Telemedicine and Healthcare Implications for Central Virginia: A Systematic Review of the Literature

Background: Uncertainties and challenges associated with COVID-19 have affected the efficient delivery of health care in Central Virginia. Integrating and redesigning health systems could boost the quality and efficiency of care delivery. Telemedicine has been suggested as a viable solution to increase virtual access to patient advocacy healthcare education and training programs and has the potential to help facilitate the delivery of health services to rural and remote areas. It is projected that access to quality telehealth services can minimize the need for in-person hospital visitation amid the pandemic. The innovation also facilitates remote assessment of patients and monitoring of patient illness and treatment. For the rural population at risk of COVID-19 or any easily transmissible infection, telemedicine can provide convenient access to routine care without provider-patient contact, thus limiting the spread of the virus. Methods: A systematic literature review of peer-reviewed and grey literature was conducted. The authors used electronic databases including Embase, PubMed, CINAHIL and Web of Science to locate and access relevant articles based on their inclusion criteria. Studies were selected that investigated the implementation of telemedicine in the clinical and educational healthcare settings in rural or remote locations within the United States. Forty articles were identified for review. The identified articles were published between 2010 and 2021 that were used in the study. Results: There was no significant literature on telemedicine utilization in the Commonwealth of Virginia. Additionally, there were limited studies on rural and remote settings that utilized telehealth services during the COVID-19 pandemic. Evidence suggested that telemedicine could improve access to healthcare services and enable providers to monitor patients from a distance. Researchers identified six key factors associated with telemedicine\u27s success and sustainability: education, training, vision, ownership, adaptability, economics, efficiency, and equipment. Conclusions: Rural and remote communities experience healthcare disparities and poor patient outcomes due to limited access to quality care and inequalities in education, training, and resource allocation. A deficiency of technological skills, knowledge and or resistance to change may prevent a quality telehealth program from being able to serve patients adequately

Effects of Anxiety on Attentional Allocation and Task Performance: An Information Processing Analysis

An information processing signal detection methodology was employed to examine attentional allocation and its correlates in both normal comparison (NC) and generalized anxiety disorder (GAD) participants. In particular, the impact of neutral distractor and negative feedback cues on performance of an attention vigilance task was investigated. Individuals with GAD (N = 15) evidenced impaired performance on an attention vigilance task relative to NC participants (N = 15) when neutral distractor cues were presented. Contrary to prediction, no group differences in performance were detected under conditions in which participants were presented negative feedback cues they were told were relevant to their performance. Instead, GAD participants exhibited improvement during the experimental task such that their performance was equivalent to NC participants. Across trials, the clinically anxious group endorsed significantly higher levels of worry and negative affectivity; however, they failed to respond with concomitant physical arousal (e.g. increased muscle tension). These data are discussed within the context of Eysenck and Calvo\u27s processing efficiency theory. Additionally, the results of this investigation provide support for Barlow\u27s conceptualization of anxiety as requiring the interaction of cognitive schema and physiological arousal

The Color of COVID-19: Structural Racism and the Pandemic’s Disproportionate Impact on Older Racial and Ethnic Minorities

Objectives: The aim of this evidence-based theoretically informed essay is to provide an overview of how and why the COVID-19 outbreak is particularly detrimental for the health of older Black and Latinx adults. Methods: We draw upon current events, academic literature, and numerous data sources to illustrate how biopsychosocial factors place older adults at higher risk for COVID-19 relative to younger adults, and how structural racism magnifies these risks for older Black and Latinx adults. Results: We identify three proximate mechanisms through which structural racism operates as a fundamental cause of racial/ethnic inequalities in COVID-19 burden among older adults: (1) Risk of exposure; (2) Weathering processes; and (3) Health care access and quality. Discussion: While the ongoing COVID-19 pandemic is an unprecedented crisis, the racial/ethnic health inequalities among older adults it has exposed are long-standing and deeply rooted in structural racism within American society. This knowledge presents both challenges and opportunities for researchers and policymakers as they seek to address the needs of older adults. It is imperative that federal, state, and local governments collect and release comprehensive data on the number of confirmed COVID-19 cases and deaths by race/ethnicity and age to better gauge the impact of outbreak across minority communities. We conclude with a discussion of incremental steps to be taken to lessen the disproportionate burden of COVID-19 among older Black and Latinx adults, as well as the need for transformative actions that address structural racism in order to achieve population health equity

Mapping functional transcription factor networks from gene expression data

A critical step in understanding how a genome functions is determining which transcription factors (TFs) regulate each gene. Accordingly, extensive effort has been devoted to mapping TF networks. In Saccharomyces cerevisiae, protein–DNA interactions have been identified for most TFs by ChIP-chip, and expression profiling has been done on strains deleted for most TFs. These studies revealed that there is little overlap between the genes whose promoters are bound by a TF and those whose expression changes when the TF is deleted, leaving us without a definitive TF network for any eukaryote and without an efficient method for mapping functional TF networks. This paper describes NetProphet, a novel algorithm that improves the efficiency of network mapping from gene expression data. NetProphet exploits a fundamental observation about the nature of TF networks: The response to disrupting or overexpressing a TF is strongest on its direct targets and dissipates rapidly as it propagates through the network. Using S. cerevisiae data, we show that NetProphet can predict thousands of direct, functional regulatory interactions, using only gene expression data. The targets that NetProphet predicts for a TF are at least as likely to have sites matching the TF's binding specificity as the targets implicated by ChIP. Unlike most ChIP targets, the NetProphet targets also show evidence of functional regulation. This suggests a surprising conclusion: The best way to begin mapping direct, functional TF-promoter interactions may not be by measuring binding. We also show that NetProphet yields new insights into the functions of several yeast TFs, including a well-studied TF, Cbf1, and a completely unstudied TF, Eds1

Effects of Yoga on Thalamic Gamma-Aminobutyric Acid, Mood and Depression: Analysis of Two Randomized Controlled Trials

Objective: The Vagal-Gamma-Aminobutyric Acid (GABA) theory proposes that some yoga postures and breathing practices exert their effects through stimulation of vagal nerves (parasympathetic system) with associated brain GABA increases. To evaluate this theory, we compared results from a 12-week randomized controlled trial (RCT) of yoga in participants with Major Depressive Disorder (MDD) with those of a similar RCT in healthy control participants (HC). Methods: In an RCT, magnetic resonance spectroscopy (MRS) and mood measures were acquired in subjects with MDD (n=15) prior to and following a 12-week yoga intervention. The same measures were obtained in the HC (n=17) group. In both studies, thalamic GABA/Creatine was obtained using MEGAPRESS at 4 Telsa at baseline (Scan-1), post-intervention (Scan-2), and immediately following a yoga session (Scan-3). Clinical scales were completed prior to each scan. Results: The MDD-group had significantly lower GABA compared to the HC at baseline (Scan-1, p=0.001), but not after 12 weeks of yoga, either before (Scan-2, p=0.12) or after a yoga session (Scan-3, p=0.20). Depressive symptoms decreased significantly in the MDD-group (p=0.0001), and anxiety improved in both groups. Conclusion: After a 12-week yoga intervention, MDD-group mood and anxiety measures improved with scores equivalent to those of non-depressed individuals. This study provides the first evidence of brain GABA increases associated with specific yoga postures and breathing practices in MDD. These results suggest potential benefits of specific yoga postures and breathing practices as monotherapy or augmentation to other treatments to reduce anxiety and depression in MDD

Patterns of Natural and Human-Caused Mortality Factors of a Rare Forest Carnivore, the Fisher (Pekania pennanti) in California.

Wildlife populations of conservation concern are limited in distribution, population size and persistence by various factors, including mortality. The fisher (Pekania pennanti), a North American mid-sized carnivore whose range in the western Pacific United States has retracted considerably in the past century, was proposed for threatened status protection in late 2014 under the United States Endangered Species Act by the United States Fish and Wildlife Service in its West Coast Distinct Population Segment. We investigated mortality in 167 fishers from two genetically and geographically distinct sub-populations in California within this West Coast Distinct Population Segment using a combination of gross necropsy, histology, toxicology and molecular methods. Overall, predation (70%), natural disease (16%), toxicant poisoning (10%) and, less commonly, vehicular strike (2%) and other anthropogenic causes (2%) were causes of mortality observed. We documented both an increase in mortality to (57% increase) and exposure (6%) from pesticides in fishers in just the past three years, highlighting further that toxicants from marijuana cultivation still pose a threat. Additionally, exposure to multiple rodenticides significantly increased the likelihood of mortality from rodenticide poisoning. Poisoning was significantly more common in male than female fishers and was 7 times more likely than disease to kill males. Based on necropsy findings, suspected causes of mortality based on field evidence alone tended to underestimate the frequency of disease-related mortalities. This study is the first comprehensive investigation of mortality causes of fishers and provides essential information to assist in the conservation of this species

Intergenerational Transmission of Depression: Test of an Interpersonal Stress Model in a Community Sample

An interpersonal stress model of depression transmission was tested in a community sample of nearly 800 depressed and never-depressed women and their 15-year-old children. It was hypothesized that maternal depression (and depression in the maternal grandmother) contributed to chronic interpersonal stress in the mothers, affecting quality of parenting and youths' social competence. In turn, poor social functioning and interpersonal life events caused at least in part by the youths were predicted to be the proximal predictors of current depressive symptoms and diagnoses. Structural equation modeling confirmed the predicted associations among variables and the link between youth chronic and episodic interpersonal stress and depression. Additionally, the association between maternal and child depression was entirely mediated by the predicted family and interpersonal stress effects

Polysialylated NCAM and EphrinA/EphA regulate synaptic development of gabaergic interneurons in prefrontal cortex

A novel function for the neural cell adhesion molecule (NCAM) was identified in ephrinA/EphA-mediated repulsion as an important regulatory mechanism for development of GABAergic inhibitory synaptic connections in mouse prefrontal cortex. Deletion of NCAM, EphA3, or ephrinA2/3/5 in null mutant mice increased the numbers and size of perisomatic synapses between GABAergic basket interneurons and pyramidal cells in the developing cingulate cortex (layers II/III). A functional consequence of NCAM loss was increased amplitudes and faster kinetics of miniature inhibitory postsynaptic currents in NCAM null cingulate cortex. NCAM and EphA3 formed a molecular complex and colocalized with the inhibitory presynaptic marker vesicular GABA transporter (VGAT) in perisomatic puncta and neuropil in the cingulate cortex. EphrinA5 treatment promoted axon remodeling of enhanced green fluorescent protein-labeled basket interneurons in cortical slice cultures and induced growth cone collapse in wild-type but not NCAM null mutant neurons. NCAM modified with polysialic acid (PSA) was required to promote ephrinA5-induced axon remodeling of basket interneurons in cortical slices, likely by providing a permissive environment for ephrinA5/EphA3 signaling. These results reveal a new mechanism in which NCAM and ephrinAs/EphA3 coordinate to constrain GABAergic interneuronal arborization and perisomatic innervation, potentially contributing to excitatory/inhibitory balance in prefrontal cortical circuitry. © 2012 The Author