CD44 splice isoform switching determines breast cancer stem cell state.

Although changes in alternative splicing have been observed in cancer, their functional contributions still remain largely unclear. Here we report that splice isoforms of the cancer stem cell (CSC) marker CD44 exhibit strikingly opposite functions in breast cancer. Bioinformatic annotation in patient breast cancer in The Cancer Genome Atlas (TCGA) database reveals that the CD44 standard splice isoform (CD44s) positively associates with the CSC gene signatures, whereas the CD44 variant splice isoforms (CD44v) exhibit an inverse association. We show that CD44s is the predominant isoform expressed in breast CSCs. Elimination of the CD44s isoform impairs CSC traits. Conversely, manipulating the splicing regulator ESRP1 to shift alternative splicing from CD44v to CD44s leads to an induction of CSC properties. We further demonstrate that CD44s activates the PDGFRß/Stat3 cascade to promote CSC traits. These results reveal CD44 isoform specificity in CSC and non-CSC states and suggest that alternative splicing provides functional gene versatility that is essential for distinct cancer cell states and thus cancer phenotypes.

Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy.

PURPOSE: The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW). METHODS: Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3. RESULTS: Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation. CONCLUSIONS: Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).

The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis.

ABSTRACTEvidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) feedback relies mostly upon post-feedback consumer surveys. This randomized-controlled trial with cross-over investigated the benefits of NPA feedback in multiple sclerosis (MS). Seventy-one participants were randomly allocated to NPA with feedback or a "delayed-treatment" control group. The primary hypotheses were that NPA feedback would lead to improved knowledge of cognitive functioning and improved coping. Outcome instruments were administered by a research assistant blinded to group allocation. At 1-week post-NPA feedback there were no significant group-by-time interaction effects, indicating no improvement. But nor was there any significant deterioration in psychological wellbeing, despite most participants receiving "bad news" confirming cognitive impairment. At 1-month follow-up, within-subjects' analyses not only found no evidence of any delayed deterioration, but showed clinically significant improvement (small-medium effects) in perceived everyday cognitive functioning, MS self-efficacy, stress and depression. Despite lack of improvement in the RCT component at 1-week post-NPA feedback, the absence of deterioration at this time, in addition to significant improvements in perceived cognitive functioning, self-efficacy and mood at follow-up, together with high satisfaction ratings, all support NPA feedback as a safe psycho-educational intervention that is followed by improved psychological wellbeing over time.Trial registration: Uniform Trial Number identifier: U1111-1127-1585.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12612000161820.

Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.

Evaluation of the TRANSITION tool to improve communication during older patients' care transitions: Healthcare practitioners' perspectives.

AIMS: To evaluate healthcare practitioners' perceptions of the feasibility and acceptability of a communication tool, entitled the TRANSITION tool, to communicate with older patients during transition from acute care to a community setting. BACKGROUND: Transitional care for older patients is challenging due to their complex care needs and rapid care transitions. Research has identified effective models of transitional care. However, optimal communication between healthcare practitioners and older patients remains under-investigated. DESIGN: Exploratory descriptive qualitative design. METHODS: The methods are reported using the Consolidated Criteria for Reporting Qualitative Studies checklist. The setting comprised two acute medical wards in an urban hospital in Australia. Twenty-two nursing and allied healthcare practitioners used the TRANSITION tool to guide communication about transitional care with an older patient and then participated in an interview about their experience of using the tool. All data were thematically analysed. FINDINGS: Healthcare practitioners reported their perceptions that the TRANSITION tool was feasible and acceptable, and that they perceived the tool supported them to know what to ask and to find out information regarding their patient's transitional care needs. Some ward-based nurses reported their perception that transitional care was not their role. CONCLUSIONS: Findings emphasise transitional care as a continuing care process that requires effective communication between nurses and older patients in acute medical wards. RELEVANCE TO CLINICAL PRACTICE: Given shorter lengths of stay, complex care needs and slow recovery, ward-based nurses are vital in communicating with older patients about their transitional care needs. The TRANSITION tool may support communication between ward-based nurses and older patients to improve assessment and planning. Implementation of the tool will require a planned strategy to facilitate translation of the tool into routine practice of ward-based nurses to support their roles during older patients' care transitions.

Barriers to rehabilitation after critical illness: a survey of multidisciplinary healthcare professionals caring for ICU survivors in an acute care hospital.

BACKGROUND: There is scant literature on the barriers to rehabilitation for patients discharged from the intensive care unit (ICU) to acute care wards. OBJECTIVES: The objective of this study was to assess ward-based rehabilitation practices and barriers and assess knowledge and perceptions of ward clinicians regarding health concerns of ICU survivors. METHODS, DESIGN, SETTING, AND PARTICIPANTS: This was a single-centre survey of multidisciplinary healthcare professionals caring for ICU survivors in an Australian tertiary teaching hospital. MAIN OUTCOME MEASURES: The main outcome measures were knowledge of post-intensive care syndrome (PICS) amongst ward clinicians, perceptions of ongoing health concerns with current rehabilitation practices, and barriers to inpatient rehabilitation for ICU survivors. RESULTS: The overall survey response rate was 35% (198/573 potential staff). Most respondents (66%, 126/190) were unfamiliar with the term PICS. A majority of the respondents perceived new-onset physical weakness, sleep disturbances, and delirium as common health concerns amongst ICU survivors on acute care wards. There were multifaceted barriers to patient mobilisation, with inadequate multidisciplinary staffing, lack of medical order for mobilisation, and inadequate physical space near the bed as common institutional barriers and patient frailty and cardiovascular instability as the commonly perceived patient-related barriers. A majority of the surveyed ward clinicians (66%, 115/173) would value education on health concerns of ICU survivors to provide better patient care. CONCLUSION: There are multiple potentially modifiable barriers to the ongoing rehabilitation of ICU survivors in an acute care hospital. Addressing these barriers may have benefits for the ongoing care of ICU survivors.

Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT.

BACKGROUND: There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW's alcohol intake, wellbeing, and engagement with alcohol treatment. METHODS: A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic 'thank you' message, and a nested qualitative study to further explore the intervention's feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index - Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability. DISCUSSION: This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392 ).

Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample.

Stress and affective distress have previously been shown to predict sleep quality, and all the factors have been shown to predict fatigue severity. However, few prior studies have examined the likely indirect mediational relationships between stress, affective distress, and sleep quality in predicting fatigue severity, and the potential role played by ruminative thinking. A short questionnaire asked 229 participants about their recent experiences of stress, affective distress, rumination, sleep, and fatigue in a community sample. High stress, anxiety, and depression were related to more ruminative thinking, which in turn was related to poor sleep quality (composed of subjective sleep quality, daytime dysfunction, sleep latency, and sleep disturbance) and poor sleep quality predicted worse fatigue. The results suggest that rumination parsimoniously explains the tendency of stress and affective distress to contribute to poor sleep quality, and together with poor sleep, it may also contribute to worse fatigue in some individuals.

User experience and care for older people transitioning from hospital to home: Patients' and carers' perspectives.

BACKGROUND: Transitioning from hospital to home is challenging for many older people living with chronic health conditions. Transitional care facilitates safe and timely transfer of patients between levels of care and across care settings and includes communication between practitioners, assessment and planning, preparation, medication reconciliation, follow-up care and self-management education. To date, there is limited understanding of how to actively involve care recipient service users in transitional care. OBJECTIVE: This study was part of a larger research project. The objective of this article was to report the first study phase, in which we aimed to describe user experience pertaining to patients and carers. DESIGN, SETTING AND PARTICIPANTS: The study design was qualitative descriptive using interviews. Patients (n = 19) and carers (n = 7) participated in semi-structured interviews about their experience of transition from hospital to home in an urban Australian health-care setting. Interview data were analysed using thematic analysis. FINDINGS: All participants reported that they needed to become independent in transition. Participants perceived a range of social processes supported their independence at home: supportive relationships with carers, caring relationships with health-care practitioners, seeking information, discussing and negotiating the transitional care plan and learning to self-care. DISCUSSION: Findings contribute to our understanding that quality transitional care should focus on patients' need to regain independence. Social processes supporting the capacities of patients and carers should be emphasized in future initiatives. CONCLUSION: Future transitional care interventions should emphasize strategies to enable negotiation for suitable supports and assist care recipients to overcome barriers identified in this study.

User Experience and Care Integration in Transitional Care for Older People From Hospital to Home: A Meta-Synthesis.

This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.

Can body temperature dysregulation explain the co-occurrence between overweight/obesity, sleep impairment, late-night eating, and a sedentary lifestyle?

PURPOSE: Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occurring problems. There is a tendency for them to co-occur together more often than they occur alone. In some cases, there is clarity as to the time course and evolution of the phenomena. However, specific mechanism(s) that are proposed to explain a single co-occurrence cannot fully explain the more generalized tendency to develop concurrent symptoms and/or disorders after developing one of the phenomena. Nor is there a clinical theory with any utility in explaining the development of co-occurring symptoms, disorders and behaviour and the mechanism(s) by which they occur. Thus, we propose a specific mechanism-dysregulation of core body temperature (CBT) that interferes with sleep onset-to explain the development of the concurrences. METHODS: A detailed review of the literature related to CBT and the phenomena that can alter CBT or are altered by CBT is provided. RESULTS: Overweight/obesity, sleep disturbance and certain behaviour (e.g. late-night eating, sedentarism) were linked to elevated CBT, especially an elevated nocturnal CBT. A number of existing therapies including drugs (e.g. antidepressants), behavioural therapies (e.g. sleep restriction therapy) and bright light therapy can also reduce CBT. CONCLUSIONS: An elevation in nocturnal CBT that interferes with sleep onset can parsimoniously explain the development and perpetuation of common co-occurring symptoms, disorders and behaviour including overweight/obesity, sleep disturbance, late-night eating, and sedentarism. Nonetheless, a significant correlation between CBT and the above symptoms, disorders and behaviour does not necessarily imply causation. Thus, statistical and methodological issues of relevance to this enquiry are discussed including the likely presence of autocorrelation. LEVEL OF EVIDENCE: Level V, narrative review.

A model for lesbian, bisexual and queer-related influences on alcohol consumption and implications for policy and practice.

Research consistently reports higher rates of problematic drinking among lesbian, bisexual and queer women than among heterosexual women, but relatively little research has identified underlying factors. Within this context, the aim of the present study was to qualitatively explore the sociocultural influences on alcohol consumption among lesbian, bisexual and queer women in Australia. An ethnographic study including in-depth interviews and 10 sessions of participant observation was conducted with 25 Australian lesbian, bisexual and queer women. Analysis of transcripts and fieldnotes focused on lesbian, bisexual and queer-related influences on alcohol consumption. Three lesbian, bisexual and queer-related factors were identified that influenced alcohol use: (1) coping, (2) connection and (3) intersections with lesbian, bisexual and queer identity. Most participants reported consuming alcohol to cope with discrimination or to connect with like-minded others. Alcohol use had positive influences for some women through facilitating social connection and wellbeing. Women with a high lesbian, bisexual and queer identity salience were more likely to seek lesbian, bisexual and queer community connection involving alcohol, to publicly identify as lesbian, bisexual and queer and to experience discrimination. National policies need to address underlying causes of discrimination against lesbian, bisexual and queer women. Alcohol policies and clinical interventions should acknowledge the impact of discrimination on higher alcohol consumption amongst lesbian, bisexual and queer women compared with heterosexual women, and should utilise health promotion messages regarding safe drinking that facilitate lesbian, bisexual and queer social connection.

Building healthcare workers' confidence to work with same-sex parented families.

This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.

Perceived cognitive difficulties and cognitive test performance as predictors of employment outcomes in people with multiple sclerosis.

Perceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory - Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS.

Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review.

BACKGROUND: Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice. METHODS: Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias. RESULTS: Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management. CONCLUSIONS: Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.

Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study.

Objective: To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors. Design: Prospective, multicentre observational cohort study. Setting: Four tertiary medical-surgical ICUs in Australia. Participants: Intubated and non-intubated adult ICU survivors. Main outcome measures: Primary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire. Results: Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66-3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53-3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions. Conclusions: Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.

Development of the Tinnitus response scales: factor analyses, subscale reliability and validity analyses.

OBJECTIVE: Patients suffering with tinnitus are often advised to accept the noise, but few studies have examined what tinnitus acceptance entails. The present project developed and tested a new instrument to assess the mindfulnessbased constructs of acceptance, control, and defeat, in relation to the experience of chronic tinnitus. METHOD: Initial scale development involved an expert panel. Participants were recruited from the general population and tinnitus support organizations and complete the first version of the Tinnitus Response Scales (TRS) and measures of tinnitus coping, severity and distress, general distress, illness cognitions, and tinnitus and health characteristics. RESULTS: Three interpretable TRS factors were found: acceptance, control and defeat (an Internet sample, N = 273) and confirmed using another sample (hard-copy sample, N = 278). Factors were shown to have high internal consistency and testretest reliabilities and differed in terms of their related cognitions, behaviour, and emotional responses to tinnitus, and their tinnitus characteristics. CONCLUSION: The TRS factors provide an alternative conceptualisation of tinnitus responding. TRS is a brief psychometrically valid measure of tinnitus responding that appears to distinguish between adaptive and non-adaptive responses to tinnitus noise, and should prove useful as a clinical measure.

Is tinnitus acceptance the same as tinnitus habituation?

INTRODUCTION: Tinnitus habituation and tinnitus acceptance both describe an apparent lack of responding to tinnitus noise. However, no prior studies have evaluated the possible overlap between tinnitus habituation and acceptance processes in chronic tinnitus sufferers. OBJECTIVES: We examined responses to the seven acceptance items from the Tinnitus Response Scales (TRS) along with 19 items that tapped the perceptual/behavioural aspects of tinnitus habituation. MATERIALS AND METHODS: A large sample of chronic tinnitus sufferers (n = 273) were recruited via advertisements placed at tinnitus clinics and websites and in the media. They were asked to complete an online survey asking about their tinnitus history and recent experiences of tinnitus habituation, sensitization to tinnitus noise, and tinnitus acceptance, and distress. RESULTS: Exploratory factor analysis showed that a single factor solution explained 40% of the variance in the scale items. Acceptance and tinnitus habituation (vs. sensitization) subscale scores were highly negatively correlated with each other. CONCLUSION: Tinnitus acceptance and tinnitus habituation may describe related cognitive and perceptual/behavioral aspects of tinnitus adaptation. That is in this study, tinnitus-habituation items tapped perceptual awareness and behavioral responses to tinnitus, whereas tinnitus acceptance items tapped cognitive responses to the noise (i.e. lack of need to respond to the noise).

ACPSEM position paper: dosimetry for magnetic resonance imaging linear accelerators.

Consistency and clear guidelines on dosimetry are essential for accurate and precise dosimetry, to ensure the best patient outcomes and to allow direct dose comparison across different centres. Magnetic Resonance Imaging Linac (MRI-linac) systems have recently been introduced to Australasian clinics. This report provides recommendations on reference dosimetry measurements for MRI-linacs on behalf of the Australiasian College of Physical Scientists and Engineers in Medicine (ACPSEM) MRI-linac working group. There are two configurations considered for MRI-linacs, perpendicular and parallel, referring to the relative direction of the magnetic field and radiation beam, with different impacts on dose deposition in a medium. These recommendations focus on ion chambers which are most commonly used in the clinic for reference dosimetry. Water phantoms must be MR safe or conditional and practical limitations on phantom set-up must be considered. Solid phantoms are not advised for reference dosimetry. For reference dosimetry, IAEA TRS-398 recommendations cannot be followed completely due to physical differences between conventional linac and MRI-linac systems. Manufacturers' advice on reference conditions should be followed. Beam quality specification of TPR20,10 is recommended. The configuration of the central axis of the ion chamber relative to the magnetic field and radiation beam impacts the chamber response and must be considered carefully. Recommended corrections to delivered dose are [Formula: see text], a correction for beam quality and [Formula: see text], for the impact of the magnetic field on dosimeter response in the magnetic field. Literature based values for [Formula: see text] are given. It is important to note that this is a developing field and these recommendations should be used together with a review of current literature.

Development of a Scale to Examine Responses to Bodily Sensations.

OBJECTIVE: Individual differences in the perception of bodily sensations is known to be associated with affective symptomatology. However, the way people psychologically respond to everyday bodily sensations has not been examined in a systematic and balanced way. Thus, we developed the Bodily Sensations Response Scale (BSRS) to evaluate participants' self-reported cognitive, emotional, and behavioral responses to their bodily sensations. We investigated the scale's factor structure and its psychometric properties in two studies. METHOD: In Study 1, 297 participants completed the 50-item BSRS and exploratory factor analysis (EFA) was performed on the responses. In Study 2 (N = 284), confirmatory factor analysis (CFA) was used to confirm the factor structure of the 32-item BSRS identified in Study 1. RESULTS: In Study 1, the EFA identified a 32-item three-factor solution as the best fit for the data. Factor 1 described a defeat response to bodily sensations, Factor 2 described an acceptance response, and Factor 3 described a sensitization response. In Study 2, the three-factor solution was shown not to be parsimonious. Rather, CFA identified that the 27-item BSRS had two interpretable factors (Defeat and Acceptance) that explained participants' psychological responses to bodily sensations. The Defeat subscale was moderately to strongly correlated with awareness of bodily sensations (i.e., Body Perception Questionnaire-Short Form scores) and depression, anxiety, and stress symptom severity (i.e., Depression Anxiety Stress Scales-21 scores), whereas the Acceptance subscale was unrelated or only slightly negatively correlated to awareness of bodily sensations and depression, anxiety, and stress symptoms. CONCLUSION: The 27-item BSRS provides a psychometrically robust assessment of the way in which people psychologically respond to everyday bodily sensations. The measure can assist researchers to better understand how people psychologically process their salient bodily sensations and how this is linked to psychopathology.