Protocol: Strategy instruction for improving short- and long-term writing performance on secondary and upper-secondary students: A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows. This review aims to investigate the effectiveness of all types of teacher-delivered classroom-based strategy instruction aimed at students in the general population (all students) including struggling students (with or at-risk of academic difficulties) in ages 12-19 for increasing writing performance. The majority of previous reviews scoped all outcomes presented in the primary studies. This review will solely focus on covering three most common outcomes: story quality, story elements and word count/length.

Increasing the transparency of systematic reviews: presenting a generalized registration form

This paper presents a generalized registration form for systematic reviews that can be used when currently available forms are not adequate. The form is designed to be applicable across disciplines (i.e., psychology, economics, law, physics, or any other field) and across review types (i.e., scoping review, review of qualitative studies, meta-analysis, or any other type of review). That means that the reviewed records may include research reports as well as archive documents, case law, books, poems, etc. Items were selected and formulated to optimize broad applicability instead of specificity, forgoing some benefits afforded by a tighter focus. This PRISMA 2020 compliant form is a fallback for more specialized forms and can be used if no specialized form or registration platform is available. When accessing this form on the Open Science Framework website, users will therefore first be guided to specialized forms when they exist. In addition to this use case, the form can also serve as a starting point for creating registration forms that cater to specific fields or review types.

Putting the Self in Self-Correction: Findings From the Loss-of-Confidence Project

Science is often perceived to be a self-correcting enterprise. In principle, the assessment of scientific claims is supposed to proceed in a cumulative fashion, with the reigning theories of the day progressively approximating truth more accurately over time. In practice, however, cumulative self-correction tends to proceed less efficiently than one might naively suppose. Far from evaluating new evidence dispassionately and infallibly, individual scientists often cling stubbornly to prior findings. Here we explore the dynamics of scientific self-correction at an individual rather than collective level. In 13 written statements, researchers from diverse branches of psychology share why and how they have lost confidence in one of their own published findings. We qualitatively characterize these disclosures and explore their implications. A cross-disciplinary survey suggests that such loss-of-confidence sentiments are surprisingly common among members of the broader scientific population yet rarely become part of the public record. We argue that removing barriers to self-correction at the individual level is imperative if the scientific community as a whole is to achieve the ideal of efficient self-correction.

Getting Started Creating Data Dictionaries: How to Create a Shareable Data Set

As researchers embrace open and transparent data sharing, they will need to provide information about their data that effectively helps others understand their data sets’ contents. Without proper documentation, data stored in online repositories such as OSF will often be rendered unfindable and unreadable by other researchers and indexing search engines. Data dictionaries and codebooks provide a wealth of information about variables, data collection, and other important facets of a data set. This information, called metadata, provides key insights into how the data might be further used in research and facilitates search-engine indexing to reach a broader audience of interested parties. This Tutorial first explains terminology and standards relevant to data dictionaries and codebooks. Accompanying information on OSF presents a guided workflow of the entire process from source data (e.g., survey answers on Qualtrics) to an openly shared data set accompanied by a data dictionary or codebook that follows an agreed-upon standard. Finally, we discuss freely available Web applications to assist this process of ensuring that psychology data are findable, accessible, interoperable, and reusable.

A social differential outcomes learning task: Performance, EEG, and questionnaire data

This article contains performance data, questionnaire ratings, and EEG data from a differential outcomes learning task from two experiments. In both experiments, the standard differential outcomes learning task was extended to involve a social dimension, in order to capture how people can learn from others by observation. In Experiment 1 (N = 20), using a within-subjects design, participants learned pairings of image stimuli in four conditions: 1) individual-differential outcomes, 2) individual-non-differential outcomes, 3) social-differential outcomes, and 4) social-non-differential outcomes. The social condition had a screen-captured video recording of the outcomes (but not the actions themselves) of another person performing the task. During the task, the performance of the participants was measured. After the task, participants rated their experience in a questionnaire. The procedure for Experiment 2 (N = 33) was similar to Experiment 1, but with a stronger social manipulation using a video of another person's face showing facial expressions reflecting the outcomes. In addition, EEG was measured while performing the task. For more insight, please see Vicarious value learning: Knowledge transfer through affective processing on a social differential outcomes task (Rittmo et al., 2020).

Vicarious Value Learning: Knowledge transfer through affective processing on a social differential outcomes task

The findings of differential outcomes training procedures in controlled stimulus-response learning settings have been explained through theorizing two processes of response control. These processes concern: i) a stimulus-response route, and, ii) an outcome expectancy route through which valuations of stimuli (typically auditory or visual) may be represented. Critically, under certain contingencies of learning, the interaction of these two processes enables a transfer of knowledge. Transfer is hypothesized to occur via implicit inference for response selection given novel stimulus-response pairings. In this article, we test this transfer of knowledge, previously only examined in individual settings, in novel social settings. We find that participants are able to achieve transfer of knowledge and suggest they achieve this through vicariously learning the differential valuations of stimuli made by the (confederate) 'other' involved in the task. We test this effect under two experimental conditions through manipulation of the information made available to participants observing the confederate other's choices. The results of EEG recordings are, additionally, evaluated and discussed in the context of social signalling and emotional and cognitive empathy. We also consider implications for clinical and technological social learning settings.

Many Analysts, One Data Set: Making Transparent How Variations in Analytic Choices Affect Results

Twenty-nine teams involving 61 analysts used the same data set to address the same research question: whether soccer referees are more likely to give red cards to dark-skin-toned players than to light-skin-toned players. Analytic approaches varied widely across the teams, and the estimated effect sizes ranged from 0.89 to 2.93 ( Mdn = 1.31) in odds-ratio units. Twenty teams (69%) found a statistically significant positive effect, and 9 teams (31%) did not observe a significant relationship. Overall, the 29 different analyses used 21 unique combinations of covariates. Neither analysts’ prior beliefs about the effect of interest nor their level of expertise readily explained the variation in the outcomes of the analyses. Peer ratings of the quality of the analyses also did not account for the variability. These findings suggest that significant variation in the results of analyses of complex data may be difficult to avoid, even by experts with honest intentions. Crowdsourcing data analysis, a strategy in which numerous research teams are recruited to simultaneously investigate the same research question, makes transparent how defensible, yet subjective, analytic choices influence research results.

Between-litter variation in developmental studies of hormones and behavior: Inflated false positives and diminished power

Developmental studies of hormones and behavior often include littermates-rodent siblings that share early-life experiences and genes. Due to between-litter variation (i.e., litter effects), the statistical assumption of independent observations is untenable. In two literatures-natural variation in maternal care and prenatal stress-entire litters are categorized based on maternal behavior or experimental condition. Here, we (1) review both literatures; (2) simulate false positive rates for commonly used statistical methods in each literature; and (3) characterize small sample performance of multilevel models (MLM) and generalized estimating equations (GEE). We found that the assumption of independence was routinely violated (>85%), false positives (α=0.05) exceeded nominal levels (up to 0.70), and power (1-β) rarely surpassed 0.80 (even for optimistic sample and effect sizes). Additionally, we show that MLMs and GEEs have adequate performance for common research designs. We discuss implications for the extant literature, the field of behavioral neuroendocrinology, and provide recommendations.

Prototypes and same-gender bias in perceptions of hiring discrimination

The present study investigated the relative importance of two explanations behind perceptions of gender discrimination in hiring: prototypes and same-gender bias. According to the prototype explanation, people perceive an event as discrimination to the extent that it fits their preconceptions of typical discrimination. In contrast, the same-gender bias explanation asserts that people more readily detect discrimination toward members of their own gender. In four experiments (n = 797), women and men made considerably stronger discrimination attributions, and were moderately more discouraged from seeking work, when the victim was female rather than male. Further, a series of regressions analyses showed beliefs in discrimination of women to be moderately correlated with discrimination attributions of female victims, but little added explanatory value of participant gender, stigma consciousness, or feminist identification. The results offer strong support for the prototype explanation.

Getting along or ahead: Effects of gender identity threat on communal and agentic self-presentations

When faced with a threat to gender identity, people may try to restore their gender status by acting in a more gender-typical manner. The present research investigated effects of gender identity threat on self-presentations of agentic and communal traits in a Swedish and an Argentine sample (N = 242). Under threat (vs. affirmation), Swedish women deemphasized agentic traits (d [95% CI] = -0.41 [-0.93, 0.11]), Argentine women increased their emphasis on communal traits (d = 0.44 [-0.08, 0.97]), and Argentine men increased their emphasis on agentic traits (d = 0.49 [-0.03, 1.01]). However, Swedish men did not appear to be affected by the threat regarding agentic (d = 0.04 [-0.47, 0.55]) or communal traits (d = 0.23 [-0.29, 0.74]). The findings are to be considered tentative. Implications for identity threat research are discussed.

A closer look at the discrimination outcomes in the IAT literature

To what extent the IAT (Implicit Association Test, Greenwald et al., 1998) predicts racial and ethnic discrimination is a heavily debated issue. The latest meta-analysis by Oswald et al. (2013) suggests a very weak association. In the present meta-analysis, we switched the focus from the predictor to the criterion, by taking a closer look at the discrimination outcomes. We discovered that many of these outcomes were not actually operationalizations of discrimination, but rather of other related, but distinct, concepts, such as brain activity and voting preferences. When we meta-analyzed the main effects of discrimination among the remaining discrimination outcomes, the overall effect was close to zero and highly inconsistent across studies. Taken together, it is doubtful whether the amalgamation of these outcomes is relevant criteria for assessing the IAT's predictive validity of discrimination. Accordingly, there is also little evidence that the IAT can meaningfully predict discrimination, and we thus strongly caution against any practical applications of the IAT that rest on this assumption. However, provided that the application is thoroughly informed by the current state of the literature, we believe the IAT can still be a useful tool for researchers, educators, managers, and students who are interested in attitudes, prejudices, stereotypes, and discrimination.

Testing for Backlash in Hiring

Gender stereotypes describe women as communal and men as agentic. Laboratory-based research ( Rudman & Glick, 1999 , 2001 ) suggests that trying to disconfirm such descriptive gender stereotypes (e.g., women self-promoting their agency), entails the risk of hiring discrimination due to violation of prescriptive gender stereotypes: a backlash. To examine whether backlash occurs when applying for real jobs, we conducted a field experiment. Gender, agency, and communion were manipulated in the personal profile of 5,562 applications sent to 3,342 job openings on the Swedish labor market. The dependent variable was whether the application resulted in an invitation to a job interview or not. The results do not offer any support for the backlash hypothesis at this stage in the recruitment process.

The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease

BACKGROUND

Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.

AIM

To characterise IHD according to CD status.

METHODS

Data on duodenal or jejunal biopsies were collected in 2006-2008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.

RESULTS

We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P < 0.001) and cholesterol values (P < 0.001) and were less likely to be active smokers (OR = 0.74; 95% CI = 0.56-0.98) than reference individuals with myocardial infarction. CD patients had less extensive coronary artery disease at angiography (any stenosis: OR = 0.80; 95% CI = 0.66-0.97; three-vessel disease: OR = 0.73; 95% CI = 0.57-0.94); but there was no difference in the proportions of CD patients with positive biochemical markers of myocardial infarction (CD: 92.2% vs. reference individuals: 91.5%, P = 0.766).

CONCLUSION

Despite evidence of an increased risk of IHD and higher cardiovascular mortality, patients with coeliac disease with IHD have a more favourable cardiac risk profile compared with IHD in reference individuals.

Look at Yourself!

Previous research ( Libby, Shaeffer, & Eibach, 2009 ) has established that a third-person (external) visual perspective elicits more abstract processing than a first-person (inner) perspective. Because many moral principles constitute abstract psychological constructs, we predicted that they should weigh more heavily when people adopt a third-person visual perspective. In two experiments we show that a third- (vs. first-) person visual perspective leads to harsher judgments of one’s own morally questionable actions. Moreover, we demonstrate that this effect can be partially explained by level of mental construal. The present research suggests that simple visual perspective techniques may be used to promote moral behavior.

Mixed Discriminatory Judgments of Individuals’ Warmth and Competence-Related Abilities

Although several studies have demonstrated that stereotypes can be mixed in terms of warmth and competence (e.g., cold but competent), the possibility of mixed discrimination has received very little attention so far. To this end, the present study investigated mixed discriminatory judgments of individuals. In two studies, the participants judged the empathic (warmth) and the cognitive (competence) ability of individuals who differed only in whether they belonged to a group typically stereotyped as warm but incompetent or cold but competent. Study 1 compared Greeks with Germans (nationality) and Study 2 preschool teachers with lawyers (occupation). In both studies, the judgments were discriminatory in a mixed pattern consistent with the groups’ stereotype content.

Implicit Stereotype Content

The stereotype content model (SCM) postulates that stereotype content can be mixed in terms of diverging evaluations on the warmth and competence dimensions. The present study is the first to demonstrate this with implicit measures. Two Implicit Associations Tests (IATs) were developed, one capturing the warmth dimension and the other the competence dimension. Both IATs compared preschool teachers (stereotypically warm and incompetent) with lawyers (stereotypically cold and competent). As predicted, two samples of students from various areas of study showed the mixed implicit stereotypes, while a group of preschool-teacher students showed a univalent positive implicit stereotype of their own group, suggesting in-group favoritism. The results support the SCM.

Patients with ischemic heart disease: Quality of life predicts long-term mortality

OBJECTIVE

We have investigated whether perceived quality of life has an impact on long-term survival after a cardiac event.

DESIGN

Male (n = 316) and female (n = 97) patients were assessed by means of a self-administered quality of life questionnaire 1 year after either acute myocardial infarction (n = 296), coronary artery bypass grafting surgery (n = 99) or percutaneous coronary intervention (n = 18). Inclusion period was 1989-1991. Ten years after the last patient answered the 1-year questionnaire, mortality (status factor) up to census date was analysed using nine dimensions of quality of life as covariates (Cox regression).

RESULTS

At 1-year assessment, subjective general health (RR = 3.15), perceived arrhythmia (RR = 1.72), experience of sex life (RR = 1.55), perceived breathlessness (RR = 1.50) and experience of self-esteem (RR = 1.48) were all significantly related to death within the period up to census date.

CONCLUSION

The findings highlight that the patients' own experience of his or her quality of life, has a prognostic importance for long-term mortality after a cardiac event. Clinicians should be aware that a careful monitoring of perceived quality of life is an important part of good patient care.

Neuropsychological functions predict 1- and 3-year outcome in first-episode psychosis

OBJECTIVE

To examine neuropsychological performance as a possible predictor of course and outcome in first-episode psychotic (FEP) patients.

METHOD

A group of consecutive FEP patients (n = 120) tested with Wechsler Adult Intelligence Scales-Revised (WAIS-R) at baseline was compared with a healthy group (n = 30) matched for age, education and gender. Relationship between WAIS-R and both Brief Psychiatric Rating Scale and Global Assessment of Function (GAF) ratings were studied at baseline and at 1- and 3-year follow-ups.

RESULTS

The performance of FEP patients was significantly lower (P < 0.001) than that of healthy comparison subjects on all WAIS-R subtests except for Information and Comprehension. The WAIS-R scores of patients with schizophrenia syndromes (DSM-IV) were lower than those of patients with non-schizophrenia syndromes on Block Design. Low WAIS-R Full-Scale IQ scores in FEP patients predicted the presence of negative symptoms at 1-year follow-up and of low GAF ratings at 3-year follow-up.

CONCLUSION

Neurocognitive performance at admission appears to predict various aspects of functional outcome in FEP.

Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study

BACKGROUND

Upper oesophagogastroduodenoscopy is considered to be the gold standard for upper gastrointestinal disease assessment, but is currently seldom used in epidemiological studies. One concern is that the procedure may bias sampling among volunteers in a general adult population. The aim of this study was to explore whether the procedure affects symptom reporting.

METHODS

A random sample of 3000 adults aged 20-81 years (mean age 50.4), from two Swedish municipalities (n=21,610) was surveyed using a validated postal questionnaire (the Abdominal Symptom Questionnaire) assessing gastrointestinal symptoms. A subsample of the responders was invited, in random order, to undergo an upper endoscopy and repeated symptom reporting using the same questionnaire, as well as a serology test for Helicobacter pylori.

RESULTS

The response rate to the initial questionnaire was 74.2% and the participation rate for those eligible for the upper endoscopy was 73.3% (n = 1001, mean age 54.0 years, 48.8% male). No major social or symptom sampling error was encountered from the selection process, with the exception of an excess of symptom reporters among the youngest subjects. The prevalence of reflux symptoms, dyspeptic symptoms and irritable bowel symptoms was 40%, 37.6% and 29.6%, respectively, which is relatively high, but in no way extreme.

CONCLUSIONS

The upper endoscopy survey strategy was successful. The response rate was high and there was no major selection bias of clinical relevance. The cohort selected for this study appears to be representative of the general Swedish adult population.

Self-administered symptom questionnaires in patients with dyspepsia and their yield in discriminating between endoscopic diagnoses

BACKGROUND/AIMS

Symptoms are generally considered to be poor predictors of organic findings in patients with dyspepsia. We aimed at evaluating whether specific gastrointestinal symptoms, identified by self-administered questionnaires, correlate with specific endoscopic diagnoses and discriminate organic from functional dyspepsia.

METHODS

Adult patients with pain or discomfort centred in the upper abdominal region were consecutively enrolled. Patients with heartburn, acid regurgitation, or defaecation and bowel habit problems as their predominant symptoms were excluded. Three self-administered questionnaires were applied before an oesophagogastroduodenoscopy was performed.

RESULTS

Among the 799 patients, 50.6% had a normal endoscopy. Endoscopic diagnoses comprised: non-erosive oesophagitis (7.5%), erosive oesophagitis (11.1%), Barrett's oesophagus (1.1%), gastritis/duodenitis (8.4%), gastric ulcer (4.5%), duodenal ulcer (8.3%), and cancer (1.3%). Non-dominant heartburn and acid regurgitation were significantly more common in patients with organic dyspepsia, whereas hunger pains and rumbling occurred more often in those with functional dyspepsia. Multivariate analyses demonstrated that younger age, female gender, high scores for hunger pain, rumbling, hard stools, low scores for heartburn, and acid regurgitation predicted functional dyspepsia.

CONCLUSIONS

Self-administered questionnaires revealed differences in the symptom patterns between patients with functional and organic dyspepsia. Furthermore, the health-related well-being in patients with functional and organic dyspepsia centred was impaired to the same extent.

Effect of profound acid suppression in functional dyspepsia: a double-blind, randomized, placebo-controlled trial

BACKGROUND

Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the upper abdomen, where no structural explanation for the symptoms is found. The role of drug treatment remains controversial. The aim in this study was to evaluate the effect of omeprazole 20 mg twice daily (b.i.d) and to test methods for symptom assessment.

METHODS

197 patients fulfilling the criteria for FD were randomly allocated to double-blind treatment with omeprazole 20 mg b.i.d (n = 100) or placebo (n = 97) for 14 days. Patients with a known gastrointestinal disorder or with main symptoms indicating gastro-oesophageal reflux disease or irritable bowel syndrome were excluded. Helicobacter pylori testing and 24-h intra-oesophageal 24-h pH-metry were performed before randomization. The patients recorded dyspeptic symptoms on diary cards.

RESULTS

A stringent endpoint, 'complete symptom relief on the last day of treatment', was the primary efficacy variable. For the APT cohort, this was achieved in 29.0% and 17.7% on omeprazole and placebo, respectively (95% CI of difference (11.3%): -0.4%-23.0%, P = 0.057). Similar figures in the PP cohort were 31.0% and 15.5%, respectively (95% Cl of difference (15.5%): 3.2%-27.7%, P = 0.018). The benefit of omeprazole in the PP cohort was confirmed by secondary endpoints such as, no dyspeptic symptoms on the last 2 days of treatment and overall treatment response. H. pylori status and the level of oesophageal acid exposure did not significantly influence the response to therapy.

CONCLUSION

A subset of patients with FD will respond to therapy with omeprazole.

Telomerase regulation and telomere dynamics in germinal centers

Telomere length maintenance, usually executed by telomerase, is a prerequisite for an extended or infinite division potential. Nevertheless most telomerase positive normal cells exhibit telomere shortening. This study details the telomerase expression and telomere dynamics in purified tonsil B cell subsets during the germinal center (GC) reaction. Significant telomere lengthening was observed as naive B cells matured to centroblasts and when centroblasts matured further to centrocytes, resulting in an increase in telomere length of about 4 kbp determined by Southern blotting. Immunopurified cell populations were also studied by fluorescence in situ hybridization and flow cytometry (flow-FISH) confirming that the GC B cells exhibited lengthened telomeres. These data were further verified in unpurified tonsil cells by combining flow-FISH and immunophenotyping using selected surface markers. Centroblasts expressed high levels of telomerase activity, which was increased in centrocytes, whereas resting naive, activated naive and memory B cells were telomerase activity negative. Expression levels of the catalytic subunit (hTERT) RNA paralleled the telomerase activity levels. The unique telomere elongation in GC B cells permits extensive proliferation during the GC reaction and provides the memory cells with a substantial increase in division potential. Understanding the telomere biology of GC cells is important in defining requirements for telomere elongation in vivo, with implications for the normal immune system as well as for lymphomas, and could provide insights into how the division potential of cells can be manipulated in vitro.

The immune diversity in a test tube--non-immunised antibody libraries and functional variability in defined protein scaffolds

Technologies to develop and evolve the function of proteins and, in particular, antibodies have developed rapidly since the introduction of phage display. Importantly, it has become possible to identify molecules with binding properties that cannot be found by other means. A range of different approaches to create general libraries that are useful for the selection of such molecules specific for essentially any kind of target have emerged. We herein review some of the most prominent approaches in the field and in particular discuss specific features related to the development of antibody libraries based on single antibody framework scaffolds. This approach not only permits identification of a range of specific binders, but also facilitates further evolution of initially derived molecules into molecules with optimised functions.

Long-term effects on cholesterol levels and the utilization of lipid-lowering drugs of a hospital-based programme for secondary prevention of coronary artery disease

BACKGROUND

The study was designed to determine whether a 1-year hospital-based secondary prevention programme would have any long-term effects on serum lipid levels and the use of lipid-lowering drugs in patients with coronary artery disease 4 years after referral to primary care facilities for follow-up.

DESIGN/METHODS

After acute myocardial infarction or coronary bypass surgery, 241 consecutive patients were randomly assigned to conventional care (CC) by the primary health care facilities or to a 1-year hospital-based secondary prevention programme (SPP) with target levels for serum cholesterol (< 5.2 mmol/l) and triglycerides (< 1.5 mmol/l). After 1 year all patients were referred to the primary care sector for a further 4-year follow-up.

RESULTS

At the 1-year follow-up there was a significant decrease in serum cholesterol, LDL-cholesterol and triglyceride levels in the SPP group but no change in the CC group, and lipid-lowering drugs were used more frequently in the SPP group. These changes were maintained after 5 years. The proportion of patients achieving target serum cholesterol and triglyceride levels were larger in the SPP group.

CONCLUSIONS

Initiatives regarding cholesterol lowering and drug treatment taken by specialists within a structured hospital-based SPP have long-term impact. Accordingly, drug treatment should be initiated and adjusted to adequate doses before patients are referred to primary care for follow-up.

Human therapeutic antibodies

The development of genetic engineering technologies has today advanced to the point where the generation of high-affinity human antibodies against therapeutic targets is not a major hurdle. Rather, it is the selection of target molecules in, for example, cancer therapy that poses a challenge. Targets that are not merely passive acceptors but those that signal into the cell are preferred. Recent advances in the clinical use of antibody-based therapy--such as anti-CD20 (rituximab) for the treatment of non-Hodgkin's lymphoma and anti-tumour-necrosis-factor-alpha for Crohn's disease--as well as novel antibody designs and improved understanding of the mode of action of current antibodies lend great hope to the future of this therapeutic approach.

n-CoDeR concept: unique types of antibodies for diagnostic use and therapy

The n-CoDeR recombinant antibody gene libraries are built on a single master framework, into which diverse in vivo-formed complementarity determining regions (CDRs) are allowed to recombine. These CDRs are sampled from in vivo-processed and proof-read gene sequences, thus ensuring an optimal level of correctly folded and functional molecules. By the modularized assembly process, up to six CDRs can be varied at the same time, providing a possibility for the creation of a hitherto undescribed genetic and functional variation. The n-CoDeR antibody gene libraries can be used to select highly specific, human antibody fragments with specificities to virtually any antigen, including carbohydrates and human self-proteins and with affinities down into the subnanomolar range. Furthermore, combining CDRs sampled from in vivo-processed sequences into a single framework result in molecules exhibiting a lower immunogenicity compared to normal human immunoglobulins, as determined by computer analyses. The distinguished features of the n-CoDeR libraries in the therapeutic and diagnostic areas are discussed.

Transcription factor AP-4 is a ligand for immunoglobulin-kappa promoter E-box elements

Immunoglobulin (Ig)-kappa promoters from humans and mice share conserved sequences. The octamer element is common to all Ig promoters and pivotal for their function. However, other conserved sequence motifs, that differ between Ig variable gene families, are required for normal promoter function. These conserved motifs do not stimulate transcription in the absence of an octamer. One example is an E-box of the E47/E12 type (5'-CAGCTG-3'), which is found in all promoters of the human and murine Ig-kappa gene subgroups/families, with the exception of subgroups II and VI and their related murine families. In the present study we show that the ubiquitously expressed transcription factor AP-4, and not E47, interacts specifically with the kappa promoter E-boxes when tested in electrophoretic mobility-shift assays using nuclear extracts derived from human and murine B-cell lines. Furthermore, AP-4, unlike E47, did not act as a transactivator, which is in agreement with previous studies on intact kappa promoters, showing that transcription is absent when the octamer element has been mutated. Based on these data, and the conservation of the 5'-CAGCTG-3' motif among human and murine kappa promoters, we propose that AP-4 is the major ligand for Ig-kappa promoter E-boxes.

A central core structure in an antibody variable domain determines antigen specificity

Antibody binding sites provide an adaptable surface capable of interacting with essentially any molecular target. Using CDR shuffling, residues important for the assembly of mucin-1 specific paratopes were defined by random recombination of the complementarity determining regions derived from a set of mucin-1 specific clones, previously selected from an antibody fragment library. It was found that positions 33 and 50 in the heavy chain and 32, 34, 90, 91 and 96 in the light chain were conserved in many of the clones. These particular residues seem to be located centrally in the binding site as indicated by a structure model analysis. The importance of several of these conserved residues was supported by their presence in a mouse monoclonal antibody with a known structure and the same epitope specificity. Several of these corresponding residues in the mouse monoclonal antibody are known to interact with the antigen. In conclusion, critical residues important for maintaining a human antigen-specific binding site during the process of in vitro antibody evolution were defined. Furthermore, an explanation for the observed restricted germline gene usage in certain antibody responses against protein epitopes is provided.

Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease

OBJECTIVES

Brief, reliable, and valid self-administered questionnaires could facilitate the diagnosis of gastroesophageal reflux disease in primary care. We report the development and validation of such an instrument.

METHODS

Content validity was informed by literature review, expert opinion, and cognitive interviewing of 50 patients resulting in a 22-item survey. For psychometric analyses, primary care patients completed the new questionnaire at enrollment and at intervals ranging from 3 days to 3 wk. Multitrait scaling, test-retest reliability, and responsiveness were assessed. Predictive validity analyses of all scales and items used specialty physician diagnosis as the "gold standard."

RESULTS

Iterative factor analyses yielded three scales of four items each including heartburn, acid regurgitation, and dyspepsia. Multitrait scaling criteria including internal consistency, item interval consistency, and item discrimination were 100% satisfied. Test-retest reliability was high in those reporting stable symptoms. Scale scores significantly changed in those reporting a global change. Regressing specialty physician diagnosis on the three scales revealed significant effects for two scales (heartburn and regurgitation). Combining the two significant scales enhanced the strength of the model. Symptom response to self-directed treatment with nonprescription antisecretory medications was highly predictive of the diagnosis also, although the item demonstrated poor validity and reliability.

CONCLUSIONS

A brief, simple 12-item questionnaire demonstrated validity and reliability and seemed to be responsive to change for reflux and dyspeptic symptoms.

Signals sustaining human immunoglobulin V gene hypermutation in isolated germinal centre B cells

Affinity maturation of antibody responses depends on somatic hypermutation of the immunoglobulin V genes. Hypermutation is initiated specifically in proliferating B cells in lymphoid germinal centres but the signals driving this process remain unknown. This study identifies signals that promote V gene mutation in human germinal centre (GC) B cells in vitro. Single GC B cells were cultured by limiting dilution to allow detection of mutations arising during proliferation in vitro. Cells were first cultured in the presence of CD32L cell transfectants and CD40 antibody (the 'CD40 system') supplemented with combinations of cytokines capable of supporting similar levels of CD40-dependent GC B-cell growth [interleukin (IL)-10 + IL-1beta + IL-2 and IL-10 + IL-7 + IL-4]. Components of the 'EL4 system' were then added to drive differentiation, providing sufficient immunoglobulin mRNA for analysis. Analysis of VH3 genes from cultured cells by reverse transcription-polymerase chain reaction (RT-PCR)-based single-strand conformation polymorphism indicated that the combination IL-10 + IL-1beta + IL-2 promoted active V gene mutation whereas IL-10 + IL-7 + IL-4 was ineffective. This was confirmed by sequencing which also revealed that the de novo generated mutations were located in framework and complementarity-determining regions and shared characteristics with those arising in vivo. Somatic mutation in the target GC B-cell population may therefore be actively cytokine driven and not simply a consequence of continued proliferation. The experimental approach we describe should facilitate further studies of the mechanisms underlying V gene hypermutation.

Endoscopy-negative reflux disease

The majority of patients with symptoms of gastro-oesophageal reflux have no endoscopic evidence of oesophagitis. There has been remarkably little systematic gathering of information about this group of patients. It is commonly believed that they have a mild form of reflux disease, with low levels of dysfunction that usually respond to simple therapeutic measures. Emerging data from recent studies indicate that this is not the case. Endoscopy-negative patients have symptom severities comparable to those with erosive disease, and which significantly impair their quality of life. The limited data available on the pathophysiology of endoscopy-negative reflux disease suggest that, in the majority of patients, it is as much a disease of excessive gastro-oesophageal reflux as it is in patients with oesophageal lesions. The same principles that apply to successful treatment in patients with oesophagitis also hold true for patients with endoscopy-negative disease.

Recombining germline-derived CDR sequences for creating diverse single-framework antibody libraries

We constructed a single-chain Fv antibody library that permits human complementarity-determining region (CDR) gene fragments of any germline to be incorporated combinatorially into the appropriate positions of the variable-region frameworks VH-DP47 and VL-DPL3. A library of 2 x 109 independent transformants was screened against haptens, peptides, carbohydrates, and proteins, and the selected antibody fragments exhibited dissociation constants in the subnanomolar range. The antibody genes in this library were built on a single master framework into which diverse CDRs were allowed to recombine. These CDRs were sampled from in vivo-processed gene sequences, thus potentially optimizing the levels of correctly folded and functional molecules, and resulting in a molecule exhibiting a lower computed immunogenicity compared to naive immunoglobulins. Using the modularized assembly process to incorporate foreign sequences into an immunoglobulin scaffold, it is possible to vary as many as six CDRs at the same time, creating genetic and functional variation in antibody molecules.

Differences in quality of life in men and women with ischemic heart disease. A prospective controlled study

A study was conducted in Sweden in 1989-1992 to evaluate differences in quality of life (QL) in consecutive male and female patients after acute myocardial infarction (AMI), coronary artery by-pass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). Somatic and psychological dimensions of QL were assessed by self-administered questionnaire in patients one month (n = 376) and one year (n = 349) after the cardiac event. Normal controls (n = 88) were used for comparison. Differences between gender groups, as well as between study patients and controls in somatic and psychological dimensions of QL were studied. Patients were shown to experience poorer QL when compared with demographically similar controls, especially at the one-month assessment. Female patients had poorer QL after one month (in general health, feeling of arrythmia, anxiety, depression, self-esteem, experience of sex life) and after one year (general health, anxiety, depression) compared with male patients. In all dimensions of QL a proportion of patients (19-45%) experienced a decrease in QL from the one-month to the one-year assessment occasion. Healthcare workers concerned with secondary prevention must be aware that QL differs between male and female patients in several dimensions after a cardiac event. These findings should be taken into account in the clinical management of patients, particularly for female patients who may need special attention.

On demand therapy with omeprazole for the long-term management of patients with heartburn without oesophagitis--a placebo-controlled randomized trial

AIM

To observe the natural course of gastro-oesophageal reflux disease (GERD) in patients without oesophagitis following effective symptom relief, and to determine the place of acid pump inhibitor therapy in the long-term management of these patients.

METHODS

We investigated the efficacy of on-demand therapy with omeprazole 20 mg or 10 mg, or placebo in a double-blind, randomized multicentre trial. It involved 424 patients with troublesome heartburn without endoscopic evidence of oesophagitis in whom heartburn had been resolved with short-term treatment. Patients were told to take study medication on demand once daily on recurrence of symptoms until symptoms resolved over a 6-month period. They also had access to antacids. The primary efficacy variable was time to discontinuation of treatment, due to unwillingness to continue.

RESULTS

According to life-table analysis, after 6 months the remission rates were 83% (95% CI: 77-89%) with omeprazole 20 mg, 69% (61-77%) with omeprazole 10 mg, and 56% (46-64%) with placebo (P < 0.01 for all intergroup differences). The mean (s.d.) number of study medications used per day in these groups was 0.43 (0.27), 0.41 (0.27) and 0.47 (0.27), respectively. The use of antacids was highest in the placebo group and lowest in the omeprazole 20 mg group. Treatment failure was associated with more than a doubling of antacid use, and a deterioration in patient quality of life.

CONCLUSIONS

Approximately 50% of patients with heartburn who do not have oesophagitis need acid inhibitory therapy in addition to antacid medication to maintain a normal quality of life. On-demand therapy with omeprazole 20 mg, is an effective treatment strategy in these patients.

Quality of life in patients with heartburn but without esophagitis: effects of treatment with omeprazole

OBJECTIVE

Because improvement in quality of life (QoL) is an important therapeutic goal in patients with heartburn but without esophagitis, the aim of the present study was to compare the impact of omeprazole 20 mg or 10 mg daily with that of placebo on QoL in patients with heartburn as the predominant symptom.

METHODS

QoL was measured at baseline and after 4 wk using two validated questionnaires, the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptom Rating Scale.

RESULTS

The two questionnaires were completed by 163 patients in the omeprazole 20 mg group, 163 in the omeprazole 10 mg group, and 82 in the placebo group. The reflux dimension of the Gastrointestinal Symptom Rating Scale showed a significant improvement in terms of reflux symptoms on omeprazole 20 mg versus omeprazole 10 mg and placebo, and on omeprazole 10 mg compared with placebo. The total score of the PGWB index improved significantly more on both doses of omeprazole than on placebo. The mean scores rose from 96.8 to 103.9 on omeprazole 20 mg, from 98.4 to 106.0 on omeprazole 10 mg, and from 98.0 to 100.6 on placebo. All dimensions of the PGWB index improved on treatment with omeprazole, but the improvements were most pronounced in the dimensions depicting anxiety, depressed mood, and self-control.

CONCLUSIONS

It is concluded that treatment with omeprazole 20 mg and omeprazole 10 mg restores QoL to a level comparable with that observed in a healthy population.