4,998 research outputs found
The Effects of Music Therapy on Pediatric Patients with Congenital Heart Defects in the Pre and Postoperative Setting
Congenital heart defects is a prominent medical occurrence especially in pediatrics. These defects often require surgeries and extensive treatment plans. These treatment plans often include invasive surgeries and extensive treatment plans which can require long recovery times along with potential surgical complications. This study aims to evaluate the effectiveness of music therapy on pediatric patients with congenital heart defects in the pre and postoperative setting and how music therapy can be implemented in treatment plans to yield effective recovery results for these patients. This research is significant as elevated vital signs and preoperative anxiety are associated with an increased need for anesthesia and analgesia requirements which can correlate to a risk for surgical complications. Elevated postoperative pain can result in an increased need for analgesic medications which can contribute to medication toxicity in a pediatric patient which can cause further complications. This study would consist of 80 pediatric patients on a cardiac unit aged 1 day to 10 years old diagnosed with a congenital heart defect who is undergoing cardiac surgery. A quasi-experimental randomized control trial will be conducted to compare the results of these cardiac patients in both preoperative and postoperative procedures. In these settings nurses would be responsible for gathering pre and postoperative vital signs, assessing preoperative anxiety, and assessing postoperative pain levels. With this study it is expected that patients who received music therapy during both pre and post operative procedures experienced a stabilization of vital signs, reduced preoperative anxiety, and lower postoperative pain levels
UMSL Bulletin 2023-2024
The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp
The effect of autologous macrophage therapy in cirrhosis in response to individual immune reparative pathways: developing a novel therapy
BACKGROUND:
Liver cirrhosis is the end stage of any injury process to the liver. Once established it inevitably progresses to complications such as portal hypertension, cancer and death. There is not cure for liver cirrhosis besides liver transplant. We face
an unmet demand for treatment of this condition. The role of macrophages in fibrosis
development and resolution in the liver has been extensively investigated. Prof Forbes group invested in the development of autologous macrophage product to promote
fibrosis resolution hence cirrhosis regression. This has demonstrated its efficacy and safety in animal models. From these encouraging pre-clinic data a phase 1 first in
human clinical trial of autologous activated macrophage product for cirrhotic patients was developed.
METHODS:
Using an established 3+3 dose escalation model we enrolled a total of 9 subject in the phase 1 trial reaching a maximum achieved and safe dose of 1x10^9 macrophages. In addition to adverse events, dose toxicity and macrophage activation
syndrome (MAS) parameter, we evaluated a varied range of circulating cytokines and chemokine pre and post treatment using a commercial kit. Moreover we developed a protocol for P13- magnetic resonance spectrometry (MRS) for the analysis of the
metabolically active liver parenchyma. Data from the phase 1 trial were used to improve the autologous cellular produce and phase 2 randomised controlled trial.
RESULTS:
The autologous activated macrophage produce is demonstrated not to cause any toxicity in this first in human study of cirrhotic population of different aetiology. Cytokine and chemokine analysis supports these findings and specifically demonstrates low levels of IL-8, which represent cardinal feature of MAS. Other
interesting cytokine signals may support extra cellular matrix remodelling effect of the autologous macrophage product infusion. In addition we demonstrated a reproducible protocol for MRS in liver disease.
DISCUSSION:
Autologous activated macrophage infusion did not result in any toxicity in cirrhotic subjects taking part in this study and shows preliminary signs of efficacy in fibrosis resolution both clinically and biochemically. This work places the basis of development of cellular products for treatment of cirrhosis and fibrosis and provides invaluable insight in immune response to cellular treatment
Safe passage for attachment systems:Can attachment security at international schools be measured, and is it at risk?
Relocations challenge attachment networks. Regardless of whether a person moves or is moved away from, relocation produces separation and loss. When such losses are repeatedly experienced without being adequately processed, a defensive shutting down of the attachment system could result, particularly when such experiences occur during or across the developmental years. At schools with substantial turnover, this possibility could be shaping youth in ways that compromise attachment security and young peopleâs willingness or ability to develop and maintain deep long-term relationships. Given the well-documented associations between attachment security, social support, and long-term physical and mental health, the hypothesis that mobility could erode attachment and relational health warrants exploration. International schools are logical settings to test such a hypothesis, given their frequently high turnover without confounding factors (e.g. war trauma or refugee experiences). In addition, repeated experiences of separation and loss in international school settings would seem likely to create mental associations for the young people involved regarding how they and others tend to respond to such situations in such settings, raising the possibility that people at such schools, or even the school itself, could collectively be represented as an attachment figure. Questions like these have received scant attention in the literature. They warrant consideration because of their potential to shape young peopleâs most general convictions regarding attachment, which could, in turn, have implications for young peopleâs ability to experience meaning in their lives
The Influence of Neuroendocrine and Genetic Markers of Stress on Cognitive Processing and Intrusive Symptoms
This body of research investigated the influence of neuroendocrine and genetic elements of arousal on cognitive processes in the development of intrusive memories and flash-forward intrusions as related to Post-Traumatic Stress Disorder. Specifically, this thesis investigated various mechanisms that may underlie intrusive symptoms as postulated by prevalent theories of PTSD. Study 1 examined the distinctive relationship between peritraumatic dissociation and subsequent re-experiencing symptoms. Network analyses revealed strong positive edges between peritraumatic dissociation and subsequent amnesia, as well as the re-experiencing symptoms of physical reactivity to reminders, flashbacks, intrusions, and dreams, and to a lesser extent emotional numbness and hypervigilance. The finding that peritraumatic dissociation is related to subsequent re-experiencing symptoms is consistent with cognitive models that emphasize the role of dissociative experiences during a traumatic event in the etiology of PTSD re-experiencing symptoms. Study 2 aimed to determine whether peri-traumatic stress, as measured via salivary cortisol and salivary alpha-amylase, as well as pre-existing genetic polymorphisms on the FKBP5 gene increased dissociation and data-driven processing, and subsequently impacted intrusive memories related to a trauma film. The findings revealed that greater noradrenergic arousal predicted less intrusive memory distress in individuals who scored higher on data-driven processing and trait dissociation, and in FKBP5 low-risk carriers. For individuals who reported less data-driven processing and trait dissociation, and in FKBP5 high-risk carriers, as noradrenergic arousal increased, intrusive memory distress increased. This study also showed no association between data-driven processing with memory fragmentation, and fragmentation with intrusive memories. Whilst these findings support some aspect of cognitive models of PTSD as they indicate a role for data-driven processing and dissociation in intrusive symptoms, they highlight a threshold at which these variables stop moderating the relationship between arousal and intrusive memories and suggest that memory fragmentation is not related to intrusive memories. Study 3 examined the role of cognitive control in flash-forward intrusions in the context of an enduring stressor, the COVID-19 pandemic. In line with expectations, results showed that as cognitive control worsened, FKBP5 high-risk carriers reported more flash-forward distress, and low-risk carriers reported less distress. These findings are considered in the context of hippocampal changes and are consistent with emerging theories of PTSD. Lastly, study 4 sought to investigate the role of two neurological processes, pattern separation and pattern completion in intrusive memories in individuals with PTSD compared to trauma exposed controls. Consistent with existing literature, the data indicate that individuals with PTSD reported more data-driven processing, more intrusive symptoms, and demonstrated better behavioural pattern completion than trauma-exposed controls. These findings are in line with current cognitive models of PTSD, as they again indicate a role for data-driven processing in PTSD. However, study 4 found no support for the postulate that deficient pattern separation is a feature of PTSD and found an opposite effect for the role of pattern completion. Whilst these findings are inconsistent with theory, they are in line with existing experimental studies. Overall, the findings from this thesis provide insight into cognitive and biological models of PTSD and shed light on the mechanisms underlying the nature and development of intrusive symptoms
Physical activity and pulmonary rehabilitation in difficult-to-treat asthma associated with elevated body mass index
This thesis studies physical activity levels, pulmonary rehabilitation and their effects in participants with difficult-to-treat asthma associated with elevated body mass index (BMI). The three results chapters present the original research which I conducted during my period of study. All three chapters are presented as contracted papers, two of which have been peer-reviewed and published in scientific journals. This thesis has been approved for submission as an âalternative formatâ thesis by the Higher Degrees Committee of the University of Glasgow.
The focus of the thesis is exercise in participants with difficult-to-treat asthma associated with elevated body mass index. There are two research questions addressed by the thesis, do asthma severity or body mass index affect physical activity levels in asthma? The first results chapter concludes that they both do. Secondly, does pulmonary rehabilitation improve asthma control in this group of participants? The results of the work suggest that it may lead to some improvements in asthma control, but not to a clinically significant degree.
âPhysical activity levels in asthma: relationship with disease severity, body mass index and novel accelerometer-derived metricsâ was published in the Journal of Asthma, online version published 2nd August 2022. This paper reports physical activity (PA) levels in participants with varying degrees of asthma severity and body mass index (BMI). It incorporates the use of two novel accelerometerbased metrics and how they correlate with asthma control. This paper provides an introduction into how difficult-to-treat asthma and elevated BMI affect physical activity and leads onto the main work in pulmonary rehabilitation.
âA pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult-to-control asthma and elevated body mass indexâ was published in BMC Pulmonary Medicine, online version published 24th September 2022. This paper presents the initial outcomes at completion of an eight-week asthma-tailored pulmonary rehabilitation programme, comparing participants who completed PR with a control group who had usual care.
The final results chapter, âImmediate and longer-term effects of an asthma tailored pulmonary rehabilitation programme in overweight and obese participants with difficult-to-treat asthmaâ has been submitted to Respiratory Medicine, to be considered for publication. This paper presents wider results of the above trial in a prospective observational format, as everyone who was randomised to usual care was invited to participate in PR after completion of the initial 8-week observation period. Here we consider the immediate and longerterm outcomes of a larger group of participants undergoing PR, and look at possible predictors of response
Sickness experience and language : aspects of Tongan and Western accounting
In this study of Tongan healing practices, the author has chosen not simply to record participantsâ roles or medicinal preparations but rather, the concern of this study is to understand the âdoingâ of sickness as a social practice.
Two main sociological techniques have been applied. Firstly, a hermeneutic - phenomenological approach was used to attain recordings of, and to analyze, the sickness theorizing of members of Tongan society. The âsickness talkâ of these members provides a record of some aspects of contemporary Tongan healing practices. The âsickness talkâ is also analyzed using Wittgensteinâs concept of ârule-usageâ in the âlanguage gameâ of sickness. This form of analysis indicated certain individual and public relevances which are grounded upon the Tongan way of life. Thus speakersâ accounts are analyzed in terms of what sickness talk âshowsâ as well as what it âsaysâ, disclosing cultural process instead of simply cultural product.
Discussion on âdiagnosisâ shows that in order to define the problematic situation of sickness, the phenomena are organized into a classification, that is, members have to âcaptureâ, âfixâ, âconcretizeâ the confronting transient phenomena and apply a sickness label as a âworking definitionâ. Tongan sickness âtypesâ are shown to be not only different from Western âtypesâ, but aspects of the process of constructing that difference are also shown to be implicit in the sickness talk. Diagnosis as a social process is not seen as the labelling of an âobjective factâ, âa sicknessâ; nor is therapy understood as being some âthingâ that gets a person âbetterâ. Tongan explanatory models, developed to explain sickness causation, differ essentially from Western explanatory models of sickness in that Tongans have developed a social model of prevention and cure while in the West, a biological model has been developed. Explanation is understood here not as the causal accounting of sickness but as the explanation of enigmatic consequences.
The latter sections of the study on doing sickness as âkinshipâ and as âhealerâ not only add to the record on contemporary healing practices but also emphasize the Tongan social model of sickness. This study therefore, is not only a record, albeit a partial one, of contemporary Tongan healing practices, it also shows how these particular Tongans define certain sickness situations and devise a strategy to resolve that problematic situation. That is, it shows how committing certain experiences to language âisâ the ordering process. Rather than any magico-religious or scientific-biological model providing the basis of sickness practice in Tongan society, kinship is proposed as the underlying organizing principle.
The comparative mode of analysis, in relation to Tongan and Western sickness theorizing, avoids presenting Western explanation as a model by which Tongan theorizing can be evaluated. Instead, in analyzing Tongan healing practices showing knowledge and relevance(s), substantive dimensions of Western theorizing and practice are disclosed.
In selecting a limited number of membersâ sickness accounts over a period of six and a half months in Tonga, I have not attempted to randomly sample the Tongan population in order to generalize my âfindingsâ to the whole of Tongan society. Instead my interest has been to give an interpretation of some aspects of Tongan sickness theorizing which may or may not be altered by similar and more extensive studies in the future.
Contrary to what may be seen as being medical and anthropological expectations, Tongan traditional healing practices have not declined since Western contact, rather, they have developed from reportedly limited skills at that time, to an extensive network of healing practice today
MULTIMODAL ASSESSMENT OF CETACEAN CENTRAL NERVOUS AUDITORY PATHWAYS WITH EMPHASIS ON FORENSIC DIAGNOSTICS OF ACOUSTIC TRAUMA
Cetaceans encompass some of the worldâs most enigmatic species, with one of their greatest adaptations to the marine environment being the ability to âseeâ by hearing. Their anatomy and behavior are fine-tuned to emit and respond to underwater sounds, which is why anthropogenic noise pollution is likely to affect them negatively. There are many effects of noise on living organisms, and while knowledge on their entire palette and interplay remain incomplete, evidence for insults ranging from acoustic trauma over behavioral changes, to masking and stress, is accumulating. Humans are subject to peak interest in terms of medical research on noise-induced hearing loss. As major health concerns can be expected across species, addressing this problem in free-ranging cetacean populations will lead to a more sustainable management of marine ecosystems, more effective and balanced policies, and successes in conservation. While progress has been made in behavioral monitoring, electrophysiological hearing assessments and post-mortem examination of the inner ear of cetaceans, but very little is known about the neurochemical baseline and neuropathology of their central auditory pathways. In the present work, we reviewed the known effects of sound on cetaceans in both wild and managed settings and explored the value of animal models of neurodegenerative disease. We began by evaluating a row of antibodies associated with neurodegeneration in a more readily available species, the dog, where acute neurological insult could be derived from clinical history. We then set out to systematically validate a key panel of protein biomarkers for the assessment of similar neurodegenerative processes of the cetacean central nervous system. For this, we developed protocols to adequately sample cetacean auditory nuclei, optimized the immunohistochemical workflow, and used Western blot and alignment of protein sequences between the antigen targeted by our antibodies and the dolphin proteome. A Histoscore was used to semi-quantitively categorize immunoreactivity patterns and dolphins by age and presence of pathology. First results indicated significant differences both between sick and healthy, and young and old animals. We then expanded our list of validated antibodies for use in the bottlenose dolphin and the techniques used to assess them in a multimodal, quantitative way. 7T-MRI and stereology were implemented to assess the neuronal, axonal, glial and fiber tract counts in the inferior colliculus and ventral cochlear nucleus of a healthy bottlenose dolphin, which created a baseline understanding of protein expression in these structures, and the influence of tissue processing. This will make a valuable comparison for when positive controls of acoustic trauma would become available. Furthermore, we explored the connectome and neuronal morphology of auditory nuclei and experimented with probe designs and machine learning algorithms to quantify structures of interest. Comparisons with pathological human brains revealed similarities in the configuration of extracellular matrix components to those of a healthy dolphin, in line with existing knowledge on the tolerance to hypoxia in these diving animals. This could have interesting implications in future investigation of the evolutionary development of marine mammal brains, as well as help diversify out-of-the-box approaches to researching human neurodegenerative disease, as is being done with hibernating species. The data and methodologies described herein contribute to the knowledge on neurochemical signature of the cetacean central nervous system. They are intended to facilitate understanding of auditory and non-auditory pathology and build an evidence-based backbone to future policies regarding noise and other form of anthropogenic threats to the marine environment.Cetaceans encompass some of the worldâs most enigmatic species, with one of their greatest adaptations to the marine environment being the ability to âseeâ by hearing. Their anatomy and behavior are fine-tuned to emit and respond to underwater sounds, which is why anthropogenic noise pollution is likely to affect them negatively. There are many effects of noise on living organisms, and while knowledge on their entire palette and interplay remain incomplete, evidence for insults ranging from acoustic trauma over behavioral changes, to masking and stress, is accumulating. Humans are subject to peak interest in terms of medical research on noise-induced hearing loss. As major health concerns can be expected across species, addressing this problem in free-ranging cetacean populations will lead to a more sustainable management of marine ecosystems, more effective and balanced policies, and successes in conservation. While progress has been made in behavioral monitoring, electrophysiological hearing assessments and post-mortem examination of the inner ear of cetaceans, but very little is known about the neurochemical baseline and neuropathology of their central auditory pathways. In the present work, we reviewed the known effects of sound on cetaceans in both wild and managed settings and explored the value of animal models of neurodegenerative disease. We began by evaluating a row of antibodies associated with neurodegeneration in a more readily available species, the dog, where acute neurological insult could be derived from clinical history. We then set out to systematically validate a key panel of protein biomarkers for the assessment of similar neurodegenerative processes of the cetacean central nervous system. For this, we developed protocols to adequately sample cetacean auditory nuclei, optimized the immunohistochemical workflow, and used Western blot and alignment of protein sequences between the antigen targeted by our antibodies and the dolphin proteome. A Histoscore was used to semi-quantitively categorize immunoreactivity patterns and dolphins by age and presence of pathology. First results indicated significant differences both between sick and healthy, and young and old animals. We then expanded our list of validated antibodies for use in the bottlenose dolphin and the techniques used to assess them in a multimodal, quantitative way. 7T-MRI and stereology were implemented to assess the neuronal, axonal, glial and fiber tract counts in the inferior colliculus and ventral cochlear nucleus of a healthy bottlenose dolphin, which created a baseline understanding of protein expression in these structures, and the influence of tissue processing. This will make a valuable comparison for when positive controls of acoustic trauma would become available. Furthermore, we explored the connectome and neuronal morphology of auditory nuclei and experimented with probe designs and machine learning algorithms to quantify structures of interest. Comparisons with pathological human brains revealed similarities in the configuration of extracellular matrix components to those of a healthy dolphin, in line with existing knowledge on the tolerance to hypoxia in these diving animals. This could have interesting implications in future investigation of the evolutionary development of marine mammal brains, as well as help diversify out-of-the-box approaches to researching human neurodegenerative disease, as is being done with hibernating species. The data and methodologies described herein contribute to the knowledge on neurochemical signature of the cetacean central nervous system. They are intended to facilitate understanding of auditory and non-auditory pathology and build an evidence-based backbone to future policies regarding noise and other form of anthropogenic threats to the marine environment
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