The Moral Obligation to Prioritize Research Into Deep Brain Stimulation Over Brain Lesioning Procedures for Severe Enduring Anorexia Nervosa

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost

T cells but not NK cells are associated with a favourable outcome for resected colorectal liver metastases

T cells, but not NK cells, are preferentially recruited to colorectal liver metastases. NK cells within colorectal metastases have an intrahepatic and potentially tolerogenic, rather than a peripheral, phenotype. Similar to primary tumours, the magnitude of the T cell infiltrate in colorectal metastases is positively associated with surviva

Applying emotion-focused therapy to work with the ‘anorexic voice’ within anorexia nervosa: a brief intervention

Existent treatments for anorexia nervosa (AN) have produced dissatisfactory outcomes. Research suggests that many people with AN experience an internal “voice” that is related to eating disorder symptoms and relapse. This study was designed to consider the feasibility and acceptability of a new emotion-focused therapy (EFT) of AN, which is designed to work directly with the anorexic voice (AV; EFT-AV). Six adult clients diagnosed with AN who were experiencing an AV and awaiting psychological treatment were recruited from an adult outpatient service. Informed by EFT and previous AV research, the intervention involved six weekly individual sessions that focused on transforming AV experiences and promoting self-compassion. Participants completed standardized measures of eating disorder symptoms, relating to the AV, illness beliefs, motivation to change, and hope of recovery. Participants were also interviewed at the conclusion of the intervention to ascertain their views of on its acceptability. Findings suggested good recruitment, retention, and treatment adherence, which supported the feasibility of the EFT-AV intervention. Thematic analysis of participant interviews indicated the intervention was acceptable and tolerable. Future directions for the treatment of AN, including the potential value of EFT-AV as an adjunct to existing therapies, are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved

Communicating about medications during primary care outpatient visits: the role of electronic medical records

Objectives To assess the role of electronic medical records (EMR) in facilitating the content and process of patient_provider exchanges about medications during outpatient primary care visits. Methods Fifty encounters with six physicians using The EMR were videotaped, transcribed and content-analysed by applying conversation analysis and ethno-methodology techniques. The analysis focused on three aspects of medication communication: (1) process of care: practices by patients and physicians to implement medication decisions; (2) themes: medication topics that consistently emerge; and (3) names: ways patients and physicians refer to medications. In-depth analysis of 20 encounters examined the extent to which either or both parties initiated, expanded and concluded medication discussions. Results On average 21.2 (range: 8_35; SD=7.4) distinct exchanges per encounter were observed. Of those, 33% were related to medication. Of the 350 medication-related exchanges throughout the encounters, 56% were categorised as routine medication discussion such as ordering and/or refilling medications. Mailing issues were the next most common medication-related exchanges (10.6%), followed by partial adherence (8.9%), self-regulation (7.4%), alternative therapy/over-the-counter medication (6.6%), side effects (6%) and formulary issues (4.6%). Patients and providers used three ways to name medications: generic/scientific name (42%); physical description (39.7%) and brand name (18.3%). Forty-one percent of exchanges included initiation by one or both parties but no further discussion of the issue; 42% included initiation and expansion by both parties but not conclusion; only 17% of exchanges contained complete medication exchanges (initiation, expansion and conclusion) by both parties. Conclusions EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, fewer than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens

Offering patients choices: A pilot study of interactions in the seizure clinic

Using conversation analysis (CA), we studied conversations between one United Kingdom-based epilepsy specialist and 13 patients with seizures in whom there was uncertainty about the diagnosis and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five, a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g., to address patient resistance). Close linguistic and, interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician dominated. (C) 2010 Elsevier Inc. All rights reserved

Does urban agriculture contribute to food security, and how might this be achieved?

Food system challenges exacerbate inequalities in access to fresh healthy food and threaten food security. Lack of food security, referred to as food insecurity, is associated with poorer physical and mental health outcomes and has been identified as a key challenge to address by calls for food system transformation. Increasing food production through urban agriculture, the production of fruit and vegetables in urban areas, has been identified as a potentially effective contributor to food system transformation, but the effect of this on household or UK-level food security is unclear. This paper reviews international evidence of urban agriculture's impact on food security. While findings are mixed, available evidence suggests that urban agriculture makes a modest, yet positive, contribution to food security by facilitating the availability of and access to fresh fruit and vegetables to food insecure households. In the UK, studies have shown this to be particularly beneficial during times of food system disruption. Capitalising on such benefits to improve food security requires government investment and support at both the national and local level, therefore increasing access to land for food growing, reducing costs of related resources, and collaboration with existing community groups to enhance sharing of skills and expertise, are identified as avenues for exploration that may help to achieve this. This review also highlights opportunities for future research in this field that may strengthen the quality of the evidence supporting urban agriculture's impact on food security

Maternal Style Selectively Shapes Amygdalar Development and Social Behavior in Rats Genetically Prone to High Anxiety

The early-life environment critically influences neurodevelopment and later psychological health. To elucidate neural and environmental elements that shape emotional behavior, we developed a rat model of individual differences in temperament and environmental reactivity. We selectively bred rats for high vs. low behavioral response to novelty and found that high reactive (bHR) rats display greater risk-taking, impulsivity, and aggression relative to low reactive (bLR) rats, which show high levels of anxiety/depression-like behavior and certain stress vulnerability. The bHR/bLR traits are heritable but prior work revealed bHR/bLR maternal style differences, with bLR dams showing more maternal attention than bHRs. The present study implemented a cross-fostering paradigm to examine the contribution of maternal behavior on bLR offspring’s brain development and emotional behavior. bLR offspring were reared by biological bLR mothers or fostered to a bLR or bHR mother and then evaluated to determine effects on: 1) developmental gene expression in the hippocampus and amygdala; and 2) adult anxiety/depression-like behavior. Genome-wide expression profiling showed that cross-fostering bLR rats to bHR mothers shifted developmental gene expression in the amygdala (but not hippocampus), reduced adult anxiety and enhanced social interaction. Our findings illustrate how an early-life manipulation such as cross-fostering changes the brain’s developmental trajectory and ultimately impacts adult behavior. Moreover, while earlier studies highlighted hippocampal differences contributing to the bHR/bLR phenotypes, our results point to a role of the amygdala as well. Future work will pursue genetic and cellular mechanisms within the amygdala that contribute to bHR/bLR behavior either at baseline or following environmental manipulations