Mindful medical practice and the therapeutic alliance

This review article focuses on how the therapeutic relationship is central to clinician-client/patient relationships in psychiatry as well as other medical and psychotherapeutic encounters.  Crucial to this relationship is the alliance formed between the caregiver and the person who seeks their care.  The threats to the therapeutic alliance in psychiatry are discussed as is the importance of facing them. How mindfulness enables clinicians to build such bonds and foster well-being in themselves and in those they treat is examined in the context of quantitative and qualitative studies

Computing a rectilinear shortest path amid splinegons in plane

We reduce the problem of computing a rectilinear shortest path between two given points s and t in the splinegonal domain \calS to the problem of computing a rectilinear shortest path between two points in the polygonal domain. As part of this, we define a polygonal domain \calP from \calS and transform a rectilinear shortest path computed in \calP to a path between s and t amid splinegon obstacles in \calS. When \calS comprises of h pairwise disjoint splinegons with a total of n vertices, excluding the time to compute a rectilinear shortest path amid polygons in \calP, our reduction algorithm takes O(n + h \lg{n}) time. For the special case of \calS comprising of concave-in splinegons, we have devised another algorithm in which the reduction procedure does not rely on the structures used in the algorithm to compute a rectilinear shortest path in polygonal domain. As part of these, we have characterized few of the properties of rectilinear shortest paths amid splinegons which could be of independent interest

Physical Activity and Hippocampal Sub-Region Structure in Older Adults with Memory Complaints.

BackgroundPhysical activity (PA) plays a major role in maintaining cognition in older adults. PA has been shown to be correlated with total hippocampal volume, a memory-critical region within the medial temporal lobe (MTL). However, research on associations between PA and MTL sub-region integrity is limited.ObjectiveTo examine the relationship between PA, MTL thickness, and its sub-regions, and cognitive function in non-demented older adults with memory complaints.MethodsTwenty-nine subjects aged ≥60 years, with memory complaints were recruited for this cross-sectional study. PA was tracked for 7 days using accelerometers, and average number of steps/day determined. Subjects were categorized into two groups: those who walked ≤4000 steps/day (lower PA) and those with >4000 steps/day (higher PA). Subjects received neuropsychological testing and 3T MRI scans. Nonparametric ANCOVAs controlling for age examined differences between the two groups.ResultsTwenty-six subjects aged 72.7(8.1) years completed the study. The higher PA group (n = 13) had thicker fusiform gyrus (median difference = 0.11 mm, effect size (ES) = 1.43, p = 0.001) and parahippocampal cortex (median difference = 0.12 mm, ES = 0.93, p = 0.04) compared to the lower PA group. The higher PA group also exhibited superior performance in attention and information-processing speed (median difference = 0.90, ES = 1.61, p = 0.003) and executive functioning (median difference = 0.97, ES = 1.24, p = 0.05). Memory recall was not significantly different between the two groups.ConclusionOlder non-demented individuals complaining of memory loss who walked >4000 steps each day had thicker MTL sub-regions and better cognitive functioning than those who walked ≤4000 steps. Future studies should include longitudinal analyses and explore mechanisms mediating hippocampal related atrophy

Improved Implementation of Point Location in General Two-Dimensional Subdivisions

We present a major revamp of the point-location data structure for general two-dimensional subdivisions via randomized incremental construction, implemented in CGAL, the Computational Geometry Algorithms Library. We can now guarantee that the constructed directed acyclic graph G is of linear size and provides logarithmic query time. Via the construction of the Voronoi diagram for a given point set S of size n, this also enables nearest-neighbor queries in guaranteed O(log n) time. Another major innovation is the support of general unbounded subdivisions as well as subdivisions of two-dimensional parametric surfaces such as spheres, tori, cylinders. The implementation is exact, complete, and general, i.e., it can also handle non-linear subdivisions. Like the previous version, the data structure supports modifications of the subdivision, such as insertions and deletions of edges, after the initial preprocessing. A major challenge is to retain the expected O(n log n) preprocessing time while providing the above (deterministic) space and query-time guarantees. We describe an efficient preprocessing algorithm, which explicitly verifies the length L of the longest query path in O(n log n) time. However, instead of using L, our implementation is based on the depth D of G. Although we prove that the worst case ratio of D and L is Theta(n/log n), we conjecture, based on our experimental results, that this solution achieves expected O(n log n) preprocessing time.Comment: 21 page

Projecting current and future location, quality, and connectivity of habitat for breeding birds in the Great Basin

We estimated the current location, quality, and connectivity of habitat for 50 species of breeding birds in four mountain ranges in the central Great Basin (Lander, Nye, and Eureka Counties, Nevada) and projected the future location, quality, and connectivity of habitat for these species given different scenarios of climate-induced land-cover change. In the United States, such models are relevant to federally mandated management of wild animals by state-level agencies. We sampled birds during the breeding seasons of 2001–2009 with fixed-radius point counts. For each species, we used boosted regression trees to model incidence (proportion of years a location was surveyed in which the species was present) as a function of topography and current land cover and climate. To assess model fit, we calculated the proportion of binomial deviance explained. We used cross-validation to estimate the predictive accuracy of the models. We applied the conservation planning program Zonation to identify locations where incidences of multiple species were maximized through time given current land cover and two scenarios of land-cover change, expansion of pinyon–juniper woodland into sagebrush shrubsteppe and contraction of riparian woodland. Models based on a set of 13 covariates derived from remotely sensed data had some predictive capacity for 41 of 50 species. Model outputs suggested substantial changes in amount of habitat for many species following projected expansion of pinyon–juniper woodland, but less pronounced changes following projected contraction of riparian woodland. Zonation analyses indicated that the spatial distribution of the highest-quality habitat for the avian assemblage was relatively consistent through time under both scenarios. Breeding birds in the Great Basin commonly are grouped in management plans on the basis of their general association with land-cover classes such as pinyon–juniper woodland, sagebrush shrubsteppe, and riparian woodland. However, even within these groups, the environmental attributes that explained a high proportion of variation in species' incidences and the projected responses to different scenarios of land-cover change varied considerably among species

Orexin signaling during social defeat stress influences subsequent social interaction behaviour and recognition memory

Orexins are neuropeptides synthesized in the lateral hypothalamus that influence arousal, feeding, reward pathways, and the response to stress. However, the role of orexins in repeated stress is not fully characterized. Here, we examined how orexins and their receptors contribute to the coping response during repeated social defeat and subsequent anxiety-like and memory-related behaviors. Specifically, we used Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) to stimulate orexins prior to each of five consecutive days of social defeat stress in adult male rats. Additionally, we determined the role of the orexin 2 receptor in these behaviors by using a selective orexin 2 receptor antagonist (MK-1064) administered prior to each social defeat. Following the 5 day social defeat conditioning period, rats were evaluated in social interaction and novel object recognition paradigms to assess anxiety-like behavior and recognition memory, respectively. Activation of orexin neurons by DREADDs prior to each social defeat decreased the average latency to become defeated across 5 days, indicative of a passive coping strategy that we have previously linked to a stress vulnerable phenotype. Moreover, stimulation of orexin signaling during defeat conditioning decreased subsequent social interaction and performance in the novel object recognition test indicating increased subsequent anxiety-like behavior and reduced working memory. Blocking the orexin 2 receptor during repeated defeat did not alter these effects. Together, our results suggest that orexin neuron activation produces a passive coping phenotype during social defeat leading to subsequent anxiety-like behaviors and memory deficits

BNCI systems as a potential assistive technology: ethical issues and participatory research in the BrainAble project

This paper highlights aspects related to current research and thinking about ethical issues in relation to Brain Computer Interface (BCI) and Brain-Neuronal Computer Interfaces (BNCI) research through the experience of one particular project, BrainAble, which is exploring and developing the potential of these technologies to enable people with complex disabilities to control computers. It describes how ethical practice has been developed both within the multidisciplinary research team and with participants. Results: The paper presents findings in which participants shared their views of the project prototypes, of the potential of BCI/BNCI systems as an assistive technology, and of their other possible applications. This draws attention to the importance of ethical practice in projects where high expectations of technologies, and representations of “ideal types” of disabled users may reinforce stereotypes or drown out participant “voices”. Conclusions: Ethical frameworks for research and development in emergent areas such as BCI/BNCI systems should be based on broad notions of a “duty of care” while being sufficiently flexible that researchers can adapt project procedures according to participant needs. They need to be frequently revisited, not only in the light of experience, but also to ensure they reflect new research findings and ever more complex and powerful technologies

A waitlist-controlled trial of group cognitive behavioural therapy for depression and anxiety in Parkinson’s disease

Background: The aim of this study was to evaluate the efficacy of a group Cognitive Behavioural Therapy (CBT) treatment for depression and anxiety in Parkinson’s disease (PD). Methods: A waitlist-controlled trial design was used. Eighteen adults with PD and a comorbid DSM-IV-TR diagnosis of depression and/or anxiety were randomised to either Intervention (8-week group CBT treatment) or Waitlist (8-week clinical monitoring preceding treatment). The Depression, Anxiety, Stress Scale-21 (DASS-21) was the primary outcome. Assessments were completed at Time 1 (pretreatment), Time 2 (posttreatment/post-waitlist) and 1-month and 6-month follow-ups. Results: At Time 2, participants who received CBT reported greater reductions in depression (Mchange = -2.45) than Waitlist participants (Mchange = .29) and this effect was large, d = 1.12, p = .011. Large secondary effects on anxiety were also observed for CBT participants, d = .89, p = .025. All treatment gains were maintained and continued to improve during the follow-up period. At 6-month follow-up, significant and large effects were observed for both depression (d = 2.07) and anxiety (d = 2.26). Conclusions: Group CBT appears to be an efficacious treatment approach for depression and anxiety in PD however further controlled trials with larger numbers of participants are required