Pain Catastrophizing and Mindfulness: Exploring Mechanisms of Change Associated with Participation in a Mindfulness-Based Stress Reduction Program in Diabetic Peripheral Neuropathy Patients

Diabetic peripheral neuropathy (DPN) affects up to half of those with type 2 diabetes mellitus. Chronic neuropathic pain, a common symptom of DPN, remains difficult to treat pharmacologically. Mindfulness-based stress reduction (MBSR) has demonstrated benefits in chronic pain populations and a recently completed randomized controlled trial demonstrated improved function among patients with DPN who completed the program. The present study used archival data from this recently completed trial, with 62 participants (Mean age = 59.7 years, SD = 8.8). It was predicted that improved function following MBSR training would be explained by increased mindfulness and a reduction of pain catastrophizing. Mediation analysis indicated that while mindfulness was a mediator, pain catastrophizing was not, when controlling for baseline scores. This suggests that MBSR may improve function through self-awareness and one's ability to engage in the present moment non-judgmentally, rather than through ones ability to control and reduce pain-related catastrophic cognitions

An Experimental Trial of a Dog-Training Program in a Juvenile Detention Center

Objectives This research examines the effect of a dog-training program among juveniles ordered to a county juvenile detention facility in a large, Midwestern city. Methods A pre-test, post-test experimental design was constructed to examine changes in self-esteem, empathy, optimism, pessimism, compassion, and social competence between juveniles who were randomly assigned to the canine-assisted activity program and to the standard conditions of the detention center without access to the program. Two-way and repeated measures ANOVA models are used to assess the differential effect of the program. Results The dog-training program evaluated in this study did not differentially benefit nor did it harm participants in relation to juveniles who received the standard operating practices and procedures of the detention center. Conclusions Generalized conclusions about the effectiveness of dog-training programs in secure correctional facilities should not be made from this study. Despite the unique program model structure used in this study, the results demonstrate that once selection effects are mitigated through randomization, the mere exposure to a dog-training program does not translate to improved outcomes. The results raise more questions about the influence of selection effects on reported findings and stimulate inquiry on dog-training program models, research designs used to assess program effects, and the importance of intermediate interventions

Exercise Training and Functional Connectivity Changes in Mild Cognitive Empairment and Healthy Elders

Background: Effective interventions are needed to improve brain function in mild cognitive impairment (MCI), an early stage of Alzheimer’s disease (AD). The posterior cingulate cortex (PCC)/precuneus is a hub of the default mode network (DMN) and is preferentially vulnerable to disruption of functional connectivity in MCI and AD. Objective: We investigated whether 12 weeks of aerobic exercise could enhance functional connectivity of the PCC/precuneus in MCI and healthy elders. Methods: Sixteen MCI and 16 healthy elders (age range = 60–88) engaged in a supervised 12-week walking exercise intervention. Functional MRI was acquired at rest; the PCC/precuneus was used as a seed for correlated brain activity maps. Results: A linear mixed effects model revealed a significant interaction in the right parietal lobe: the MCI group showed increased connectivity while the healthy elders showed decreased connectivity. In addition, both groups showed increased connectivity with the left postcentral gyrus. Comparing pre to post intervention changes within each group, the MCI group showed increased connectivity in 10 regions spanning frontal, parietal, temporal and insular lobes, and the cerebellum. Healthy elders did not demonstrate any significant connectivity changes. Conclusion: The observed results show increased functional connectivity of the PCC/precuneus in individuals with MCI after 12 weeks of moderate intensity walking exercise training. The protective effects of exercise training on cognition may be realized through the enhancement of neural recruitment mechanisms, which may possibly increase cognitive reserve. Whether these effects of exercise training may delay further cognitive decline in patients diagnosed with MCI remains to be demonstrated

Watermelon Supplementation to Improve Systemic Atherosclerotic Risk Factor Biomarkers in Overweight Post-Menopausal Women in a Community Setting

The purpose of this study was to determine the degree to which six select markers of atherosclerotic risk were affected by a six-week watermelon consumption intervention in overweight post-menopausal women in a community setting. Forty five subjects completed the pre- and post- study visit after an overnight fast. Height, weight, percentage of body fat, and a blood sample were taken during both visits. During the pre-study visit, the subjects were randomly assigned to either the control (no intervention) group or the watermelon treatment group. The watermelon group consumed 710 mL of watermelon puree per day for the six-week period. The plasma concentration of sVCAM-1, ADAMTS 13, GDF-15, sICAM-1, and sP-selectin were measured pre- and post-treatment period. There was a significant 8.4% increase in the plasma concentration of L-arginine that occurred in the watermelon group between the pre- and post-treatment period. Also, there was a significant decrease in plasma VCAM-1 concentrations that occurred in the watermelon group between the pre- and post-treatment. The six-week watermelon supplementation treatment resulted in a small but significant increase in VCAM-1, but no changes in the other atherosclerotic biomarkers measured

Guidance for researchers wanting to link NHS data using non-consent approaches:a thematic analysis of feedback from the Health Research Authority Confidentiality Advisory Group

Introduction: The use of linked data and non-consent methodologies is a rapidly growing area of health research due to the increasing detail, availability and scope of routinely collected electronic health records data. However, gaining the necessary legal and governance approvals to undertake data linkage is a complex process in England. / Objectives: We reflect on our own experience of establishing lawful basis for data linkage through Section 251 approval, with the intention to build a knowledgebase of practical advice for future applicants. / Methods: Thematic analysis was conducted on a corpus of Section 251 feedback reports from the NHS Health Research Authority Confidentiality Advisory Group. / Results: Four themes emerged from the feedback. These were: (a) Patient and Public Involvement, (b)~Establishing Rationale, (c) Data maintenance and contingency, and the need to gain (d) Further Permissions from external authorities prior to full approval. / Conclusions: Securing Section 251 approval poses ethical, practical and governance challenges. However, through a comprehensive, planned approach Section 251 approval is possible, enabling researchers to unlock the potential of linked data for the purposes of health research

Prenatal Care Cards: Imparting Patient Autonomy During Pregnancy.

Introduction/Problem: Indiana University Student Outreach Clinic (IU-SOC) has been providing medical care to vulnerable populations for the past 12 years. In that time, students have witnessed barriers to care impacting the neighbors in the community, including lack of health insurance due to financial limitations or limited residency documentation. These barriers are particularly burdensome to pregnant patients, and the bimonthly Prenatal Clinic was created five years ago to address this need. A major limitation is ensuring effective communication between the IU-SOC Electronic Medical Record (EMR), Practice Fusion, and the multiple health systems in the community. Intervention: After reviewing the Pan American Health Organization (P.A.H.O) recommendations for similar communities, we created a tool that can be utilized at all outreach clinics: the prenatal care card. These care cards contain all relevant prenatal information such as first, second, and third trimester prenatal labs, blood pressure measurements, fetal anatomy ultrasound results, and other tests that will allow providers to establish baseline values that determine future care. The card can be easily translated for improved clarity and is printed on sturdy, laminated cardstock. IU-SOC contact information is included on the bottom of the card in case future providers have concerns, and patients receive a photocopy of the card for safekeeping. Our copy is uploaded to Practice Fusion for future reference at IU-SOC. Conclusion: The IU-SOC prenatal care card has been implemented as a way to communicate between the clinic and other healthcare providers, in accordance with P.A.H.O. standards of perinatal care. Since September 2021, four IU-SOC patients have been offered the prenatal care card and have expressed overall satisfaction so far. The value of the prenatal card is three-fold: to provide patients with ownership of their medical information, to be easily shareable with any medical center, and to enhance their pregnancy experience overall. The utility of the prenatal card will be further established as more pregnant patients are provided this tool

In vivo imaging of D\u3csub\u3e2\u3c/sub\u3e receptors and corticosteroids predict behavioural responses to captivity stress in a wild bird

© 2019, The Author(s). Individual physiological variation may underlie individual differences in behaviour in response to stressors. This study tested the hypothesis that individual variation in dopamine and corticosteroid physiology in wild house sparrows (Passer domesticus, n = 15) would significantly predict behaviour and weight loss in response to a long-term stressor, captivity. We found that individuals that coped better with captivity (fewer anxiety-related behaviours, more time spent feeding, higher body mass) had lower baseline and higher stress-induced corticosteroid titres at capture. Birds with higher striatal D2 receptor binding (examined using positron emission tomography (PET) with 11C-raclopride 24 h post-capture) spent more time feeding in captivity, but weighed less, than birds with lower D2 receptor binding. In the subset of individuals imaged a second time, D2 receptor binding decreased in captivity in moulting birds, and larger D2 decreases were associated with increased anxiety behaviours 2 and 4 weeks post-capture. This suggests changes in dopaminergic systems could be one physiological mechanism underlying negative behavioural effects of chronic stress. Non-invasive technologies like PET have the potential to transform our understanding of links between individual variation in physiology and behaviour and elucidate which neuroendocrine phenotypes predict stress resilience, a question with important implications for both humans and wildlife

Clinical vignette: Leaching liver lesions: a case of invasive Klebsiella pneumoniae liver abscess syndrome

Klebsiella pneumoniae liver abscesses are becoming more prevalent in the United States and have the ability to spread to several sites via septic embolization. 8-15% of patients have infections at other anatomical sites which is considered invasive K. pneumoniae liver abscess syndrome (IKPLAS). An otherwise healthy 42-year-old Vietnamese man who immigrated to the United States six years prior presented to the emergency department with a nine-day history of back pain. The patient reported his pain worsened acutely just prior to presentation when lifting a heavy object. He also described numbness of the left leg. At presentation, the patient was septic. Because of this, a MRI of the lumbar spine was obtained which demonstrated multiple paraspinal and gluteal region abscesses. A chest CT demonstrated a 2cm right hepatic lobe hypoattenuating lesion suggestive of an abscess as well as multiple pulmonary nodules with peripheral and upper lobe predominance. Blood cultures drawn prior to initiation of antibiotics grew out Klebsiella pneumoniae. Given the patients ethnic background and the organism isolated, the liver lesion was suspected as the primary abscess, with hematogenous dissemination to the lungs, paraspinal and gluteal regions, this being consistent with IKPLAS. The patient underwent drainage of the piriformis muscle abscess which also yielded K. pneumoniae. When cultures returned positive for K. pneumoniae, the antibiotic regimen was narrowed to ceftriaxone based on organism susceptibility. Despite appropriate antibiotic therapy, he went on to develop further abscesses as well osteomyelitis of the L1 and L2 vertebrae. He underwent subsequent abscess drainage after which the patient defervesced and his back pain improved. The patient was eventually discharged on ceftriaxone 2gm every 12 hours and received a total of eight weeks of antibiotics. Invasive Klebsiella pneumoniae liver abscesses syndrome (IKPLAS) is a rare clinical disease entity defined as a liver abscess and disseminated Klebsiella infection. It is often seen in patients of Asian descent and is increasing in prevalence within the United States. IKPLAS is associated with a high degree of morbidity and mortality. It should be considered in septic patients who are found to have liver abscesses and are of Asian descent.\u2

Resting Cerebral Blood Flow After Exercise Training in Mild Cognitive Impairment

Background: Exercise training has been associated with greater cerebral blood flow (CBF) in cognitively normal older adults (CN). Alterations in CBF, including compensatory perfusion in the prefrontal cortex, may facilitate changes to the brain’s neural infrastructure. Objective: To examine the effects of a 12-week aerobic exercise intervention on resting CBF and cognition in CN and those with mild cognitive impairment (MCI). We hypothesized individuals with MCI (vs. CN) would exhibit greater whole brain CBF at baseline and that exercise would mitigate these differences. We also expected CBF changes to parallel cognitive improvements. Methods: Before and after a 12-week exercise intervention, 18 CN and 17 MCI participants (aged 61–88) underwent aerobic fitness testing, neuropsychological assessment, and an MRI scan. Perfusion-weighted images were collected using a GE 3T MR system. Repeated measures analyses of covariance were used to test within- and between-group differences over time, followed by post-hoc analyses to examine links between CBF changes and cognitive improvement. Results: At baseline, individuals with MCI (vs. CN) exhibited significantly elevated perfusion in the left insula. Twelve weeks of aerobic exercise reversed this discrepancy. Additionally, exercise improved working memory (measured by the Rey Auditory Verbal Learning Test) and verbal fluency (measured by the Controlled Oral Word Association Test) and differentially altered CBF depending on cognitive status. Among those with MCI, decreased CBF in the left insula and anterior cingulate cortex was associated with improved verbal fluency. Conclusions: Exercise training alters CBF and improves cognitive performance in older adults with and without cognitive impairment. Future studies must evaluate the mediating effects of CBF on the association between exercise training and cognition