Sleeping Mindfully

Insomnia is a disorder of hyperarousal that affects up to 30% of adults. Insomnia is based on cognitive dysfunction that causes us to worry and neuroendocrine factors that upregulate our autonomic nervous system. Studies have shown that just 10 minutes of daily mindfulness practice can improve sleep. Mindfulness is able to work at the root of both causes of insomnia. It improves our ability to relax through increasing attentional factors that impart control over stress hormones and helps reduce ruminative thoughts.https://scholarworks.uvm.edu/fmclerk/1520/thumbnail.jp

The 2017 Vermont Opioid Prescribing Rules: Prescriber Attitudes

Introduction. In July of 2017, Vermont enacted new rules on acute opioid pre- scribing to reduce misuse, addiction, and overdose associated with prescription opioids. The new rules include requirements of non-opioid therapy use when possible, querying VPMS, patient education and informed consent, and co-prescription of naloxone. Our study objective was to gain insight into the perspectives of opioid prescribers on the new rules. Methods. The 17-item survey included closed and open-ended questions addressing prescriber perceptions about the new rules as well as demographic information about respondents. The survey was sent to Vermont-based opioid prescribers via email, to multiple healthcare organizations and professional societies, and through personal contacts. Open-ended responses were categorized using paired reviewers and group consensus, using a grounded theory approach. Results. A total of 431 responses were obtained, with MD/DOs accounting for 65%, APRNs- 14%, DDS/DMD- 7%, PAs-13%, and NDs- 1%. Of the respondents, 75% thought that more restrictive opioid prescribing rules were necessary, 74% felt the new rules would have some positive effect on the opioid crisis, but only 48% were in favor of the new rules. Barriers to implementation included co-prescribing naloxone (50% were unsuccessful), justifying exceptions to rules in medical record (46% unsuc- cessful), considering non-pharmacologic therapies (39% unsuccessful), and adhering to prescription limits (31% unsuccessful). Conclusions. Roll-out of the new rules has been criticized for implementation issues, overall reducing favorability among prescribers. Feedback obtained may be utilized by the Vermont Health Department and by other states to improve current models of opioid prescribing.https://scholarworks.uvm.edu/comphp_gallery/1264/thumbnail.jp

Metagenomics reveals impact of geography and acute diarrheal disease on the Central Indian human gut microbiome

© 2020, © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. Background: The Central Indian gut microbiome remains grossly understudied. Herein, we sought to investigate the burden of antimicrobial resistance and diarrheal diseases, particularly Clostridioides difficile, in rural-agricultural and urban populations in Central India, where there is widespread unregulated antibiotic use. We utilized shotgun metagenomics to comprehensively characterize the bacterial and viral fractions of the gut microbiome and their encoded functions in 105 participants. Results: We observed distinct rural-urban differences in bacterial and viral populations, with geography exhibiting a greater influence than diarrheal status. Clostridioides difficile disease was more commonly observed in urban subjects, and their microbiomes were enriched in metabolic pathways relating to the metabolism of industrial compounds and genes encoding resistance to 3rd generation cephalosporins and carbapenems. By linking phages present in the microbiome to their bacterial hosts through CRISPR spacers, phage variation could be directly related to shifts in bacterial populations, with the auxiliary metabolic potential of rural-associated phages enriched for carbon and amino acid energy metabolism. Conclusions: We report distinct differences in antimicrobial resistance gene profiles, enrichment of metabolic pathways and phage composition between rural and urban populations, as well as a higher burden of Clostridioides difficile disease in the urban population. Our results reveal that geography is the key driver of variation in urban and rural Indian microbiomes, with acute diarrheal disease, including C. difficile disease exerting a lesser impact. Future studies will be required to understand the potential role of dietary, cultural, and genetic factors in contributing to microbiome differences between rural and urban populations

Pre-transplant immune factors may be associated with BK polyomavirus reactivation in kidney transplant recipients

BK polyomavirus (BKPyV) reactivation in kidney transplant recipients can lead to allograft damage and loss. The elements of the adaptive immune system that are permissive of reactivation and responsible for viral control remain incompletely described. We performed a prospective study evaluating BKPyV-specific T-cell response, humoral response and overall T-cell phenotype beginning pre-transplant through one year post-transplant in 28 patients at two centers. We performed an exploratory analysis of risk factors for the development of viremia and viruria as well as compared the immune response to BKPyV in these groups and those who remained BK negative. 6 patients developed viruria and 3 developed viremia. BKPyV-specific CD8+ T-cells increased post-transplant in viremic and viruric but not BK negative patients. BKPyV-specific CD4+ T-cells increased in viremic, but not viruric or BK negative patients. Anti-BKPyV IgG antibodies increased in viruric and viremic patients but remained unchanged in BK negative patients. Viremic patients had a greater proportion of CD8+ effector cells pre-transplant and at 12 months post-transplant. Viremic patients had fewer CD4+ effector memory cells at 3 months post-transplant. Exploratory analysis demonstrated lower CD4 and higher total CD8 proportions, higher anti-BKPyV antibody titers and the cause of renal failure were associated BKPyV reactivation. In conclusion, low CD4, high CD8 and increased effector CD8 cells were found pre-transplant in patients who became viremic, a phenotype associated with immune senescence. This pre-transplant T-cell senescence phenotype could potentially be used to identify patients at increased risk of BKPyV reactivation

Metagenomics Reveals Impact of Geography and Acute Diarrhoeal Disease on the Central Indian Human Gut Microbiome

Background: The Central Indian gut microbiome remains grossly understudied. Herein, we sought to investigate the burden of antimicrobial resistance and diarrhoeal diseases, particularly Clostridioides difficile, in rural-agricultural and urban populations in Central India, where there is widespread unregulated antibiotic use. We utilised shotgun metagenomics to comprehensively characterise the bacterial and viral fractions of the gut microbiome and their encoded functions in 105 participants. Results: We observed distinct rural-urban differences in bacterial and viral populations, with geography exhibiting a greater influence than diarrhoeal status. Clostridioides difficile disease was more commonly observed in urban subjects, and their microbiomes were enriched in metabolic pathways relating to the metabolism of industrial compounds and genes encoding resistance to 3rd generation cephalosporins and carbapenems. By linking phages present in the microbiome to their bacterial hosts through CRISPR spacers, phage variation could be directly related to shifts in bacterial populations, with the auxiliary metabolic potential of rural-associated phages enriched for carbon and amino acid energy metabolism.Conclusions: We report distinct differences in antimicrobial resistance gene profiles, enrichment of metabolic pathways and phage composition between rural and urban populations, as well as a higher burden of Clostridioides difficile disease in the urban population. Our results reveal that geography is the key driver of variation in urban and rural Indian microbiomes, with acute diarrhoeal disease, including C. difficile disease exerting a lesser impact. Future studies will be required to understand the potential role of dietary, cultural and genetic factors in contributing to microbiome differences between rural and urban populations

Study subject characteristics.

<p>Study subject characteristics.</p

BKPyV specific (A) CD4⁺ and (B) CD8⁺ T-cells.

<p>Line represents mean value. “-” = BK Negative, “U” = viruria, “P” = viremia, “mo” = months post-transplant. “Pre-Tx” = Pre-transplant. P values were calculated by Kruskall-Wallis comparing all 3 groups at each time point. <b>A</b>: No significant difference at any time point. <b>B</b>: 3 month mean %IFN-γ producing CD8⁺ T-Cells for BK negative 1.29 (±2.36), viruria 1.54 (±1.21), viremia 6.67 ±0.54), P = 0.02; 6 months mean for BK negative 1.81 (±4.10), viruria 12.65 (±11.10) and viremia 17.22 (±18.68), P = 0.05; 12 months mean for BK negative 0.53 (±0.91), viruria 9.44 (±7.13), viremia 10.97 (±8.85), P = 0.01.</p

GEE Linear regression for change in variable per month post-transplant.

<p>GEE Linear regression for change in variable per month post-transplant.</p

Prevalence of BKPyV detected in the plasma or urine.

<p>Prevalence of BKPyV detected in the plasma or urine.</p