Therapeutic Art for Individuals with Multiple Sclerosis

Introduction: Depression is more prevalent in individuals with MS than in the average population, which presents complications of quality of life beyond simply the primary disease process. This project aims to explore the immediate emotional benefits of therapeutic art sessions for individuals with MS, in addition to exploring the feasibility of reducing concomitant depression in this population with therapeutic art alongside standard medical therapy. Methods: Therapeutic art sessions were held with 3 support groups of 5 to 12 individuals with MS. Participants were initially prompted with a writing exercise regarding how they perceive themselves, and then prompted to paint a self-portrait using their writing as a guide. Each participant produced 1 painting per session, with many participants engaging in multiple sessions across time. Acrylic paint was used in order to allow participants of all levels of motor function, dexterity, and artistic skill to participate. Results: The products ranged from literal portraits of participants’ faces to interpretive pieces of what it feels like to live with MS. During the therapeutic sessions, participants reflected on their experience living with MS and expressed the resurfaced emotions in their paintings, as well as during debrief discussions. The pieces were presented at the Philadelphia MS Breakthroughs Conference, where not only the project was appreciated by members of the MS community but interest in the continuation of the project was expressed. Discussion: The results from this project demonstrate the immediate benefits of therapeutic art sessions for participants of the study whose involvement produced meaningful, emotional experiences. Moving forward, the greater MS community expressed positivity towards the project and support for its future expansion which will explore not only the feasibility of therapeutic art sessions but additionally its measured clinical effects on depression, aiming to validate the use of therapeutic art for depression with MS

Cortisolsekretion während computerassistierter intravenöser Alkoholselbstverabreichung bei jungen gesunden sozialen Trinkern

Background: Studies with experimental administration of alcohol offer inconsistent approaches and interpretations in which ways an acute alcohol exposure affects the HPA-system and the cortisol secretion. So far published alcohol experiments differ in alcohol application, the possibility of alcohol self-administration at the subjects own discretion as well as the age of the participants. Question: Is cortisol secretion modified by gender during alcohol infusion? Do men and women show different cortisol levels under alcohol exposure when compared to the baseline? Is there a dose-response relationship between cortisol secretion and acute alcohol exposure? Have family history, smoking habits and alcohol induced side effects like nausea an influence on the cortisol secretion under alcohol exposure? Materials and methods: 48 18 year old subjects participated in two identical sessions in which they were able to regulate their maximum blood alcohol concentration up to a safety limit of 1.2 ‰ (i.e., 0.12%). The experiment was conducted by using a special software for self-infusion of ethanol (CASE) which guided the participants through a two and a half hours long experiment. CASE is founded on a validated physiologically-based pharmacokinetic model and involves calculating the infusion volume needed to increase the blood alcohol concentration in a linear manner. The BAC increases after each alcohol request by 0,075 ‰ (i.e., 0.0075%) within in two and a half minutes. If the subject infuses no alcohol the blood alcohol concentration will decrease by 0.01 ‰ (i.e., 0.001%) per minute. Through the precise calculation of the infusion rate, individual differences can be eliminated. Cortisol levels were measured at five time points: an initial baseline measurement and four measurements at fixed time points during the alcohol self-administration of subjects with two completed alcohol experiments. As an appropriate measure to examine the effect of alcohol self-administration on cortisol secretion, the maximum blood alcohol concentration was determined. In addition the day of experiment, gender and family history were observed as well as exploratory maximum nausea and smoking habits. Results: In conclusion, the results confirmed that women have higher cortisol levels than men at baseline and under alcohol influence. Blood alcohol concentration as examined influencing variable was shown to have different effects on the HPA system on day one and two. On the first day of experimentation there was no effect of blood alcohol concentration on the HPA system. On the second day a dose-response relationship could be identified between cortisol secretion and acute alcohol exposure. Individually higher blood alcohol concentrations attenuated cortisol stronger in comparison to subjects with lower blood alcohol concentrations. Family history, smoking habits and unpleasant side effects (nausea) did not affect the cortisol secretion under alcohol exposure in this series of experiments. Conclusions: Current data suggests that alcohol experiments affect the cortisol secretion in young social drinkers. These findings could be detected for the first time. Up to this point there has not been an experimental study that investigated and evaluated the dose-effect relationship between cortisol secretion and alcohol in a study design which uses intravenous alcohol self-administration. It can be theorized that the first day of experimentation is suitable as a settling-in phase due to unspecific confounding factors, whereas the second day can be considered, in an identical setting, apt for hypothesis testing. The increased cortisol level in women when compared to men is consistent with previous studies and there was no indication that family history, smoking habits and alcohol induced unpleasant side effects have an influence on cortisol secretion.:Inhaltsverzeichnis 3 Abbildungsverzeichnis 6 Tabellenverzeichnis 7 Abkürzungsverzeichnis 8 1 Einleitung 10 1.1 Alkohol – eine kurze Einführung 10 1.2 Bedeutung des Zusammenhangs von HPA-System und Alkohol 12 1.2.1 Experimentelle Alkoholselbstverabreichung 12 1.2.2 Neuropharmakologie von Alkohol 13 1.2.3 Geschlechtsunterschiede bei der Cortisolsekretion 14 1.2.4 Übelkeit und die Auswirkungen auf die Cortisolsekretion unter Alkoholexposition 15 1.3 Orale Alkoholverabreichung versus intravenöse Alkoholverabreichung 16 1.4 Zielsetzung 19 2 Material und Methoden 20 2.1 Versuchsteilnehmer 20 2.1.1 Einschlusskriterien 20 2.1.2 Ausschlusskriterien 21 2.1.3 Aufnahmeuntersuchung 22 2.2 Versuchsaufbau und Durchführung 22 2.2.1 Versuchsprinzip 23 2.2.2 Versuchsablauf 24 2.2.3 Verwendete Materialien 27 2.2.4 CASE Software 27 2.2.5 Herstellung der 6%igen Alkohol-Infusionslösung 29 2.2.6 Messung der BAK 30 2.2.7 Verwendete Fragebögen und Selbsteinschätzungstests 30 2.3 Blutverarbeitung 31 2.3.1 Blutbehandlung im Labor (Testkit der Firma IBL International GMBH) 32 2.3.1.1 Testprinzip im Labor 32 2.3.1.2 Testdurchführung bei Serumproben 32 2.3.1.3 Testauswertung 33 2.4 Statistische Auswertung 33 3 Ergebnisse 37 3.1 Versuchsteilnehmer 37 3.2 Konfirmatorische Datenanalyse der Cortisolsekretion 38 3.2.1 CASE Ergebnisvariablen 38 3.2.2 Analyse von Baseline Cortisol Tag eins vs. Tag zwei 39 3.2.3 Einfluss von Familienanamnese, Geschlecht und maximalem Blutalkohol auf die Cortisolsekretion 40 3.2.3.1 Beobachtung beider Experimentaltage zusammen 40 3.2.3.2 Getrennte Beobachtung für den ersten Experimentaltag 44 3.2.3.3 Getrennte Beobachtung für den zweiten Experimentaltag 46 3.2.3.4 Einfluss von max BAK Tag zwei auf den prozentualen Anteil der Nettofläche an der Gesamtfläche Tag zwei 48 Explorative Analyse von potentiellen weiteren Einflussfaktoren 49 3.3.1 Der Effekt von Übelkeit auf die Cortisolsekretion 49 3.3.2 Der Effekt von Rauchen auf die Cortisolsekretion 50 4 Diskussion 52 4.1 Auswahl der CASE Ergebnisvariablen 52 4.2 Unterschiede zwischen dem ersten und zweiten Experimentaltag 53 4.3 Verschiedene Einflüsse auf die Cortisolsekretion 54 4.3.1 Einfluss von Geschlecht 54 4.3.2 Einfluss von max BAK 55 4.3.3 Einfluss von Familienanamnese 55 4.4 Unterschiede zu vorhergehenden Studien 56 4.5 Diskussion der explorativen Datenanalyse 57 4.5.1 Einfluss von Übelkeit auf die Cortisolsekretion 57 4.5.2 Einfluss von Rauchen auf die Cortisolsekretion 58 4.6 Limitation der D-LAYA Studie 59 4.7 Ausblick 60 Zusammenfassung 6

Laboratory alcohol self-administration experiments do not increase subsequent real-life drinking in young adult social drinkers

BACKGROUND: While the utility of experimental free-access alcohol self-administration paradigms is well established, little data exist addressing the question of whether study participation influences subsequent natural alcohol consumption. We here present drinking reports of young adults before and after participation in intravenous alcohol self-administration studies. METHODS: Timeline Follow-back drinking reports for the 6 weeks immediately preceding the first, and the 6 weeks after the last experimental alcohol challenge were examined from subjects completing 1 of 2 similar alcohol self-administration paradigms. In study 1, 18 social drinkers (9 females, mean age 24.1 years) participated in 3 alcohol self-infusion sessions up to a maximum blood alcohol concentration (BAC) of 160 mg%. Study 2 involved 60 participants (30 females, mean age 18.3 years) of the Dresden Longitudinal Study on Alcohol Use in Young Adults (D-LAYA), who participated in 2 sessions of alcohol self-infusion up to a maximum BAC of 120 mg%, and a nonexposed age-matched control group of 42 (28 females, mean age 18.4 years) subjects. RESULTS: In study 1, participants reported (3.7%) fewer heavy drinking days as well as a decrease of 2.5 drinks per drinking day after study participation compared to prestudy levels (p < 0.05, respectively). In study 2, alcohol-exposed participants reported 7.1% and non-alcohol-exposed controls 6.5% fewer drinking days at poststudy measurement (p < 0.001), while percent heavy drinking days and drinks per drinking day did not differ. CONCLUSIONS: These data suggest that participation in intravenous alcohol self-administration experiments does not increase subsequent real-life drinking of young adults

Adolescent women induce lower blood alcohol levels than men in a laboratory alcohol self-administration experiment

Background Adolescence is a critical period for the development of alcohol use disorders; drinking habits are rather unstable and genetic influences, such as male sex and a positive Family History of alcoholism (FH), are often masked by environmental factors such as peer pressure. Methods We investigated how sex and FH modulate alcohol use in a sample of 18-19-year-olds from the Dresden Longitudinal Study on Alcohol use in Young Adults (D-LAYA). Adolescents reported their real-life drinking in a TimeLine Follow-Back (TLFB) interview. They subsequently completed a training and an experimental session of free-access intravenous Alcohol Self-Administration (i.v. ASA) using the computer-assisted alcohol infusion system in order to control for environmental cues as well as for biological differences in alcohol pharmacokinetics. During i.v. ASA, we assessed subjective alcohol effects at eight time points. Results Women reported significantly less real-life drinking than men and achieved significantly lower mean arterial Blood Alcohol Concentrations (aBACs) in the laboratory. At the same time, women reported greater sedation relative to men and rated negative effects as high as did men. A positive FH was associated with lower real-life drinking in men but not in women. In the laboratory, FH was not linked to i.v. ASA. Greater real-life drinking was significantly positively associated with higher mean aBACs in the laboratory, and all i.v. ASA indices were highly correlated across the two sessions. Conclusions We conclude that adolescent women chose lower aBACs because they experienced adverse alcohol effects, namely sedation and negative effects, at lower aBACs than men. A positive FH was not apparent as risk factor for drinking in our young sample. The i.v. ASA method demonstrated good external validity as well as test-retest reliability, the latter indicating that a separate training session is not required when employing the i.v. ASA paradigm

Palaeogenomic analysis of black rat (Rattus rattus) reveals multiple European introductions associated with human economic history

The distribution of the black rat (Rattus rattus) has been heavily influenced by its association with humans. The dispersal history of this non-native commensal rodent across Europe, however, remains poorly understood, and different introductions may have occurred during the Roman and medieval periods. Here, in order to reconstruct the population history of European black rats, we first generate a de novo genome assembly of the black rat. We then sequence 67 ancient and three modern black rat mitogenomes, and 36 ancient and three modern nuclear genomes from archaeological sites spanning the 1st-17th centuries CE in Europe and North Africa. Analyses of our newly reported sequences, together with published mitochondrial DNA sequences, confirm that black rats were introduced into the Mediterranean and Europe from Southwest Asia. Genomic analyses of the ancient rats reveal a population turnover in temperate Europe between the 6th and 10th centuries CE, coincident with an archaeologically attested decline in the black rat population. The near disappearance and re-emergence of black rats in Europe may have been the result of the breakdown of the Roman Empire, the First Plague Pandemic, and/or post-Roman climatic cooling.Peer reviewe

Management of anaphylaxis due to COVID-19 vaccines in the elderly

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.Peer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Cortisolsekretion während computerassistierter intravenöser Alkoholselbstverabreichung bei jungen gesunden sozialen Trinkern

Background: Studies with experimental administration of alcohol offer inconsistent approaches and interpretations in which ways an acute alcohol exposure affects the HPA-system and the cortisol secretion. So far published alcohol experiments differ in alcohol application, the possibility of alcohol self-administration at the subjects own discretion as well as the age of the participants. Question: Is cortisol secretion modified by gender during alcohol infusion? Do men and women show different cortisol levels under alcohol exposure when compared to the baseline? Is there a dose-response relationship between cortisol secretion and acute alcohol exposure? Have family history, smoking habits and alcohol induced side effects like nausea an influence on the cortisol secretion under alcohol exposure? Materials and methods: 48 18 year old subjects participated in two identical sessions in which they were able to regulate their maximum blood alcohol concentration up to a safety limit of 1.2 ‰ (i.e., 0.12%). The experiment was conducted by using a special software for self-infusion of ethanol (CASE) which guided the participants through a two and a half hours long experiment. CASE is founded on a validated physiologically-based pharmacokinetic model and involves calculating the infusion volume needed to increase the blood alcohol concentration in a linear manner. The BAC increases after each alcohol request by 0,075 ‰ (i.e., 0.0075%) within in two and a half minutes. If the subject infuses no alcohol the blood alcohol concentration will decrease by 0.01 ‰ (i.e., 0.001%) per minute. Through the precise calculation of the infusion rate, individual differences can be eliminated. Cortisol levels were measured at five time points: an initial baseline measurement and four measurements at fixed time points during the alcohol self-administration of subjects with two completed alcohol experiments. As an appropriate measure to examine the effect of alcohol self-administration on cortisol secretion, the maximum blood alcohol concentration was determined. In addition the day of experiment, gender and family history were observed as well as exploratory maximum nausea and smoking habits. Results: In conclusion, the results confirmed that women have higher cortisol levels than men at baseline and under alcohol influence. Blood alcohol concentration as examined influencing variable was shown to have different effects on the HPA system on day one and two. On the first day of experimentation there was no effect of blood alcohol concentration on the HPA system. On the second day a dose-response relationship could be identified between cortisol secretion and acute alcohol exposure. Individually higher blood alcohol concentrations attenuated cortisol stronger in comparison to subjects with lower blood alcohol concentrations. Family history, smoking habits and unpleasant side effects (nausea) did not affect the cortisol secretion under alcohol exposure in this series of experiments. Conclusions: Current data suggests that alcohol experiments affect the cortisol secretion in young social drinkers. These findings could be detected for the first time. Up to this point there has not been an experimental study that investigated and evaluated the dose-effect relationship between cortisol secretion and alcohol in a study design which uses intravenous alcohol self-administration. It can be theorized that the first day of experimentation is suitable as a settling-in phase due to unspecific confounding factors, whereas the second day can be considered, in an identical setting, apt for hypothesis testing. The increased cortisol level in women when compared to men is consistent with previous studies and there was no indication that family history, smoking habits and alcohol induced unpleasant side effects have an influence on cortisol secretion.:Inhaltsverzeichnis 3 Abbildungsverzeichnis 6 Tabellenverzeichnis 7 Abkürzungsverzeichnis 8 1 Einleitung 10 1.1 Alkohol – eine kurze Einführung 10 1.2 Bedeutung des Zusammenhangs von HPA-System und Alkohol 12 1.2.1 Experimentelle Alkoholselbstverabreichung 12 1.2.2 Neuropharmakologie von Alkohol 13 1.2.3 Geschlechtsunterschiede bei der Cortisolsekretion 14 1.2.4 Übelkeit und die Auswirkungen auf die Cortisolsekretion unter Alkoholexposition 15 1.3 Orale Alkoholverabreichung versus intravenöse Alkoholverabreichung 16 1.4 Zielsetzung 19 2 Material und Methoden 20 2.1 Versuchsteilnehmer 20 2.1.1 Einschlusskriterien 20 2.1.2 Ausschlusskriterien 21 2.1.3 Aufnahmeuntersuchung 22 2.2 Versuchsaufbau und Durchführung 22 2.2.1 Versuchsprinzip 23 2.2.2 Versuchsablauf 24 2.2.3 Verwendete Materialien 27 2.2.4 CASE Software 27 2.2.5 Herstellung der 6%igen Alkohol-Infusionslösung 29 2.2.6 Messung der BAK 30 2.2.7 Verwendete Fragebögen und Selbsteinschätzungstests 30 2.3 Blutverarbeitung 31 2.3.1 Blutbehandlung im Labor (Testkit der Firma IBL International GMBH) 32 2.3.1.1 Testprinzip im Labor 32 2.3.1.2 Testdurchführung bei Serumproben 32 2.3.1.3 Testauswertung 33 2.4 Statistische Auswertung 33 3 Ergebnisse 37 3.1 Versuchsteilnehmer 37 3.2 Konfirmatorische Datenanalyse der Cortisolsekretion 38 3.2.1 CASE Ergebnisvariablen 38 3.2.2 Analyse von Baseline Cortisol Tag eins vs. Tag zwei 39 3.2.3 Einfluss von Familienanamnese, Geschlecht und maximalem Blutalkohol auf die Cortisolsekretion 40 3.2.3.1 Beobachtung beider Experimentaltage zusammen 40 3.2.3.2 Getrennte Beobachtung für den ersten Experimentaltag 44 3.2.3.3 Getrennte Beobachtung für den zweiten Experimentaltag 46 3.2.3.4 Einfluss von max BAK Tag zwei auf den prozentualen Anteil der Nettofläche an der Gesamtfläche Tag zwei 48 Explorative Analyse von potentiellen weiteren Einflussfaktoren 49 3.3.1 Der Effekt von Übelkeit auf die Cortisolsekretion 49 3.3.2 Der Effekt von Rauchen auf die Cortisolsekretion 50 4 Diskussion 52 4.1 Auswahl der CASE Ergebnisvariablen 52 4.2 Unterschiede zwischen dem ersten und zweiten Experimentaltag 53 4.3 Verschiedene Einflüsse auf die Cortisolsekretion 54 4.3.1 Einfluss von Geschlecht 54 4.3.2 Einfluss von max BAK 55 4.3.3 Einfluss von Familienanamnese 55 4.4 Unterschiede zu vorhergehenden Studien 56 4.5 Diskussion der explorativen Datenanalyse 57 4.5.1 Einfluss von Übelkeit auf die Cortisolsekretion 57 4.5.2 Einfluss von Rauchen auf die Cortisolsekretion 58 4.6 Limitation der D-LAYA Studie 59 4.7 Ausblick 60 Zusammenfassung 6