-receptor. The neurons in mice lacking both co-receptors shared the same defects as the neurons in the mice lacking RET. Loss of either co-receptor alone did not produce these abnormalities. This indicates that both co-receptors can mediate the normal development of these neurons, with GFRa2 signaling in cis and GFRa1 signaling in trans.
Fleming, Vysochan et al. propose that cis and trans RET signaling can lead to the same biological outcomes in these neurons. Future experiments should reveal if cis and trans RET signaling contribute towards common biological processes in other cell types inside the body as well. Such findings might also be important for understanding the role of RET signaling in cancer and other human diseases.
PMCID: PMC4408446  PMID: 25838128
RET signaling; DRG neuron development; cis and trans activation; neurotrophins; mouse
2.  Breastfeeding is Associated with Reduced Childhood Hospitalization: Evidence from a Scottish Birth Cohort (1997-2009) 
The Journal of Pediatrics  2015;166(3):620-625.e4.
To evaluate the risk of childhood hospitalization associated with infant feeding patterns at 6-8 weeks of age in Scotland.
Study design
A retrospective population level study based on the linkage of birth, death, maternity, infant health, child health surveillance, and admission records for children born as single births in Scotland between 1997 and 2009 (n = 502 948) followed up to March 2012. Descriptive analyses, Kaplan Meier tests, and Cox regression were used to quantify the association between the mode of infant feeding and risk of childhood hospitalization for respiratory, gastrointestinal, and urinary tract infections, and other common childhood ailments during the study period.
Within the first 6 months of life, there was a greater hazard ratio (HR) of hospitalization for common childhood illnesses among formula-fed infants (HR 1.40; 95% CI 1.35-1.45) and mixed-fed infants (HR 1.18; 95% CI 1.11-1.25) compared with infants exclusively breastfed after adjustment for parental, maternal, and infant health characteristics. Within the first year of life and beyond, a greater relative risk of hospitalization was observed among formula-fed infants for a range of individual illnesses reported in childhood including gastrointestinal, respiratory, and urinary tract infections, otitis media, fever, asthma, diabetes, and dental caries.
Using linked administrative data, we found greater risks of hospitalization in early childhood for a range of common childhood illnesses among Scottish infants who were not exclusively breastfed at 6-8 weeks of age.
PMCID: PMC4344374  PMID: 25556021
HR, Hazard ratio; PAF, Population-attributable fraction
3.  Training Mentors of Clinical and Translational Research Scholars: A Randomized Controlled Trial 
To determine whether a structured mentoring curriculum improves research mentoring skills.
The authors conducted a randomized controlled trial (RCT) at 16 academic health centers (June 2010 to July 2011). Faculty mentors of trainees who were conducting clinical/translational research ≥50% of the time were eligible. The intervention was an eight-hour, case-based curriculum focused on six mentoring competencies. The primary outcome was the change in mentors’ self-reported pretest to posttest composite scores on the Mentoring Competency Assessment (MCA). Secondary outcomes included changes in the following: mentors’ awareness as measured by their self-reported retrospective change in MCA scores, mentees’ ratings of their mentors’ competency as measured by MCA scores, and mentoring behaviors as reported by mentors and their mentees.
A total of 283 mentor–mentee pairs were enrolled: 144 mentors were randomized to the intervention; 139 to the control condition. Self-reported pre-/posttest change in MCA composite scores was higher for mentors in the intervention group compared with controls (P < .001). Retrospective changes in MCA composite scores between the two groups were even greater, and extended to all six subscale scores (P < .001). More intervention-group mentors reported changes in their mentoring practices than control mentors (P < .001). Mentees working with intervention-group mentors reported larger changes in retrospective MCA pre-/posttest scores (P = .003) and more changes in their mentors’ behavior (P = .002) than those paired with control mentors.
This RCT demonstrates that a competency-based research mentor training program can improve mentors’ skills.
PMCID: PMC4121731  PMID: 24667509
4.  Prevalence of Involuntary Commitment for Alcohol Dependence 
Alcohol dependence is a chronic relapsing illness. While some patients respond to treatment, others continue to drink alcohol and suffer serious health effects such as delirium tremens, liver failure, heart disease, and central nervous effects. One option society has used to force treatment and abstinence is the legal mechanism of “involuntary commitment.” The goal of this study was to determine the utilization of “involuntary commitment” among the 72 counties in Wisconsin.
A statewide survey was conducted using a mailed survey to assess the current use of this treatment option.
Forty-nine counties responded to the survey (68%); the mean number of commitments in the last year was 5 with a range of 0 to 30. Of the petitioners who participated in the commitment, 98% were family members, 62% were friends, 49% were physicians, and 26% were counselors. Over half of the respondents (53%) felt that the process was effective in helping people deal with their alcoholism.
The overall perception among those surveyed is that involuntary commitment for the treatment of alcohol dependence can help addicted persons, but its utilization varies by county in Wisconsin. Physicians may consider exploring the use of this legal process to assist patients struggling with alcoholism.
PMCID: PMC4106265  PMID: 22616471
5.  Mindfulness Meditation for Alcohol Relapse Prevention: A Feasibility Pilot Study 
Journal of addiction medicine  2008;2(3):165-173.
Meditation is a promising treatment for alcohol dependence. This 16-week prospective case series was designed to gather preliminary data about the efficacy of meditation for relapse prevention and to evaluate study methods feasibility.
Nineteen adult alcohol-dependent graduates of an intensive outpatient program were enrolled. Fifteen subjects completed the 8-week meditation course supplemented by at-home meditation and “standard of care” therapy. Outcome measures included surveys and 2 stress-responsive biomarkers.
Subjects (N = 19, 38.4 standard deviation [SD] = 8.6-year-old) were abstinent for 30.9 (SD = 22.2) days at enrollment. Completers (N = 15) attended 82% of meditation course sessions and meditated on average 4.6 (SD = 1.1) days per week; they were abstinent on 94.5% (SD = 7.4) of study days, with 47% reporting complete abstinence and 47% reporting 1 or more heavy drinking days. Their severity of depression, anxiety, stress (P < 0.05), and craving (P < 0.08), documented relapse triggers, decreased, and the degree of mindfulness increased (P < 0.05). The meditation course was rated as a “very important” (8.7/10, SD = 1.8) and “useful relapse prevention tool” (8.5/10, SD = 2.1); participants reported being “very likely” to continue meditating (9.0/10, SD = 1.5). “Gaining skills to reduce stress,” “coping with craving,” and “good group support” were the most common qualitative comments about the course value. Compared with baseline, at 16 weeks, interleukin-6 levels decreased (N = 12, P = 0.05); cortisol levels (N = 10) were reduced but not significantly. There were no adverse events or side effects.
Meditation may be an effective adjunctive therapy for relapse prevention in alcohol dependence, worthy of investigation in a larger trial. The study methods are appropriate for such a trial.
PMCID: PMC4106278  PMID: 21768988
meditation; addiction; alcohol dependence; substance use disorders; relapse prevention
6.  Emergency Department–Based Brief Intervention to Reduce Risky Driving and Hazardous/Harmful Drinking in Young Adults: A Randomized Controlled Trial 
Risky driving and hazardous drinking are associated with significant human and economic costs. Brief interventions for more than one risky behavior have the potential to reduce health-compromising behaviors in populations with multiple risk-taking behaviors such as young adults. Emergency department (ED) visits provide a window of opportunity for interventions meant to reduce both risky driving and hazardous drinking.
We determined the efficacy of a Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol addressing risky driving and hazardous drinking. We used a randomized controlled trial design with follow-ups through 12 months. ED patients aged 18 to 44 who screened positive for both behaviors (n = 476) were randomized to brief intervention (BIG), contact control (CCG), or no-contact control (NCG) groups. The BIG (n = 150) received a 20-minute assessment and two 20-minute interventions. The CCG (n = 162) received a 20-minute assessment at baseline and no intervention. The NCG (n = 164) were asked for contact information at baseline and had no assessment or intervention. Outcomes at 3, 6, 9, and 12 months were self-reported driving behaviors and alcohol consumption.
Outcomes were significantly lower in BIG compared with CCG through 6 or 9 months, but not at 12 months: Safety belt use at 3 months (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08 to 0.65); 6 months (AOR, 0.13; 95% CI, 0.04 to 0.42); and 9 months (AOR, 0.18; 95% CI, 0.06 to 0.56); binge drinking at 3 months (adjusted rate ratio [ARR] 0.84; 95% CI, 0.74 to 0.97) and 6 months (ARR, 0.81; 95% CI, 0.67 to 0.97); and ≥ 5 standard drinks/d at 3 months (AOR, 0.43; 95% CI, 0.20 to 0.91) and 6 months (AOR, 0.41; 95% CI, 0.17 to 0.98). No substantial differences were observed between BIG and NCG at 12 months.
Our findings indicate that SBIRT reduced risky driving and hazardous drinking in young adults, but its effects did not persist after 9 months. Future research should explore methods for extending the intervention effect.
PMCID: PMC4106279  PMID: 23802878
Brief Intervention; Hazardous Drinking; Risky Driving
7.  The Mentoring Competency Assessment: Validation of a New Instrument to Evaluate Skills of Research Mentors 
To determine the psychometric properties of the Mentoring Competency Assessment (MCA), a 26-item skills inventory that enables research mentors and mentees to evaluate six competencies of mentors: maintaining effective communication, aligning expectations, assessing understanding, addressing diversity, and fostering independence promoting professional development.
In 2010, investigators administered the MCA to 283 mentor–mentee pairs from 16 universities participating in a trial of a mentoring curriculum for clinical and translational research mentors. The authors analyzed baseline MCA data to describe the instrument’s psychometric properties.
Coefficient alpha scores for the MCA showed reliability (internal consistency). The hypothesized model with its six latent constructs (competencies) resulted in an acceptable fit to the data. For the instrument completed by mentors, chi-square = 663.20; df = 284; P < .001; root mean square error of approximation (RMSEA) = 0.069 (90% CI, 0.062–0.076); confirmatory fit index (CFI) = 0.85; and Tucker-Lewis index (TLI) = 0.83. For the instrument completed by mentees, chi-square = 840.62; df = 284; P < .001; RMSEA = 0.080 (90% CI, 0.063–0.077); CFI = 0.87; and TLI = 0.85. The correlations among the six competencies were high: 0.49–0.87 for mentors, 0.58–0.92 for mentees. All parameter estimates for the individual items were significant; standardized factor loadings ranged from 0.32–0.81 for mentors and 0.56–0.86 for mentees.
The findings demonstrate that the MCA has reliability and validity. In addition, this study provides preliminary norms derived from a national sample of mentors and mentees.
PMCID: PMC3727250  PMID: 23702534
8.  Inhibition, Executive Function, and Freezing of Gait 
Journal of Parkinson's disease  2014;4(1):111-122.
Studies suggest that freezing of gait (FoG) in people with Parkinson’s disease (PD) is associated with declines in executive function (EF). However, EF is multi-faceted, including three dissociable components: inhibiting prepotent responses, switching between task sets, and updating working memory.
This study investigated which aspect of EF is most strongly associated with FoG in PD.
Three groups were studied: adults with PD (with and without FoG) and age-matched, healthy adults. All participants completed a battery of cognitive tasks previously shown to discriminate among the three EF components. Participants also completed a turning-in-place task that was scored for FoG by neurologists blind to subjects’ self-reported FoG.
Compared to both other groups, participants with FoG showed significant performance deficits in tasks associated with inhibitory control, even after accounting for differences in disease severity, but no significant deficits in task-switching or updating working memory. Surprisingly, the strongest effect was an intermittent tendency of participants with FoG to hesitate, and thus miss the response window, on go trials in the Go-Nogo task. The FoG group also made slower responses in the conflict condition of the Stroop task. Physician-rated FoG scores were correlated both with failures to respond on go trials and with failures to inhibit responses on nogo trials in the Go-Nogo task.
These results suggest that FoG is associated with a specific inability to appropriately engage and release inhibition, rather than with a general executive deficit.
PMCID: PMC4028962  PMID: 24496099
Parkinson’s disease; Freezing of Gait; Inhibition; Executive Function; Conflict Resolution
9.  A Research Mentor Training Curriculum for Clinical and Translational Researchers 
To design and evaluate a research mentor training curriculum for clinical and translational researchers. The resulting eight hour curriculum was implemented as part of a national mentor training trial.
The mentor training curriculum was implemented with 144 mentors at 16 academic institutions. Facilitators of the curriculum participated in a train-the-trainer workshop to ensure uniform delivery. The data used for this report were collected from participants during the training sessions through reflective writing, and following the last training session via confidential survey with a 94% response rate.
88% of respondents reported high levels of satisfaction with the training experience, and 90% noted they would recommend the training to a colleague. Participants also reported significant learning gains across six mentoring competencies as well as specific impacts of the training on their mentoring practice.
The data suggest the described research mentor training curriculum is an effective means of engaging research mentors to reflect upon and improve their research mentoring practices. The training resulted in high satisfaction, self-reported skill gains as well as behavioral changes of clinical and translation research mentors. Given success across 16 diverse sites, this training may serve as a national model.
PMCID: PMC3572855  PMID: 23399086
10.  The anatomy, function, and development of mammalian Aβ low-threshold mechanoreceptors 
Frontiers in biology  2013;8(4):10.1007/s11515-013-1271-1.
Touch sensation is critical for our social and environmental interactions. In mammals, most discriminative light touch sensation is mediated by the Aβ low-threshold mechanoreceptors. Cell bodies of Aβ low-threshold mechanoreceptors are located in the dorsal root ganglia and trigeminal ganglia, which extend a central projection innervating the spinal cord and brain stem and a peripheral projection innervating the specialized mechanosensory end organs. These specialized mechanosensory end organs include Meissner’s corpuscles, Pacinian corpuscles, lanceolate endings, Merkel cells, and Ruffini corpuscles. The morphologies and physiological properties of these mechanosensory end organs and their innervating neurons have been investigated for over a century. In addition, recent advances in mouse genetics have enabled the identification of molecular mechanisms underlying the development of Aβ low-threshold mechanoreceptors, which highlight the crucial roles of neurotrophic factor signaling and transcription factor activity in this process. Here, we will review the anatomy, physiological properties, and development of mammalian low-threshold Aβ mechanoreceptors.
PMCID: PMC3873732  PMID: 24376457
mechanoreceptor; Meissner’s corpuscle; Pacinian corpuscle; lanceolate ending; Merkel cell; Ruffini corpuscle; dorsal root ganglion
11.  Racial Disparities in Pain Management in Primary Care 
This descriptive, cross-sectional, secondary data analysis was conducted to examine racial disparities in pain management of primary care patients with chronic nonmalignant pain using chronic opioid therapy. Data from 891 patients, including 201 African Americans and 691 Caucasians were used to test an explanatory model for these disparities. We predicted that: (1) African American patients would report worse pain management and poor quality of life (QOL) than Caucasians; (2) the association between race and pain management would be mediated by perceived discrimination relating to hopelessness; and (3) poor pain management would negatively affect QOL. Results revealed significant differences between African Americans and Caucasians on pain management and QOL, with African Americans faring worse. The proposed mediational model, which included race, perceived discrimination, hopelessness, and pain management was supported: (1) African Americans compared to Caucasians had higher perceived discrimination, (2) perceived discrimination was positively associated with hopelessness, and (3) higher hopelessness was associated with worse pain management. Further, pain management predicted QOL. This is the first study in which an explanatory model for the racial disparities in pain management of primary care patients with chronic nonmalignant pain was examined. Perceived discrimination and hopelessness were implicated as explanatory factors for the disparities.
PMCID: PMC3827865  PMID: 24244911
Pain Management; Chronic nonmalignant pain; Model of racial disparities; racial and ethnic minorities; perceived discrimination
12.  Older adolescents’ views regarding participation in Facebook research 
Facebook continues to grow in popularity among adolescents as well as adolescent researchers. Guidance on conducting this research with appropriate attention to privacy and ethics is scarce. To inform such research efforts, the purpose of this study was to determine older adolescents’ responses after learning that they were participants in a research study that involved identification of participants using Facebook.
Public Facebook profiles of older adolescents age 18 to 19 years from a large state university were examined. Profile owners were then interviewed. During the interview participants were informed that they were identified by examining publicly available Facebook profiles. Participants were asked to discuss their views on this research method.
A total of 132 participants completed the interview (70% response rate), the average age was 18.4 years (SD=0.5) and our sample included 64 males (48.5%). Participant responses included: endorsement (19.7%), fine (36.4%), neutral (28.8%), uneasy (9.1%) and concerned (6.1%). Among participants who were uneasy or concerned, the majority voiced confusion regarding their current profile security settings (p=0.00).
The majority of adolescent participants viewed the use of Facebook for research positively. These findings are consistent with the approach taken by many US courts. Researchers may consider these findings when developing research protocols involving Facebook.
PMCID: PMC3478668  PMID: 23084164
Adolescent; college student; social networking sites; research ethics; privacy; qualitative research
13.  Total Economic Cost and Burden of Dengue in Nicaragua: 1996–2010 
The burden of dengue in Nicaragua has been steadily rising during the last three decades; however, there have been few efforts to quantify the burden (measured in disability-adjusted life years [DALYs]) and cost to society. Using primary data from the Nicaraguan Ministry of Health (MINSA), the total cost and burden of dengue were calculated from 1996 to 2010. Total costs included both direct costs from medical expenditures and prevention activities and indirect costs from lost productivity. The annual disease burden ranged from 99 to 805 DALYs per million, with a majority associated with classic dengue fever. The total cost was estimated to be US$13.5 million/year (range: US$5.1–27.6 million). This analysis can help improve allocation of dengue control resources in Nicaragua and the region. As one of the most comprehensive analyses of its type to date in Nicaragua and Latin America, this study can serve as a model to determine the burden and cost of dengue.
PMCID: PMC3516309  PMID: 22890033
15.  Mentoring Translational Science Investigators 
PMCID: PMC3767996  PMID: 23168821
16.  RCR Online Course: Build an Online Course to Augment RCR Training Using Evidenced-Based Learning Theory 
Accountability in research  2012;19(4):247-266.
This article demonstrates how to apply evidenced-based instructional design principles to develop a supplemental, online Responsible Conduct of Research (RCR) course. The supplement RCR course may serve to appropriately augment the National Institutes of Health (NIH) required RCR training. The way to ensure that an online RCR course is effective is to incorporate evidence-based learning theories into the development of the course content. This article specifically demonstrates application of Bloom’s taxonomy and Gagne’s Nine Instructional Events to a research misconduct course. At the conclusion, the reader will be able to apply evidence-based learning theories to the development of any online course.
PMCID: PMC3768005  PMID: 22861181
online; asynchronous; Responsible Conduct of Research training; Bloom’s taxonomy; Gagne’s Instructional Events; evidenced-based learning methodologies
17.  Changes in Association between Previous Therapeutic Abortion and Preterm Birth in Scotland, 1980 to 2008: A Historical Cohort Study 
PLoS Medicine  2013;10(7):e1001481.
Gordon C. Smith and colleagues used national databases to investigate the association between previous termination of pregnancy and preterm birth in Scotland between 1980 to 2008, and whether the type of procedure was an important factor.
Please see later in the article for the Editors' Summary
Numerous studies have demonstrated that therapeutic termination of pregnancy (abortion) is associated with an increased risk of subsequent preterm birth. However, the literature is inconsistent, and methods of abortion have changed dramatically over the last 30 years. We hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008.
Methods and Findings
We studied linked Scottish national databases of births and perinatal deaths. We analysed the risk of preterm birth in relation to the number of previous abortions in 732,719 first births (≥24 wk), adjusting for maternal characteristics. The risk (adjusted odds ratio [95% CI]) of preterm birth was modelled using logistic regression, and associations were expressed for a one-unit increase in the number of previous abortions. Previous abortion was associated with an increased risk of preterm birth (1.12 [1.09–1.16]). When analysed by year of delivery, the association was strongest in 1980–1983 (1.32 [1.21–1.43]), progressively declined between 1984 and 1999, and was no longer apparent in 2000–2003 (0.98 [0.91–1.05]) or 2004–2008 (1.02 [0.95–1.09]). A statistical test for interaction between previous abortion and year was highly statistically significant (p<0.001). Analysis of data for abortions among nulliparous women in Scotland 1992–2008 demonstrated that the proportion that were surgical without use of cervical pre-treatment decreased from 31% to 0.4%, and that the proportion of medical abortions increased from 18% to 68%.
Previous abortion was a risk factor for spontaneous preterm birth in Scotland in the 1980s and 1990s, but the association progressively weakened and disappeared altogether by 2000. These changes were paralleled by increasing use of medical abortion and cervical pre-treatment prior to surgical abortion. Although it is plausible that the two trends were related, we could not test this directly as the data on the method of prior abortions were not linked to individuals in the cohort. However, we speculate that modernising abortion methods may be an effective long-term strategy to reduce global rates of preterm birth.
Please see later in the article for the Editors' Summary
Editors' Summary
Therapeutic termination of pregnancy is relatively common, with an estimated 40 million procedures performed worldwide every year. Until two decades ago, most terminations were performed as a surgical procedure, but now the majority of terminations are medically induced with a combination of drugs—selective progesterone receptor antagonists, such as mifepristone, and prostaglandins—that cause less damage to the woman's cervix. Although surgical terminations are still performed, nowadays prostaglandins are also used to help prevent damage to the cervix. Protecting the woman's cervix can help to reduce the risk of spontaneous preterm birth (delivery before 37 weeks gestation) in subsequent pregnancies. As many women who have abortions go on to have subsequent births, the widespread use of termination may be a significant factor in the high global rates of preterm delivery.
Why Was This Study Done?
A previous meta-analysis (a study that combines information from several studies) showed that the risk of preterm delivery was higher in women who had had a previous termination compared to women who had not. Based on this meta-analysis, UK guidelines on the care of women requesting a termination currently recommend that they be informed of the increased risk of subsequent preterm birth. However, it is biologically plausible that women undergoing medical termination or current practice for surgical termination (using prostaglandins to protect and prepare the cervix) may not have an increased risk of subsequent preterm delivery, because such approaches may cause less trauma to the cervix than traditional surgical termination. So in this study, the researchers used a large dataset from Scotland with three decades of information about previous terminations and subsequent preterm deliveries to test this possibility.
What Did the Researchers Do and Find?
The researchers linked two national databases—the Scottish Morbidity Record 02 (SMR02), which records the clinical and demographic characteristics and outcomes of all patients giving birth in Scottish maternity hospitals, and the Scottish Stillbirth and Infant Death Survey (SSBIDS), which classifies all perinatal deaths in Scotland. SMR02 data were available from 1980 onwards and also recorded each woman's self-reported total number of previous abortions, and SSBIDS data were available from 1985. Then the researchers used information from NHS National Services Scotland to examine secular trends in terminations over the past few decades, specifically, whether a recorded termination was surgical or medical, and also whether surgical abortion was preceded by cervical preparation.
Using these methods, the researchers identified that there were 757,060 live, singleton first births between 1980 and 2008 and that 56,816 women reported one previous termination, 5,790 women reported two previous terminations, and 822 women reported three previous terminations. In their analysis (adjusted for maternal characteristics) the researchers found that there was an independent association of spontaneous preterm birth, but not induced preterm birth, with previous termination. The researchers calculated that the chance (odds) of spontaneous preterm birth for one, two, and three or more previous abortions was 1.17, 1.51, and 1.64, after adjusting for maternal characteristics, including smoking. Over the time period, the researchers found that the proportion of surgical terminations without use of cervical pre-treatment decreased from 31% in 1992 to 0.4% in 2008, and over the same period the proportion of medical terminations increased from 18% to 68%. These trends are important, because in their analysis by year of delivery, the researchers found that the association between preterm delivery and previous termination was strongest in 1980–1983, progressively declined between 1984 and 1999, and was no longer present from 2000 to 2008.
What Do These Findings Mean?
These findings support the established association between previous termination and preterm delivery. But most importantly, the changes in this association over the past two decades—from strong in 1980–1983 to nonexistent in 2000–2008—a period in which the use of medical termination and pre-treatment of the cervix for surgical termination increased dramatically in Scotland, suggest that surgical termination without cervical pre-treatment is responsible for the increased risk of spontaneous preterm birth: the decrease in the proportion of this procedure over the study period may have led to the disappearance of the established association between previous termination and preterm delivery from 2000 onwards. However, these findings are limited in that the researchers could not directly test whether the two trends were related because they did not have information on the method of previous termination linked to subsequent birth outcome for individual women. However, based on the findings of this study, it is possible that using modern methods of termination of pregnancy (rather than purely surgical methods) could be a factor in reducing global rates of spontaneous preterm delivery in the future.
Additional Information
Please access these websites via the online version of this summary at
Wikipedia gives more information about termination of pregnancy (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages)
More information is available about the SMR02 dataset used in this study
The World Health Organization gives information on preterm birth
PMCID: PMC3706322  PMID: 23874161
18.  College Students’ Alcohol Displays on Facebook: Intervention Considerations 
The purpose of this study was to investigate college freshmen’s views towards potential social networking site (SNS) screening or intervention efforts regarding alcohol.
Freshmen college students between February 2010 and May 2011.
Participants were interviewed, all interviews were audio recorded and transcribed. Qualitative analysis was conducted using an iterative approach.
A total of 132 participants completed the interview (70% response rate), the average age was 18.4 years (SD 0.49) and 64 were males (48.5%). Three themes emerged from our data. First, most participants stated they viewed displayed alcohol content as indicative of alcohol use. Second, they explained they would prefer to be approached in a direct manner by someone they knew. Third, the style of approach was considered critical.
When approaching college students regarding alcohol messages on SNSs, both the relationship and the approach are key factors.
PMCID: PMC3375871  PMID: 22686361
Alcohol; Counseling; Health Education
19.  An Imperative: Patient-Centered Care for Our Aging Population 
The Ochsner Journal  2013;13(2):190-193.
PMCID: PMC3684326  PMID: 23789003
Case management; chronic disease; patient-centered care
20.  Evaluating and Giving Feedback to Mentors: New Evidence-Based Approaches 
A comprehensive mentoring program includes a variety of components. One of the most important is the ongoing assessment of and feedback to mentors. Scholars need strong active mentors who have the expertise, disposition, motivation, skills, and the ability to accept feedback and to adjust their mentoring style. Assessing the effectiveness of a given mentor is no easy task. Variability in learning needs and academic goals among scholars makes it difficult to develop a single evaluation instrument or a standardized procedure for evaluating mentors. Scholars, mentors, and program leaders are often reluctant to conduct formal evaluations, as there are no commonly accepted measures. The process of giving feedback is often difficult and there is limited empirical data on efficacy. This article presents a new and innovative six-component approach to mentor evaluation that includes the assessment of mentee training and empowerment, peer learning and mentor training, scholar advocacy, mentee–mentor expectations, mentor self-reflection, and mentee evaluation of their mentor.
PMCID: PMC3476454  PMID: 22376261
mentors; evaluation; outcomes
21.  Deriving Competencies for Mentors of Clinical and Translational Scholars 
Although the importance of research mentorship has been well established, the role of mentors of junior clinical and translational science investigators is not clearly defined. The authors attempt to derive a list of actionable competencies for mentors from a series of complementary methods. We examined focus groups, the literature, competencies derived for clinical and translational scholars, mentor training curricula, mentor evaluation forms and finally conducted an expert panel process in order to compose this list. These efforts resulted in a set of competencies that include generic competencies expected of all mentors, competencies specific to scientists, and competencies that are clinical and translational research specific. They are divided into six thematic areas: (1) Communication and managing the relationship, (2) Psychosocial support, (3) Career and professional development, (4) Professional enculturation and scientific integrity, (5) Research development, and (6) Clinical and translational investigator development. For each thematic area, we have listed associated competencies, 19 in total. For each competency, we list examples that are actionable and measurable. Although a comprehensive approach was used to derive this list of competencies, further work will be required to parse out how to apply and adapt them, as well future research directions and evaluation processes.
PMCID: PMC3476465  PMID: 22686206
mentoring; mentor; competencies; translational
22.  Identifying and Aligning Expectations in a Mentoring Relationship 
The mentoring relationship between a scholar and their primary mentor is a core feature of research training. Anecdotal evidence suggests this relationship is adversely affected when scholar and mentor expectations are not aligned. We examined three questions: (1) What is the value in assuring that the expectations of scholars and mentors are mutually identified and aligned? (2) What types of programmatic interventions facilitate this process? (3) What types of expectations are important to identify and align? We addressed these questions through a systematic literature review, focus group interviews of mentors and scholars, a survey of Clinical and Translational Science Award (CTSA) KL2 program directors, and review of formal programmatic mechanisms used by KL2 programs. We found broad support for the importance of identifying and aligning the expectations of scholars and mentors and evidence that mentoring contracts, agreements, and training programs facilitate this process. These tools focus on aligning expectations with respect to the scholar’s research, education, professional development and career advancement as well as support, communication, and personal conduct and interpersonal relations. Research is needed to assess test the efficacy of formal alignment activities.
PMCID: PMC3476480  PMID: 22212226
mentors; mentoring; career development; faculty development; staff development
23.  The majority of dorsal spinal cord gastrin releasing peptide is synthesized locally whereas neuromedin B is highly expressed in pain- and itch-sensing somatosensory neurons 
Molecular Pain  2012;8:52.
Itch is one of the major somatosensory modalities. Some recent findings have proposed that gastrin releasing peptide (Grp) is expressed in a subset of dorsal root ganglion (DRG) neurons and functions as a selective neurotransmitter for transferring itch information to spinal cord interneurons. However, expression data from public databases and earlier literatures indicate that Grp mRNA is only detected in dorsal spinal cord (dSC) whereas its family member neuromedin B (Nmb) is highly expressed in DRG neurons. These contradictory results argue that a thorough characterization of the expression of Grp and Nmb is warranted.
Grp mRNA is highly expressed in dSC but is barely detectable in DRGs of juvenile and adult mice. Anti-bombesin serum specifically recognizes Grp but not Nmb. Grp is present in a small number of small-diameter DRG neurons and in abundance in layers I and II of the spinal cord. The reduction of dSC Grp after dorsal root rhizotomy is significantly different from those of DRG derived markers but similar to that of a spinal cord neuronal marker. Double fluorescent in situ of Nmb and other molecular markers indicate that Nmb is highly and selectively expressed in nociceptive and itch-sensitive DRG neurons.
The majority of dSC Grp is synthesized locally in dorsal spinal cord neurons. On the other hand, Nmb is highly expressed in pain- and itch-sensing DRG neurons. Our findings provide direct anatomic evidence that Grp could function locally in the dorsal spinal cord in addition to its roles in DRG neurons and that Nmb has potential roles in nociceptive and itch-sensitive neurons. These results will improve our understanding about roles of Grp and Nmb in mediating itch sensation.
PMCID: PMC3495671  PMID: 22776446
Gastrin releasing peptide; Neuromedin B; Itch; Dorsal root ganglion; Spinal cord
24.  Mentoring K scholars: Strategies to support research mentors 
The goal of this paper is to present strategies utilized to support K scholar research mentors. K scholars are generally assistant professors who are close to developing independent research programs. Of all the various types of mentees, K scholars offer the greatest challenges, as well as the greatest rewards, for research mentors. To see one's mentee achieve independent PI status and become an established investigator is one of the great joys of being a research mentor. Research mentors for K scholars, however, may not directly benefit from their mentoring relationship, neither in terms of obtaining data to support their research program or laboratory, nor in assistance with grants or scientific papers. There is a pressing need for the research community to address the workload, institutional expectations and reward system for research mentors. The dearth of research mentors and role models in clinical translational science parallels the decreasing number of physicians choosing careers in clinical research. While there is limited empirical information on the effectiveness of mentor support mechanisms, this white paper concludes that providing mentor support is critical to expanding the available pool of mentors, as well as providing training opportunities for K scholars.
PMCID: PMC3136377  PMID: 21707951
translational research; salary; protected time; resources
25.  Selection of Research Mentors for K Funded Scholars 
Mentoring is an important element in the training of new investigators, particularly for KL2, K12, K08, and K23 funded scholars who are often physicians or other clinicians with limited prior research experience. Matching K scholars with appropriate mentors who have the mentoring skills and available time is an ongoing challenge for most universities. The goal of this paper is to present a variety of strategies used to select mentors for K awardees. The information presented in this special communication is derived from the literature, a national survey of CTSA leaders, as well as K scholar and K mentor focus groups.
Some of the mentor selection methods discussed in this paper include a) having the scholar find a mentor as part of the application process for the award, b) selecting mentors post award, c) expecting the chair of the department to identify a mentor(s), d) using a committee to match the scholar and a mentor based on a pool of approved mentors e) selecting additional mentors as the scholar’s research program develops. The paper concludes that mentor selection requires an ongoing programmatic approach with the active participation of K scholars, CTSA program leaders, center directors, research deans and chairs.
PMCID: PMC3072229  PMID: 21463493
research mentor selection

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