A Delphi Process to Inform a Clinical Trial Using Acupuncture to Reduce Perceived Stress Levels

University of Technology Sydney. Faculty of Science.Stress is a common part of modern life. While it provides a positive stimulus for physiological functions, it may still lead to negative effects when featuring high intensity or duration for an individual. As a population facing many specific challenges, students are often subjected to multiple types of stressors. Limited data exists to show acupuncture as an effective stress reduction intervention, but there is little consensus about treatment protocols. This thesis aims to further inform the possible protocols to be used in subsequent clinical trials. The project aims to inform possible further study in acupuncture and stress by refining proposed acupuncture protocols for stress via a Delphi process. Expert consensus was sought regarding diagnosis, syndrome differentiation, signs and symptoms, acupuncture point selection and treatment frequency. This thesis contains a literature review, a clinical trial protocol and a Delphi process. The literature review highlights the scarcity of acupuncture research specifically about stress. A clinical trial protocol was developed using the literature review results to investigate the impact of acupuncture at different treatment frequencies, focussing on tertiary students as the population group. Finally, a two-round Delphi process seeking expert consensus regarding clinical diagnosis and treatment of stress was undertaken with a threshold level set at 80%. The literature review found very little evidence of studies using acupuncture for stress (n=11; RCTs n=8, UCTs n=3). There was very little cohesiveness between studies regarding acupuncture dosage (treatment frequency or number of treatments total), acupuncture points used or diagnosis. The Delphi process showed expert consensus on zangfu relevant to stress diagnoses (Heart and Liver), syndromes relevant to stress diagnoses (qi stasis and zangfu disharmony) and acupuncture points relevant to stress treatment (Liver 3, Pericardium 6, Heart 7 and Yin Tang). There was no consensus on frequency of treatments or number of treatments preferred. The clinical trial acupuncture point protocol is valid for future use according to expert consensus. Further research is needed to determine satisfactory acupuncture dosage for use in clinical trials across a range of variables including treatment frequency and total number of treatments

An elderly woman with obstructed obturator hernia: a less common variety of external abdominal hernia

Obturator hernia is a type of external abdominal hernia. Site of herniation is the obturator canal, which is the superolateral aspect of the obturator foramen. The herniation sac exits the pelvis near the obturator nerve and vessels . Herniated loops of small bowel extend between the pectineus and obturator muscles. In this report, we present a case of obstructed obturator hernia

Enteropathy-associated T cell lymphoma subtypes are characterized by loss of function of SETD2

Enteropathy-associated T cell lymphoma (EATL) is a lethal, and the most common, neoplastic complication of celiac disease. Here, we defined the genetic landscape of EATL through whole-exome sequencing of 69 EATL tumors. SETD2 was the most frequently silenced gene in EATL (32% of cases). The JAK-STAT pathway was the most frequently mutated pathway, with frequent mutations in STAT5B as well as JAK1 , JAK3 , STAT3 , and SOCS1 . We also identified mutations in KRAS , TP53 , and TERT . Type I EATL and type II EATL (monomorphic epitheliotropic intestinal T cell lymphoma) had highly overlapping genetic alterations indicating shared mechanisms underlying their pathogenesis. We modeled the effects of SETD2 loss in vivo by developing a T cell–specific knockout mouse. These mice manifested an expansion of γδ T cells, indicating novel roles for SETD2 in T cell development and lymphomagenesis. Our data render the most comprehensive genetic portrait yet of this uncommon but lethal disease and may inform future classification schemes

Manuel des contrats de licence

Het Handboek Licentieovereenkomsten schetst op een bevattelijke wijze het Belgisch juridisch kader dat gemeenschappelijk is aan de overeenkomsten tot gebruik van intellectuele eigendomsrechten. Waar aangewezen wordt de aandacht gevestigd op de specificiek regelgeving die, afhankelijk van het betrokken type van intellectuele eigendom, van toepassing is op een licentieovereenkomst. In het Eerste Deel van het Handboek komen de burgerrechtelijke aspecten aan bod: na de definiëring en de bespreking van de verschillende types licentieovereenkomsten, wordt in het bijzonder aandacht besteed aan het sluiten, de uitlegging, de uitvoering, de overdracht en de uitdoving van de licentieovereenkomst. In het tweede Deel komt de verhouding tussen de exploitatie van de intellectuele eigendom (de licentieovereenkomst) en het mededingingsrecht aan bod. Na enkele inleidende overwegingen volgt de toetsing van de licentieovereenkomst aan de artikelen 81 en 82 EG. Daar een goed functioneren van de Interne Markt één van de objectieven van het mededingingsrecht is, wordt tenslotte de verhouding tussen de licentieovereenkomst en die Interne Markt, het vrij verkeer van goederen binnen de Europese Economische Ruimte, behandeld