Sonography of the Lateral Antebrachial Cutaneous Nerve With Magnetic Resonance Imaging and Anatomic Correlation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135544/1/jum20143381475.pd

“Maybe I Made Up the Whole Thing”: Placebos and Patients’ Experiences in a Randomized Controlled Trial

Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo—e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment—provides an inadequate model to explain its salubrious benefits

Patients’ experiences treated with open-label placebo versus double-blind placebo: a mixed methods qualitative study

Background: There is increasing evidence suggesting that open-label placebo (OLP) is an effective treatment for several medical conditions defined by self-report. However, little is known about patients’ experiences with OLP, and no studies have directly compared patients’ experiences in double-blind placebo (DBP) conditions. Methods: This study was nested in a large randomized-controlled trial comparing the effects of OLP and DBP treatments in individuals with irritable bowel syndrome (IBS). We randomly selected 33 participants for interviews concerning their experiences in the parent trial. The data were qualitatively analyzed using an iterative immersion/crystallization approach. We then compared the qualitative interview data to the quantitative IBS severity data assessed during the parent trial, using a mixed methods approach. Results: Two prominent interview themes were identified: (1) the participants’ feelings about their treatment allocation and (2) their reflections about the treatment. Both OLP and DBP participants mentioned hope and curiosity as major feelings driving them to engage with their treatment. However, while DBP participants tended to be more enthusiastic about their allocation, OLP participants were more ambivalent. Furthermore, OLP participants reflected more on their treatment, often involving noticeable cognitive and emotional processes of self-reflection. They offered a variety of explanations for their symptom improvement and were significantly less likely to attribute it to the treatment itself than DBP participants (Χ2 [3] = 8.28; p =.041). Similarly, the participants’ retrospective narratives of symptom improvement were significantly correlated with their corresponding quantitative IBS severity scores only in DBP (p’s ≤.006) but not in OLP (p’s ≥.637). Conclusion: OLP and DBP participants share feelings of hope, uncertainty and curiosity but differ in the extent of conscious reflection. The counter-intuitive OLP prompts more self-examination, ambivalent feelings and active engagement compared to DBP. At the same time, OLP participants are more reluctant to attribute symptom improvement to their treatment. Our findings substantially add to the emerging picture of factors that distinguish OLP and DBP and their potential mechanisms

The Deglaciation of Maine, USA

The glacial geology of Maine records the northward recession of the Late Wisconsinan Laurentide Ice Sheet, followed by development of a residual ice cap in the Maine-Québec border region due to marine transgression of the St. Lawrence Lowland in Canada. The pattern of deglaciation across southern Maine has been reconstructed from numerous end moraines, deltas and submarine fans deposited during marine transgression of the coastal lowland. Inland from the marine limit, a less-detailed sequence of deglaciation is recorded by striation patterns, meltwater channels, scattered moraines and waterlain deposits that constrain the trend of the ice margin. There is no evidence that the northern Maine ice cap extended as far south-west as the Boundary Mountains and New Hampshire border. Newly-obtained radiocarbon ages from marine and terrestrial ice-proximal environments have improved the chronology of glacial recession in Maine. Many of these ages were obtained by coring late-glacial sediments beneath ponds and lakes. Data from this study show that the state was deglaciated between about 14.5 and 11.0 ka BP (14C years). The coastal moraine belt in southern Maine was deposited by oscillatory ice-margin retreat during the cold pre-Bølling time. Rapid ice recession to northern Maine then occurred between 13 and 11 ka BP, during the warmer Bølling/Allerød chronozones. Radiocarbon-dated pond sediments in western and northern Maine show lithologic evidence of Younger Dryas climatic cooling and persistence of the northern ice cap into Younger Dryas time. A large discrepancy still exists between radiocarbon ages of deglaciation in coastal south-western Maine and the timing of ice retreat indicated by New England varve records in areas to the west. Part of this problem may stem from the uncertainty of reservoir corrections applied to the radiocarbon ages of marine organics

Factors Associated With the Provision of Hospice Care for Children

Children at end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown

The Lantern Vol. 51, No. 1, Fall 1984

• Sky Eyes • Flowerwait • Haiku • Sunwatch • Epitaph of A Tale • How Do You Tell A Child • Vineyard Wind • By The Sea • The Wanderer • In Back of the Real Supermarket in Collegeville • Mitosis • Smoke Dreams • On Humankind Today - A Message • Dragon • The Lull • Finale • The Sun • Three Steps in Life • Seaside • To Mark • To Father • Yesterday - Today • The Stars • The Journey • Our Shared Experience, Miles Away • Coming Home • Blossom • Life is the Teacher • Midnight Stroll in February • Eyes (Karen\u27s Poem) • Your Love • Same Welcome as Odysseus • Europa • Sinn Fein • Idle Dreams • I Can Take A Hint • In Retrospect • Rest • China and Porcelain are One in the Same • Momenthttps://digitalcommons.ursinus.edu/lantern/1125/thumbnail.jp

Evidence and argument in policymaking: development of workplace smoking legislation

<p>Abstract</p> <p>Background</p> <p>We sought to identify factors that affect the passage of public health legislation by examining the use of arguments, particularly arguments presenting research evidence, in legislative debates regarding workplace smoking restrictions.</p> <p>Methods</p> <p>We conducted a case-study based content analysis of legislative materials used in the development of six state workplace smoking laws, including written and spoken testimony and the text of proposed and passed bills and amendments. We coded testimony given before legislators for arguments used, and identified the institutional affiliations of presenters and their position on the legislation. We compared patterns in the arguments made in testimony to the relative strength of each state's final legislation.</p> <p>Results</p> <p>Greater discussion of scientific evidence within testimony given was associated with the passage of workplace smoking legislation that provided greater protection for public health, regardless of whether supporters outnumbered opponents or vice versa.</p> <p>Conclusion</p> <p>Our findings suggest that an emphasis on scientific discourse, relative to other arguments made in legislative testimony, might help produce political outcomes that favor public health.</p

The Feasibility and Utility of Harnessing Digital Health to Understand Clinical Trajectories in Medication Treatment for Opioid Use Disorder: D-TECT Study Design and Methodological Considerations

Introduction: Across the U.S., the prevalence of opioid use disorder (OUD) and the rates of opioid overdoses have risen precipitously in recent years. Several effective medications for OUD (MOUD) exist and have been shown to be life-saving. A large volume of research has identified a confluence of factors that predict attrition and continued substance use during substance use disorder treatment. However, much of this literature has examined a small set of potential moderators or mediators of outcomes in MOUD treatment and may lead to over-simplified accounts of treatment non-adherence. Digital health methodologies offer great promise for capturing intensive, longitudinal ecologically-valid data from individuals in MOUD treatment to extend our understanding of factors that impact treatment engagement and outcomes. Methods: This paper describes the protocol (including the study design and methodological considerations) from a novel study supported by the National Drug Abuse Treatment Clinical Trials Network at the National Institute on Drug Abuse (NIDA). This study (D-TECT) primarily seeks to evaluate the feasibility of collecting ecological momentary assessment (EMA), smartphone and smartwatch sensor data, and social media data among patients in outpatient MOUD treatment. It secondarily seeks to examine the utility of EMA, digital sensing, and social media data (separately and compared to one another) in predicting MOUD treatment retention, opioid use events, and medication adherence [as captured in electronic health records (EHR) and EMA data]. To our knowledge, this is the first project to include all three sources of digitally derived data (EMA, digital sensing, and social media) in understanding the clinical trajectories of patients in MOUD treatment. These multiple data streams will allow us to understand the relative and combined utility of collecting digital data from these diverse data sources. The inclusion of EHR data allows us to focus on the utility of digital health data in predicting objectively measured clinical outcomes. Discussion: Results may be useful in elucidating novel relations between digital data sources and OUD treatment outcomes. It may also inform approaches to enhancing outcomes measurement in clinical trials by allowing for the assessment of dynamic interactions between individuals\u27 daily lives and their MOUD treatment response. Clinical Trial Registration: Identifier: NCT04535583