Symptom variability following acute exercise in myalgic encephalomyelitis/chronic fatigue syndrome: a perspective on measuring post-exertion malaise

Background: Consensus for an operational definition of post-exertion malaise (PEM) and which symptoms best characterize PEM has not been established and may be due to variability within and between studies. Purpose: Determine the magnitude of the effect of maximal and submaximal physical exertion on multiple myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms that are associated with PEM and explore variability among two studies in which mood, fatigue, and pain symptoms were measured before and after exercise. Methods: Symptoms were measured before, and 48 and 72 hours after exercise in study 1 (ME/CFS = 13; Controls = 11) and before and 24 hours after exercise in study 2 (ME/CFS = 15, Controls = 15). Between-study variability was examined by comparing Hedges d effect sizes (95% CI) from studies 1 and 2. Within-patient group variability was examined via inspection of dot density plots. Results: In study 1, large increases in general fatigue (Δ = 1.05), reduced motivation (Δ = 0.93), feelings of fatigue (Δ = 0.90), feelings of confusion (Δ = 0.93), and total mood disturbance (Δ = 0.90) were found at 72 hours. In study 2, a large increase in affective/sensory pain (Δ = 0.79) was found at 24 hours. Dot density plots in both studies revealed substantial variability among people with ME/CFS relative to healthy control participants. Conclusions: PEM symptoms are variable among people with ME/CFS and several gaps in the literature need to be addressed before guidelines for measuring PEM in the clinical or research setting can be established

Final Report of the AFIT Quality Initiative Internal Discovery Committee

This document contains results of a study designed to document the key elements for student success at AFIT in our continuing education and graduate programs and discover to what degree they exist at AFIT. The effort represents an attempt to guide improvement of our graduate and continuing education programs through experience available from our faculty, staff and students. The process outlined herein was designed to achieve success by allowing the participants to define what it means to succeed and then self-assess the presence of these factors at AFIT. It’s therefore a true internal discovery process since its output reflects the state of our internal understanding of teaching and learning excellence. This inclusive approach, which garnered participation from 400 people across AFIT’s schools, will be used in conjunction with the external committee\u27s recommendations to determine a course of action to invest into AFIT\u27s instructional capabilities

Differences in Physiological Responses to Exposure of Disturbing Auditory Versus Audiovisual Stimuli

An article that appeared in JASS, issue 2016Fear plays a significant role in the lives of many people, from crippling fear that prevents people from performing everyday activities, to that which is intentionally experienced from video game or horror movies. The physiological responses to fear-inducing stimuli may vary between individuals, but some common reactions include increased heart rate, respiration rate and muscle tension, collectively referred to in this study as the “fear response”. These common reactions are a result of the sympathetic nervous system reacting when presented with a threat, a.k.a: a scary scene in a horror movie. The hypothalamic-pituitary adrenal axis regulates the body’s behavior, including the autonomic responses that are being measured in this experiment. The purpose of this study is to analyze the fear response to either audio or audiovisual stimuli, and compare the severity of the physiological changes induced by both stimuli against each other. The 29 participants were randomly assigned to one of two groups: 15 Audio (Group A) and 14 Audiovisual (Group AV). Group A was instructed to listen only to the audio track of a stimulating horror movie trailer broken up into 4 segments, and Group AV was subjected to the same trailer but also experienced the visual aspects of the stimulus. It was hypothesized that the fear response to an auditory stimulus would be larger than the response to the audiovisual stimulus. Of the two groups, those who received the audiovisual stimulus elicited a stronger physiological response than the audio group in heart rate and respiration frequency, but there were no statistically significant difference between the two groups when measuring muscle tension and respiration frequency. However, the audio stimulus induced a biological response of greater magnitude in muscle tension compared to the audiovisual stimulus. The reason for heart rates showing the only significant difference in physiological measurements between Group A and Group AV may be because heart rate is an involuntary physiological response. In contrast, the measurements for EMG and respiration could be voluntarily altered by participants during the experiment. Overall, although our results did not all show statistical significance, differences between the two treatments groups were observed for each variable and therefore show a degree of biological significance

Maternal activity level in patients with preterm premature rupture of membranes: A Prospective Observational Cohort Study

Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM) Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor occurred. Patients were provided a pedometer to wear for the duration of their antepartum course and they have maternal activity at lib and were encouraged to go to the physical therapy gymnasium. Results: We enrolled 32 women. We stratified them in two groups: low activity as less than 500 step a day and higher maternal activity more than 500 steps a day, There were no significant differences in the demographics. Latency from PPROM to delivery were significantly prolonged in women with maternal activity \u3e 500 steps a day: 11.0 ± 8.42 vs 21.18 ± 4.26 days p = 0.004. No maternal or fetal adverse outcomes were identified. Conclusion: Maternal activity more than 500 steps a day showed a significant association with prolongation of latencyhttps://jdc.jefferson.edu/obgynposters/1001/thumbnail.jp

Symptom variability following acute exercise in myalgic encephalomyelitis/chronic fatigue syndrome: a perspective on measuring post-exertion malaise

Background: Consensus for an operational definition of post-exertion malaise (PEM) and which symptoms best characterize PEM has not been established and may be due to variability within and between studies. Purpose: Determine the magnitude of the effect of maximal and submaximal physical exertion on multiple myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms that are associated with PEM and explore variability among two studies in which mood, fatigue, and pain symptoms were measured before and after exercise. Methods: Symptoms were measured before, and 48 and 72 hours after exercise in study 1 (ME/CFS = 13; Controls = 11) and before and 24 hours after exercise in study 2 (ME/CFS = 15, Controls = 15). Between-study variability was examined by comparing Hedges d effect sizes (95% CI) from studies 1 and 2. Within-patient group variability was examined via inspection of dot density plots. Results: In study 1, large increases in general fatigue (Δ = 1.05), reduced motivation (Δ = 0.93), feelings of fatigue (Δ = 0.90), feelings of confusion (Δ = 0.93), and total mood disturbance (Δ = 0.90) were found at 72 hours. In study 2, a large increase in affective/sensory pain (Δ = 0.79) was found at 24 hours. Dot density plots in both studies revealed substantial variability among people with ME/CFS relative to healthy control participants. Conclusions: PEM symptoms are variable among people with ME/CFS and several gaps in the literature need to be addressed before guidelines for measuring PEM in the clinical or research setting can be established.This article is published as Lindheimer J, Meyer J, Stegner A, Rougherty R, Van Riper S, Shields M, Reisner A, Shukla S, Light A, Yale S, Cook D (2017). Symptom variability following acute exercise in ME/CFS: A perspective on measuring post-exertion malaise. Fatigue: Biomedicine, Health & Behavior, 5(2); 69-88. doi: 10.1080/21641846.2017.1321166.</p

Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation

BackgroundTransmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. ObjectiveThis study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. MethodsParticipants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. ResultsOverall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. ConclusionsThere is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people

Disparities in achieving and sustaining viral suppression among a large cohort of HIV-infected persons in care – Washington, DC *

One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load <200 copies/ml) at least once, and Kaplan–Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL≥200 copies/ml after achievement of VS). Among the 4,311 participants 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03–1.06 per 5-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04–1.06 per 100 cells/mm(3)). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51–0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally-infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p≤0.001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer-standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum