Using Hypnotic Suggestion to Model Loss of Control and Awareness of Movements: An Exploratory fMRI Study

The feeling of voluntary control and awareness of movement is fundamental to our notions of selfhood and responsibility for actions, yet can be lost in neuropsychiatric syndromes (e.g. delusions of control, non-epileptic seizures) and culturally influenced dissociative states (e.g. attributions of spirit possession). The brain processes involved remain poorly understood. We used suggestion and functional magnetic resonance imaging (fMRI) to investigate loss of control and awareness of right hand movements in 15 highly hypnotically suggestible subjects. Loss of perceived control of movements was associated with reduced connectivity between supplementary motor area (SMA) and motor regions. Reduced awareness of involuntary movements was associated with less activation in parietal cortices (BA 7, BA 40) and insula. Collectively these results suggest that the sense of voluntary control of movement may critically depend on the functional coupling of SMA with motor systems, and provide a potential neural basis for the narrowing of awareness reported in pathological and culturally influenced dissociative phenomena.     

Posttraumatic Headache: An Exploratory Treatment Study

Fourteen patients with posttraumatic headache (PTHA) were treated with a comprehensive treatment package targeting headache symptoms along with associated posttraumatic stress symptoms. Treatment consisted of some or all of the following depending on headache features: thermal biofeedback, electromyography biofeedback targeting the forehead and/or neck muscles, progressive muscle relaxation, education and cognitive–behavioral therapy. Mean improvement for the treatment group was 21%, whereas mean improvement for the wait-list group was –14% indicating a worsening of headache; however, the difference between groups was not statistically significant. There was a significant between groups difference on headache-free days. Within group results were modest with 29% mean improvement by the end of treatment. The reduction in headache index was significant. Minor reductions in psychopathology, most notably anxiety, were found after treatment. This study confirmed the treatment difficulties seen in this understudied population of headache sufferers, but offered hope for symptom relief.     

Companion Animals in Obituaries: An Exploratory Study

ABSTRACT

The benefits of human–animal interaction have been discussed extensively in the literature. In this paper we take a slightly different strategy in documenting that some humans acknowledge the importance of pets by actually referring to them in human obituaries. We begin with a brief overview of the human obituary, followed by the potential for pets as fictive kin to be named as survivors in obituaries. A bi-national, exploratory, content analysis of companion animal (CA)-related content in published newspaper obituaries is reported. The two criteria for inclusion were that a pet or pet survivors be named in the obituary or that donations be made to a pet-related charity. Of the 11,818 obituaries in three newspapers over a three-month period, 260 (2.2%) met one or both of these criteria. Five themes emerged within obituaries containing CA data. First, the word “pet” was rarely used. CAs were typically listed as survivors along with human family members. Second, terms of endearment were consistently used to describe animal companions left behind. Third, some family members, who likely crafted these last statements about their loved ones, engaged in a personification of (and projections onto) the animals left behind. Fourth, there was variation in the roles played by each person with their animal companion. And fifth, donations were made to a wide variety of animal charities. The possibility of CAs as fictive kin is explored, in addition to a call for further study.     

An Exploratory Framework for the Empirical Measurement of Resilience

Deliberate progress towards the goal of long-term sustainability depends on understanding the dynamics of linked social and ecological systems. The concept of social-ecological resilience holds promise for interdisciplinary syntheses. Resilience is a multifaceted concept that as yet has not been directly operationalized, particularly in systems for which our ignorance is such that detailed, parameter-rich simulation models are difficult to develop. We present an exploratory framework as a step towards the operationalization of resilience for empirical studies. We equate resilience with the ability of a system to maintain its identity, where system identity is defined as a property of key components and relationships (networks) and their continuity through space and time. Innovation and memory are also fundamental to understanding identity and resilience. By parsing our systems into the elements that we subjectively consider essential to identity, we obtain a small set of specific focal variables that reflect changes in identity. By assessing the potential for changes in identity under specified drivers and perturbations, in combination with a scenario-based approach to considering alternative futures, we obtain a surrogate measure of the current resilience of our study system as the likelihood of a change in system identity under clearly specified conditions, assumptions, drivers and perturbations. Although the details of individual case studies differ, the concept of identity provides a level of generality that can be used to compare measure of resilience across cases. Our approach will also yield insights into the mechanisms of change and the potential consequences of different policy and management decisions, providing a level of decision support for each case study area.     

An Exploratory Study of Air Quality Near Natural Gas Operations

This exploratory study was designed to assess air quality in a rural western Colorado area where residences and gas wells co-exist. Sampling was conducted before, during, and after drilling and hydraulic fracturing of a new natural gas well pad. Weekly air sampling for 1 year revealed that the number of non-methane hydrocarbons (NMHCs) and their concentrations were highest during the initial drilling phase and did not increase during hydraulic fracturing in this closed-loop system. Methylene chloride, a toxic solvent not reported in products used in drilling or hydraulic fracturing, was detected 73% of the time; several times in high concentrations. A literature search of the health effects of the NMHCs revealed that many had multiple health effects, including 30 that affect the endocrine system, which is susceptible to chemical impacts at very low concentrations, far less than government safety standards. Selected polycyclic aromatic hydrocarbons (PAHs) were at concentrations greater than those at which prenatally exposed children in urban studies had lower developmental and IQ scores. The human and environmental health impacts of the NMHCs, which are ozone precursors, should be examined further given that the natural gas industry is now operating in close proximity to human residences and public lands.     

Serum Levels of Oxylipins in Achilles Tendinopathy: An Exploratory Study

Background

Linoleic acid-derived oxidation products are found in experimental pain models. However, little is known about the levels of such oxylipins in human pain. In consequence, in the present study, we have undertaken a lipidomic profiling of oxylipins in blood serum from patients with Achilles tendinopathy and controls.

Methodology/Principal findings

A total of 34 oxylipins were analysed in the serum samples. At a significance level of P<0.00147 (<0.05/34), two linoleic acid-derived oxylipins, 13-hydroxy-10E,12Z-octadecadienoic (13-HODE) and 12(13)-dihydroxy-9Z-octadecenoic acid (12,13-DiHOME) were present at significantly higher levels in the Achilles tendinopathy samples. This difference remained significant when the dataset was controlled for age, gender and body-mass index. In contrast, 0/21 of the arachidonic acid- and 0/4 of the dihomo-γ-linolenic acid, eicosapentaenoic acid or docosahenaenoic acid-derived oxylipins were higher in the patient samples at this level of significance. The area under the Receiver-Operator Characteristic (ROC) curve for 12,13-DiHOME was 0.91 (P<0.0001). Levels of four N-acylethanolamines were also analysed and found not to be significantly different between the controls and the patients at the level of P<0.0125 (<0.05/4).

Conclusions/Significance

It is concluded from this exploratory study that abnormal levels of linoleic acid-derived oxylipins are seen in blood serum from patients with Achilles tendinopathy. Given the ability of two of these, 9- and 13-HODE to activate transient receptor potential vanilloid 1, it is possible that these changes may contribute to the symptoms seen in Achilles tendinopathy.     

Animal Hoarding in Victoria,Australia: An Exploratory Study

Animal hoarding not only presents significant welfare issues for the animals involved, but also for the hoarders and people in the surrounding community. Existing studies on the issue have primarily been undertaken in the USA and little is known about animal hoarding in other countries, including Australia. It has been estimated that the per-capita prevalence of animal hoarding in Victoria, Australia, is similar to that in the USA, but in order to design effective intervention strategies, the extent of the issue and its characteristics need to be identified. This study analyzes data from 22 recent cases of animal hoarding from a number of agencies in Victoria. The demographics and living conditions of animal hoarders in Victoria and the USA were found to be similar. In contrast, the animals involved in hoarding cases in Victoria were in a better condition than the animals in the USA, with behavioral issues being the leading animal welfare concern in Australia. Behavioral problems resulted in euthanasia of the animals in 45% of the cases studied. All of the agencies included in this study call for a greater involvement or support from human mental health services to fully address the root of the problem. The information from this study can be used to help identify groups at risk to develop effective and appropriate means of prevention of, and intervention in, animal hoarding cases.     

Parental Decision-Making and Acceptance of Newborn Bloodspot Screening: An Exploratory Study

Objective

Newborn bloodspot screening is an internationally established public health measure. Despite this, there is a paucity of information relating to the decision-making process that parents go through when accepting newborn screening. This is important as screening panels are expanding; potentially leading to an increasing amount of complex information. This study sought to understand the factors that influence parental decisions and roles they play in the decision-making process.

Patients and Methods

Qualitative thematic evaluation of semi structured interviews with parents whose children had recently undergone newborn screening in the Merseyside and Cheshire region of England, UK.

Results

Eighteen interviews with first time parents (n = 12) and those with previous children (n = 6). Seven factors were identified as being either explicitly or implicitly related to parental decision-making: Experience, Attitudes to medicine, Information-seeking behaviour, Perceived knowledge, Attitudes to screening, and Perceived choice, all of which ultimately impact on Perceived decisional quality.

Conclusions

These results indicate that while content is important, other contextual factors such as personal experience, perceived choice, and general attitudes toward medicine, are also highly influential. In particular, relationships with key healthcare professionals are central to information collection, attitudes toward screening, and the level of deliberation that is invested in decisions to accept newborn bloodspot screening.     

An 'Importance' Map of Signs and Symptoms to Classify Diabetic Polyneuropathy: An Exploratory Data Analysis

Aims/Hypothesis

Early diagnosis of diabetic polyneuropathy (DPN) is critical for a good prognosis. We aimed to identify different groups of patients, based on the various common clinical signs and symptoms of DPN, that represent a progressive worsening of the disease before the onset of plantar ulceration or amputation. We also sought to identify the most important DPN-related variables that can discriminate between groups, thus representing the most informative variables for early detection.

Methods

In 193 diabetic patients, we assessed 16 DPN-related signs, symptoms, and foot characteristics, based on the literature and the International Consensus on the Diabetic Foot. We used multiple correspondence analysis and the Kohonen algorithm to group the variables into micro and macro-classes and to identify clusters of patients that represent different DPN conditions.

Results

Four distinct groups were observed. One group showed no indication of DPN. The remaining groups were characterized by a progressive loss of the vibration perception, without a worsening of symptoms or tactile perception. The 2 intermediate groups presented different aspects of DPN: one showed mostly DPN symptoms and the other showed the incipient vibration impairment, callus and crack formation, and foot arch alteration. The fourth group showed more severe foot and DPN conditions, including ulceration and amputation, absence of vibration and tactile perception (irrespective of how many compromised foot areas), and worse foot deformities and callus and crack formation.

Conclusion

Vibration perception was more informative than tactile sensitivity in discriminating early DPN onset because its impairment was evident in more groups. Symptoms and callus and cracks did not discriminate the severity status and should be interpreted in association with other clinical variables. Reconsideration of the current screening techniques is needed to clinically determine the early onset of neuropathy using tactile perception.     

The Correlation between Rates of Cancer and Autism: An Exploratory Ecological Investigation

Background

Autism is associated with high rates of genomic aberrations, including chromosomal rearrangements and de novo copy-number variations. These observations are reminiscent of cancer, a disease where genomic rearrangements also play a role. We undertook a correlative epidemiological study to explore the possibility that shared risk factors might exist for autism and specific types of cancer.

Methodology/Principal Findings

To determine if significant correlations exist between the prevalence of autism and the incidence of cancer, we obtained and analyzed state-wide data reported by age and gender throughout the United States. Autism data were obtained from the U.S. Department of Education via the Individuals with Disabilities Education Act (IDEA) (2000–2007, reported annually by age group) and cancer incidence data were obtained from the Centers for Disease Control and Prevention (CDC) (1999–2005). IDEA data were further subdivided depending on the method used to diagnose autism (DSM IV or the Code of Federal Regulations, using strict or expanded criteria). Spearman rank correlations were calculated for all possible pairwise combinations of annual autism rates and the incidence of specific cancers. Following this, Bonferroni''s correction was applied to significance values. Two independent methods for determining an overall combined p-value based on dependent correlations were obtained for each set of calculations. High correlations were found between autism rates and the incidence of in situ breast cancer (p≤10⁻¹⁰, modified inverse chi square, n = 16) using data from states that adhere strictly to the Code of Federal Regulations for diagnosing autism. By contrast, few significant correlations were observed between autism prevalence and the incidence of 23 other female and 22 male cancers.

Conclusions

These findings suggest that there may be an association between autism and specific forms of cancer.     

Enhancing Personal Wellness in Counselor Trainees Using Biofeedback: An Exploratory Study

The purpose of this study was to explore whether biofeedback-assisted relaxation training could reduce stress-related symptoms and enhance personal well-being in a group of counselor trainees enrolled in a basic counseling skills course. Treatment participants received ten sessions of weekly biofeedback-assisted relaxation training, whereas the control participants received no intervention. The treatment group showed, significant improvements in several symptom areas measured by the Symptom Checklist 90-Revised: physical complaints (Somatization), personal inadequacy (Interpersonal Sensitivity), confused thinking or alienation or both (Psychoticism), and the overall number and severity of symptoms (Global Severity Index and Positive Symptom Total). The control participants showed no significant improvements in any symptom areas. Biofeedback-assisted relaxation was shown to be an effective stress-reducing intervention for counselor trainees, which resulted in a greater sense of personal well-being.     

Microarray-Based Genotyping and Clinical Outcomes of Staphylococcus aureus Bloodstream Infection: An Exploratory Study

The clinical course of Staphylococcus aureus bacteremia varies extensively. We sought to determine the relationship between genetic characteristics of the infecting pathogen and clinical outcomes in an exploratory study. In two study centers, 317 blood culture isolates were analyzed by DNA microarray and spa genotyping. By uni- and multivariate regression analyses associations of genotype data with 30-day all-cause mortality, severe sepsis/septic shock, disseminated disease, endocarditis, and osteoarticular infection were investigated. Univariate analysis showed significant association between S. aureus genes/gene-clusters or clonal complexes and clinical endpoints. For example CC15 was associated with 30-day mortality and CC22 with osteoarticular infection. In multivariate analysis methicillin resistance (mecA, OR 4.8 [1.43–16.06]) and the beta-lactamase-gene (bla, OR 3.12 [1.17–8.30]) remained independently associated with 30-day mortality. The presence of genes for enterotoxins (sed/sej/ser) was associated with endocarditis (OR 5.11 [1.14–18.62]). Host factors such as McCabe classification (OR 4.52 [2.09–9.79] for mortality), age (OR 1.06 [1.03–1.10] per year), and community-acquisition (OR 3.40 [1.31–8.81]) had a major influence on disease severity, dissemination and mortality. Individual genotypes and clonal complexes of S. aureus can only partially explain clinical features and outcomes of S. aureus bacteremia. Genotype-phenotype association studies need to include adjustments for host factors like age, comorbidity and community-acquisition.     

Component-Specific Self-Regulation of Slow Cortical Potentials and its Effect on Behavior: An Exploratory Study

In the present study, the possibility of component-specific self-regulation of the contingent negative variation (CNV) and the functional significance of the iCNV (initial or early CNV component) and tCNV (terminal or late CNV component) were investigated in twenty-four healthy volunteers. The subjects were able to achieve control over a particular CNV component within four sessions. Regulation of the tCNV was more successful than for the iCNV. Specific control over iCNV was associated with strategies mainly related to the pre-stimulus interval or the warning stimulus (S1), while regulation of the tCNV was assigned to activities during the whole interstimulus interval or around the imperative stimulus (S2). It can be concluded that component-specific regulation of the CNV can be used in studies of the psychophysiological meaning of this potential, representing different stages of information processing. The role of cortical pre-activation in the generation of the iCNV and the phasic performance-directed activation of the tCNV can be hypothesized.     

Glycerolized Reticular Dermis as a New Human Acellular Dermal Matrix: An Exploratory Study

Human Acellular Dermal Matrices (HADM) are employed in various reconstructive surgery procedures as scaffolds for autologous tissue regeneration. The aim of this project was to develop a new type of HADM for clinical use, composed of glycerolized reticular dermis decellularized through incubation and tilting in Dulbecco’s Modified Eagle’s Medium (DMEM). This manufacturing method was compared with a decellularization procedure already described in the literature, based on the use of sodium hydroxide (NaOH), on samples from 28 donors. Cell viability was assessed using an MTT assay and microbiological monitoring was performed on all samples processed after each step. Two surgeons evaluated the biomechanical characteristics of grafts of increasing thickness. The effects of the different decellularization protocols were assessed by means of histological examination and immunohistochemistry, and residual DNA after decellularization was quantified using a real-time TaqMan MGB probe. Finally, we compared the results of DMEM based decellularization protocol on reticular dermis derived samples with the results of the same protocol applied on papillary dermis derived grafts. Our experimental results indicated that the use of glycerolized reticular dermis after 5 weeks of treatment with DMEM results in an HADM with good handling and biocompatibility properties.     

Anthropological Views of Play

Until very recently anthropology has given little attentionto the study of human play, a circumstance which reflects theWestern view that play is unseemly behavior. Modern anthropologistsnow view play as universal and strikingly conspicuous humanbehavior that must be studied to reach the goal of understandingman and his culture. Physical anthropologists have concernedthemselves with the play of nonhuman primates, giving attentionto its bearing upon human behavior and the question of the evolutionarysignificance of play behavior. Cultural and social anthropologistslook at play as culturally molded behavior and examine similaritiesand differences in its forms throughout the world. Althoughmuch variation exists in specific forms of play, all human societiesare seen to be fundamentally alike in their play behavior. Greatestattention is now being given to the functional and dysfunctionalsignificance of play in human life and the relationship of playto other elements of culture. Major subjects of current studyare play and social control, play and social-psychological problems,play and communication-cognition, and play as related to a varietyof other subjects including religion, law, economics, motivationtoward achievement, politics, aggression, role-learning, andcreativity.     

PET-based Treatment Response Assessment for Neoadjuvant Chemoradiation in Pancreatic Adenocarcinoma: An Exploratory Study

PURPOSE: Performance of anatomical metrics of Response Evaluation Criteria in Solid Tumors (RECIST1.1) versus Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST1.0) for neoadjuvant chemoradiation (nCR) of pancreatic adenocarcinoma was evaluated based on the pathological treatment response (PTR) data. METHODS AND MATERIALS: The pre- and post-nCR CT and PET data for 14 patients with resectable or borderline resectable pancreatic head adenocarcinoma treated with nCR followed by surgery were retrospectively analyzed. These data were compared with the PTR which were graded according to tumor cell destruction (cellularity), with Grade 0, 1, 2 or 3 (G0, G1, G2 or G3) for complete, moderate, minimal and poor responses, respectively. Maximum standardized uptake value (SUVmax) was defined using body-weight (SUVbw). PERCIST1.0 was defined using lean-body mass normalized SUV (SUVlb or SUL). RECIST1.1 was defined by contouring the whole pancreas head on the CT image. Pre- and post-SUL-peak and SUVmax, RECIST1.1 and PETRECIST1.0 were correlated with PTR using Pearson’s correlation coefficient test. RESULTS: The average mean and SD in SUL-peak for all patients analyzed were lower in post-nCR (3.63±1.06) compared to those at pre-nCR (4.29±0.89). Using PERCIST1.0, 62% of patients showed stable metabolic disease (SMD), 23% partial metabolic response (PMR), and 15% progressive metabolic disease (PMD). Using RECIST1.1, 85% of patients showed stable disease (SD), 8% partial response (PR), and 7% progressive diseases (PD). A poor insignificant correlation was established between PRT and PERECIST1.0 (r=0.121), whereas no correlation was seen with RECIST1.1. CONCLUSIONS: PERCIST1.0 appears to increase the chance of detecting patients with progressive disease compared to the conventional anatomical-based assessment of RECIST1.1. The integration of these additional radiographic metrics in assessing treatment response to nCR for pancreatic adenocarcinoma may provide a promising strategy to better select patients that are most suitable for therapeutic intensification.