Effectiveness of providing university students with a mindfulness-based intervention to increase resilience to stress: 1-year follow-up of a pragmatic randomised controlled trial.

BACKGROUND: There is concern that increasing demand for student mental health services reflects deteriorating student well-being. We designed a pragmatic, parallel, single-blinded randomised controlled trial hypothesising that providing mindfulness courses to university students would promote their resilience to stress up to a year later. Here we present 1-year follow-up outcomes. METHODS: University of Cambridge students without severe mental illness or crisis were randomised (1:1, remote software-generated random numbers), to join an 8-week mindfulness course adapted for university students (Mindfulness Skills for Students (MSS)), or to mental health support as usual (SAU). RESULTS: We randomised 616 students; 53% completed the 1-year follow-up questionnaire. Self-reported psychological distress and mental well-being improved in the MSS arm for up to 1 year compared to SAU (p<0.001). Effects were smaller than during the examination period. No significant differences between arms were detected in the use of University Counselling Service and other support resources, but there was a trend for MSS participants having milder needs. There were no differences in students' workload management; MSS participants made more donations. Home practice had positive dose-response effects; few participants meditated. No adverse effects related to self-harm, suicidality or harm to others were detected. CONCLUSION: Loss to follow-up is a limitation, but evidence suggests beneficial effects on students' average psychological distress that last for at least a year. Effects are on average larger at stressful times, consistent with the hypothesis that this type of mindfulness training increases resilience to stress. TRIAL REGISTRATION NUMBER: ACTRN12615001160527.This is a summary of research funded by the University of Cambridge Vice-Chancellor’s Endowment Fund (RNER–LFHA), the University Counselling Service (no specific grant) and the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme (RNAG/564)

Brain amyloid in preclinical Alzheimer\u27s disease is associated with increased driving risk

INTRODUCTION: Postmortem studies suggest that fibrillar brain amyloid places people at higher risk for hazardous driving in the preclinical stage of Alzheimer's disease (AD). METHODS: We administered driving questionnaires to 104 older drivers (19 AD, 24 mild cognitive impairment, and 61 cognitive normal) who had a recent (18)F-florbetapir positron emission tomography scan. We examined associations of amyloid standardized uptake value ratios with driving behaviors: traffic violations or accidents in the past 3 years. RESULTS: The frequency of violations or accidents was curvilinear with respect to standardized uptake value ratios, peaking around a value of 1.1 (model r(2) = 0.10, P = .002); moreover, this relationship was evident for the cognitively normal participants. DISCUSSION: We found that driving risk is strongly related to accumulating amyloid on positron emission tomography, and that this trend is evident in the preclinical stage of AD. Brain amyloid burden may in part explain the increased crash risk reported in older adults

The Economic Stimulus: Gauging the Early Effects of ARRA Funding on Health Centers and Medically Underserved Populations and Communities

During times of economic crisis, community health centers and other health care safety net providers become even more vital to the communities they serve. The current downturn, with its high levels of unemployment and enormous impact on family incomes, carries major implications for health insurance coverage. The American Recovery and Reinvestment Act (ARRA), signed into law on February 17, 2009, provided slightly more than two billion dollars to community health centers for capital improvements, expansion (or retention) of personnel and services, and adoption of health information technology. All of these uses not only support health centers\u27 mission to serve populations with limited access to health care, such as the uninsured, low-income populations, minorities, and the homeless, but also generate new economic activities in communities hit hardest by the recession: More than 1,100 health centers throughout the United States have received ARRA funding to date. These centers are projected to serve 21 million persons in 2011, including nearly three million new patients as a direct result of ARRA funding. By targeting health centers, ARRA effectively provides needed health resources to populations at higher risk of poor health. Community health centers receiving ARRA funding tend to be located in areas with higher rates of unemployment and recent job losses. The average unemployment rate among counties with health center ARRA grantees was 9.6 percent compared to an average rate of 9.0 percent in all other counties; the average unemployment rate grew by 4.4 percent in counties with health centers compared to 4.0 percent in all other counties. The $1.85 billion invested to date in health centers under ARRA translates into$3.2 billion in new economic activity in these communities, suggesting that health centers are able to rapidly transform an infusion of funding into new services and expanded jobs. These findings indicate that ARRA has achieved its goal of directing resources into those communities that tend to bear the heaviest burden of an economic downturn, and have low community incomes, a disproportionate percentage of low wage workers, inadequate primary care access, and elevated health risks. However, the challenge lies in sustaining this expansion and assuring that the ability of health centers to respond to community needs is maintained even as overall economic circumstances begin to improve. Reforms contained in both the House and Senate bills, such as expanded Medicaid coverage for low income patients and direct investment in health center expansions, hold the greatest promise for operational sustainability and growth

Exotic Brittle Star Interactions With Native Octocoral Epizoites: An Endemic Benthic Ctenophore in Peril?

Widespread and large populations of the exotic eastern Pacific ophiuroid brittle star Opthiothela mirabilis now occur in southeastern Florida, extending the range of this recently introduced species from southern Brazil northward to the eastern Caribbean Sea and Florida. The Florida brittle stars, representing two lineages, are epibionts on shallow (3-18 m depth), tropical/subtropical plexaurid (e.g., Eunicea spp., Muricea elongata) and gorgoniid (Antillogorgia spp.) octocorals. The scope of this study includes recent distributional records of O. mirabilis in south Florida, field abundances in relation to the cohabiting endemic ctenophore Coeloplana waltoni, behavioral observations of the ophiuroid, ctenophore and the predatory amphipod Caprella penantis, as well as a laboratory experiment testing the effects of the alien ophiuroid on the native ctenophore. Individuals of O. mirabilis have been collected near St. Lucie Inlet, extending its northern-most range by about 110 km since 2019. Two years of field sampling have demonstrated significant declines of the native, benthic ctenophore with increasing abundances of the exotic ophiuroid. Evidence suggests that the ophiuroid is negatively affecting the abundances of the ctenophore through interference competition, greatly aided by its abrasive armature of calcareous spines, plates and hooks. Sporadic and intense predation by a caprellid amphipod (Caprella penantis) also probably contributes to the ctenophore’s decline, but to a lesser extent than that caused by the ophiuroid. Adding to the risk of extinction of C. waltoni is its narrow requirement of living octocorals as hosts and restricted distribution in southeast Florida and the Bahamas

A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial

Background More young people are going to university, but there is concern about an increasing demand for student mental health services. We designed a pragmatic randomised controlled trial to test the hypothesis that providing mindfulness courses to university students would promote their resilience to stress. Methods University of Cambridge students without severe mental illness or crisis (self-assessed) were remotely randomised to join an 8-week mindfulness course adapted for university students (MSS), or to mental health support as usual (SAU). The primary outcome was self-reported psychological distress during the examination period measured using the Clinical Outcomes in Routine Evaluation Outcome Measure. Main outcome intention-to-treat analysis was masked to allocation. Trial registration: ACTRN12615001160527 (complete). Findings In total, 616 students were randomised (circa 3% of all students; 309 to MSS, 307 to SAU); 74% completed the primary outcome measure; 65% of the MSS arm participants completed at least half of the MSS course. MSS reduced distress scores during the exam period compared with SAU (β=-0.44, 95%CI -0.60 to -0.29; p < 0.0001); 57% of SAU participants had distress scores above an accepted clinical threshold level compared with 37% of MSS participants. On average, six students needed to be offered the MSS course to prevent one from experiencing clinical levels of distress (number needed to treat 6, 95%CI 4 to 10). SAU distress worsened over the year whereas MSS scores improved after the course and were maintained during exams. Active monitoring revealed no adverse reactions related to self-harm, suicidality or harm to others. Interpretation The main limitation of this trial is the lack of control for non-specific effects. However, the provision of mindfulness training appears an effective component of a wider student mental health strategy. Funding University of Cambridge and NIHR Collaboration for Leadership in Applied Health Research and Care East of England.University of Cambridge and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England

Association of birth weight and the development of antipsychotic induced adiposity in individuals with treatment resistant schizophrenia.

Though weight gain is a common side effect of antipsychotic treatment, there are no useful predictors of which patients are likely to be affected and to what degree. It has been shown that exposure to adverse conditions during intra-uterine life confers a vulnerability to the development of later life metabolic complications and low birth weight for gestational age has been shown to be a robust marker of such prenatal adversity. We hypothesised that patients with schizophrenia with a lower birth weight will have increased vulnerability to the weight inducing effects of antipsychotic treatment. The relationship between birth weight and total and central adiposity, measured as body mass index (BMI) and waist-to-hip ratio (WHR) respectively, was examined in three groups: drug naïve first episode of psychosis (FEP) patients (n=41), treatment resistant schizophrenia (TRS) patients (n=42) and matched healthy volunteers (n=72). All analyses were controlled for age, gender and duration of treatment exposure. We found that a lower birth weight was associated with higher BMI and WHR only in TRS patients but not in FEP or controls, suggesting that prenatal adversity, as indicated by the surrogate marker of a lower birth weight, confers an increased vulnerability to clozapine induced weight gain.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.euroneuro.2016.03.00

The role of the most luminous, obscured AGN in galaxy assembly at z~2

We present HST WFC3 F160W imaging and infrared spectral energy distributions for twelve extremely luminous, obscured AGN at $1.8<z<2.7$, selected via "Hot, Dust Obscured" mid-infrared colors. Their infrared luminosities span $2-15\times10^{13}$L$_{\odot}$, making them among the most luminous objects in the Universe at $z\sim2$. In all cases the infrared emission is consistent with arising at least in most part from AGN activity. The AGN fractional luminosities are higher than those in either sub-millimeter galaxies, or AGN selected via other mid-infrared criteria. Adopting the $G$, M$_{20}$ and $A$ morphological parameters, together with traditional classification boundaries, infers that three quarters of the sample as mergers. Our sample do not, however, show any correlation between the considered morphological parameters and either infrared luminosity or AGN fractional luminosity. Moreover, their asymmetries and effective radii are distributed identically to those of massive galaxies at $z\sim2$. We conclude that our sample is not preferentially associated with mergers, though a significant merger fraction is still plausible. Instead, we propose that our sample are examples of the massive galaxy population at $z\sim2$ that harbor a briefly luminous, "flickering" AGN, and in which the $G$ and M$_{20}$ values have been perturbed, due to either the AGN, and/or the earliest formation stages of a bulge in an inside-out manner. Furthermore, we find that the mass assembly of the central black holes in our sample leads the mass assembly of any bulge component. Finally, we speculate that our sample represent a small fraction of the immediate antecedents of compact star-forming galaxies at $z\sim2$.Comment: ApJ, accepted. Updated to reflect the accepted versio