Excite, or Take Flight? Exploring the Relationship between Difficulties with Emotion Regulation, Outcome Expectancies, and Problem Gambling.

Emotional dysregulation is a transdiagnostic process associated with a range of addictive behaviours including problem gambling, with emerging research indicating that emotionally oriented reasons for gambling (i.e., excitement, escape) are associated with problem gambling. However, the relationships between difficulties with emotion regulation, reasons for gambling, and problem gambling, are unclear. The current study tested whether the association between difficulties with emotion regulation and problem gambling could be explained by escape and excitement gambling outcome expectancies. A total of 187 regular gamblers recruited via social media (50.3% male, 48.7% female) completed measures of difficulties with emotion regulation, gambling outcome expectancies, and problem gambling severity (Mage = 41.07, SD = 15.8). Analyses revealed that escape outcome expectancies partially mediated the relationship between difficulties with emotion regulation and problem gambling severity. However, the mediating effect of excitement on this relationship was not significant. The findings suggest that individuals with greater emotional regulation difficulties may engage in problem gambling to help manage aversive emotional states. The study's findings illustrate the importance of considering emotional dysregulation and outcome expectancies in problem gambling treatment planning and public health strategies.

The Influence of Cervical Spine Angulation on Symptoms Associated With Wearing a Rigid Neck Collar.

INTRODUCTION: Rigid cervical spine collars can be used to maintain the position of the cervical spine following injury or surgery. However, they have been associated with difficulty swallowing, pressure sores and pain, particularly in older patients. We aimed to investigate the relationship between cervical spine angulation, a rigid neck collar and neck pain in healthy young and older adults. METHODS: Twenty healthy young adults aged 25 ± 3 years and 17 healthy older adults aged 80 ± 8 years were tested. Magnetic resonance imaging scans of their cervical spines were taken before and after the rigid neck collar was worn for 1 hour. Measurement of vertebral angulation involved digitization of the scans and joint angle calculations using image processing software. Pain was quantified before and after the collar was worn, using a visual analogue scale. RESULTS: Pain scores increased in the young group after the collar was worn (p = 0.001). The older group showed no difference in pain score after the collar was worn. Statistical tests showed no significant correlations between the change in cervical angles and the change in pain scores after the collar was worn. DISCUSSION: The aging process may contribute to the changing distribution of subcutaneous tissue and increase risk of symptoms associated with wearing a collar. Oesophageal compression is not a result of collar use. CONCLUSION: There is no correlation between cervical spine vertebrae angulation and symptoms associated with wearing a neck collar. Generally, older individuals have greater cervical lordosis angles, and more straight and lordotic neck shapes. Older individuals may be more prone to skin-interface pressures from the neck collar than younger individuals.

'Nipples to knees' in the 'Me Too' era.

We live in an era of increased societal awareness of sexual harassment and frequent reporting by patients of inappropriate conduct. In this article, we reflect on traditional teaching of physical examination involving full exposure and intimate examinations, and whether this is still necessary, or appropriate, in clinical practice today. We discuss the balance between appropriate physical examination and inappropriate patient exposure resulting in perceived or actual harassment. We argue that ethical values and societal values change with time, and there is an onus on medical educators to reflect societal sensitivities in their teaching.

Multi-resistant Pseudomonas aeruginosa ST235 in cystic fibrosis.

Chronic Pseudomonas aeruginosa infection is associated with a decline in lung function and overall poorer prognosis in the cystic fibrosis population. Molecular typing of P. aeruginosa has identified multiple clonal strains with increased virulence and transmissibility. P. aeruginosa ST235 is an emerging clonal strain with multi-drug resistance and is associated with more virulent infections. Novel cephalosporins, which have recently been introduced to clinical practice, may have higher efficacy against multi-drug resistant bacteria.

Physiologically relevant, pH-responsive PEG-based block and statistical copolymers with N,N-diisopropylamine units.

In order to impart pH-responsiveness within a physiologically-relevant context to PEG-based biomaterials, a new tertiary amine containing repeat unit, N,N-diisopropyl ethanolamine glycidyl ether (DEGE), was developed and incorporated into statistical and block copolymers with ethylene oxide (EO), and allyl glycidyl ether (AGE) via anionic ring-opening polymerization. The reactivity of this novel monomeric building block in copolymerizations with EO was investigated by spectroscopy with observed reactivity ratios of rDEGE = 1.28 ± 0.14 and rEO = 0.82 ± 0.10. It was further demonstrated that DEGE containing copolymers could serve as building blocks for the formation of new pH-responsive materials with a pKa of ca. 9, which allowed macroscopic hydrogels to be prepared from symmetric triblock copolymers PDEGE5.3k-b-PEO20k-b-PDEGE5.3k. The triblock copolymers exhibited clear sol-to-gel transitions in a physiologically-relevant critical gelation range of pH 5.8-6.6 and pH-dependent viscoelastic properties. On the nanometer scale, the preparation of pH-responsive micro- or nanogels was demonstrated by crosslinking P(DEGE-co-AGE) copolymers in miniemulsion droplets stabilized by PEO-b-P(DEGE-co-AGE) diblock terpolymers. These nanoparticles exhibited a reversible pH-dependent swelling profile with a volume phase transition at physiological pH 6.5-7.5.

Poly[(ethylene oxide)-co-(methylene ethylene oxide)]: A hydrolytically-degradable poly(ethylene oxide) platform.

A facile method for imparting hydrolytic degradability to poly(ethylene oxide) (PEO), compatible with current PEGylation strategies, is presented. By incorporating methylene ethylene oxide (MEO) units into the parent PEO backbone, complete degradation was defined by the molar incorporation of MEO, and the structure of the degradation byproducts was consistent with an acid-catalyzed vinyl-ether hydrolysis mechanism. The hydrolytic degradation of poly[(ethylene oxide)-co-(methylene ethylene oxide)] was pH-sensitive, with degradation at pH 5 being significantly faster than at pH 7.4 at 37 °C in PBS buffer while long-term stability could be obtained in either the solid-state or at pH 7.4 at 6 °C.

Henoch-Schönlein purpura after etanercept therapy for psoriasis.

Etanercept is a recombinant dimeric fusion protein consisting of a tumor necrosis factor-alpha receptor ligand-binding region linked to the Fc portion of human IgG. It is approved for use in the treatment of rheumatoid arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, psoriasis, and psoriatic arthritis. Since 1998, there have been reports of vasculitic adverse events, including necrotizing vasculitis and leukocytoclastic vasculitis. In addition, the adverse events reporting system of the U.S. Food and Drug Administration has recorded 35 cases of leukocytoclastic vasculitis, 20 after etanercept therapy and 15 after infliximab. Most cases of cutaneous vasculitis describe development of symptoms within 3 months of etanercept use. In only one case report was direct immunofluorescence performed on tissue and no specific immunoreactivity found. We describe the first case of Henoch-Schönlein purpura with acute renal failure associated with increase in etanercept dose after 11 months of use for treatment of psoriasis. Discontinuation of the drug and treatment with a course of systemic steroids led to the complete resolution of the vasculitis and improvement of renal function. Vasculitis occurring even during chronic use of antitumor necrosis factor agents must be considered as possibly related to the therapy.