Serotonin Reduction in Post-acute Sequelae of Viral Infection

Post-acute sequelae of COVID-19 (PASC, Long COVID ) pose a significant global health challenge. The pathophysiology is unknown, and no effective treatments have been found to date. Several hypotheses have been formulated to explain the etiology of PASC, including viral persistence, chronic inflammation, hypercoagulability, and autonomic dysfunction. Here, we propose a mechanism that links all four hypotheses in a single pathway and provides actionable insights for therapeutic interventions. We find that PASC are associated with serotonin reduction. Viral infection and type I interferon-driven inflammation reduce serotonin through three mechanisms: diminished intestinal absorption of the serotonin precursor tryptophan; platelet hyperactivation and thrombocytopenia, which impacts serotonin storage; and enhanced MAO-mediated serotonin turnover. Peripheral serotonin reduction, in turn, impedes the activity of the vagus nerve and thereby impairs hippocampal responses and memory. These findings provide a possible explanation for neurocognitive symptoms associated with viral persistence in Long COVID, which may extend to other post-viral syndromes

Development of a novel observed structured clinical exam to assess clinical ultrasound proficiency in undergraduate medical education

Abstract Objectives A pilot study was performed to develop and test an observed structured clinical exam (OSCE) for clinical ultrasound in second-year medical students. The goal was to assess a longitudinal clinical ultrasound curriculum for medical students and to help determine readiness to perform ultrasound during clinical clerkships. Methods The OSCE contained 40 tasks over 30 min in a one-to-one examiner to examinee environment using standardized patients covering cardiac, pulmonary, and inferior vena cava (IVC) ultrasound exams along with 6 critical diagnoses. Examinees were assessed using a binary checklist approach. A two-way ANOVA analysis was performed to determine if there were differences between the day and session the OSCE was administered. Results are presented as mean ± standard deviation. Results One hundred fifty-two students were tested with an overall mean score of 64.9 ± 17.6%. Scores between the cardiac, IVC, and lung sections varied—67.8% ± 18.8%, 62.4% ± 26.2%, and 57.1% ± 20.6%, respectively. One hundred twenty-six (82.9%) answered at least one critical diagnosis incorrectly. Students in the late session performed better than the early session (1: 60% vs 2: 69%, p = .001). Conclusions Students performed better in later sessions. Additionally, the number of questions left blank at the end of the exam suggests that the length of the OSCE should be evaluated. Incorporating critical diagnoses was challenging for examinees. The proposed OSCE is a valuable assessment tool that could be adapted to assess student’s readiness to use clinical ultrasound prior to clerkships

Dance, Music, and Social Conversation Program Participation Positively Affects Physical and Mental Health in Community-Dwelling Older Adults: A Randomized Controlled Trial

Introduction: As the world population ages, practitioners use community-engaged interventions to help older adults stay healthy. Engaging in arts programs (e.g., dance or music) reportedly improves physical and mental health, but little research exists examining these effects in community-dwelling older adults. Our purposes were to examine how taking part in 10-week, twice per week community arts programs (dance and music) and control (social conversation) affected physical and mental health in community-dwelling older adults and their perceptions after program participation.Methods: In this randomized controlled trial, 64 older adults over 65 years of age (71.3 ± 4.6 years, 166.9 ± 8.3 cm, 78.1 ± 18.1 kg) took part in community-engaged arts programs: ballroom dance (n = 23), music (ukulele-playing, n = 17), or control (social conversation n = 24), two times per week for 10 weeks. Participants’ physical health using the Short Physical Performance Battery (SPPB; score 0 = worst to 12 = best) and mental health using the Montreal Cognitive Assessment (MoCA; score = 0 to 30, where less than 26 = normal) were tested three times: 1. before (pre), 2. at the end of 10 weeks (post-1), and 3. 1 month after intervention (post-2). Separate 3 (group) x 3 (time) ANOVAs and adjusted Bonferroni pairwise comparisons as appropriate examined changes across groups and time. Focus group interviews and surveys were audio recorded, transcribed, and analyzed using inductive thematic analyses to examine participants’ perceptions. Results: Across all groups, participants had an 87.8% attendance and an 87.5% retention rate. Participants’ SPPB performance improved over time (pre = 10.5 ± 1.4, post-1 = 10.7 ± 1.3, post-2 = 11.3 ± 1.0; p < 0.001), but similarly across groups (p = 0.40). Post-hoc analyses revealed that performance improved from pre to post-1 (p = 0.002) and pre to post-2 (p < 0.001). Participants’ cognition improved over time (pre = 26.3 ± 2.8, post-1 = 27.3 ± 2.6, post-2 = 27.5 ± 2.5, p < 0.001), and similarly across groups (p = 0.60). Post-hoc analyses revealed that cognition improved from pre- to post-1 (p = 0.002), and pre- to post-2 (p = 0.001). Participants consistently mentioned increased social engagement as the major reason for participation.Conclusions: Overall, taking part in community-engaged arts (dance and music) and social conversation programs positively influenced physical and mental health in older adults. Still, as all groups improved equally, the results may partly be due to participants having normal physical and mental function pre-participation and due to them learning the test over time. These study findings imply that providing fun and free community-engaged programs that empower participants to be more engaged can positively influence physical and mental health and promote successful aging in older adults

Community arts engagement supports perceptions of personal growth in older adults

Purpose: The effects of arts engagement on older adults have been well-documented. However, the ways older adults overcome common situational and dispositional barriers to enhance personal growth and well-being are less known. Methods: Fifty-six community dwelling older adults (71.3±4.6 years) took part in dance, music, or a control workshop two times/week for ten weeks. Participants’ personal growth was examined through focus groups and surveys in this mixed-methods study. Results: Focus group and survey results revealed participants experienced personal growth through engaging in the dance and music arms of the experiment. Participants, especially those in arts workshops, described personal growth experiences aligning with four themes: increased social connections, developed new skills, utilized a growth mindset, and used creativity to overcome situational and dispositional barriers to participation. The barriers included musculoskeletal challenges, hearing impairments, and difficulty retaining new information. Conclusions: The study yielded high adherence and retention rates, and participants reported increased engagement within their communities. Our observations provide avenues for future practitioners and facilitators to create programming that empowers older adults and utilizes participants’ ongoing feedback to support access, inclusion, and sense of community