The Efficacy of Binaural Beats as a Stress-buffering Technique

CONTEXT

Distress has deleterious effects on health. While complementary and alternative medicine (CAM) is a growing system of practices in the treatment of health and mental-health conditions, many individuals have limited access to mind-body interventions. Creating accessible stress-inoculation strategies may augment traditional mental-health interventions and services.

OBJECTIVE

This pilot study intended to assess the effectiveness of a theta binaural beat (TBB) auditory stimulus on heart rate and self-reported stress, which was experimentally induced by the Trier Social Stress Test (TSST).

DESIGN

The repeated measures study compared the stress levels after a stimulus and stressor for two groups, within an experimentally induced psychological stress paradigm, the Trier Social Stress Test (TSST).

SETTING

The study occurred at a private Midwestern university.

PARTICIPANTS

Participants were 64 US adults recruited from undergraduate classes at the university, with a mean age of 19 years and a range from 18 to 30.

INTERVENTION

Participants were randomly assigned to the intervention or the control group. The intervention group listened to pink sound, carrier tones, and embedded TBB, while the control group listened to pink sound and carrier tones without embedded TBB.

OUTCOME MEASURES

Participants completed self-report assessments about the auditory stimulus, perceived stress, and mindfulness and then engaged in the Trier Social Stress Test (TSST). Subsequently, they completed measures on perceived stress using a visual analogue scale (VAS), and heart rate variability (HRV) was recorded throughout the study.

RESULTS

With respect to the evaluation of subjective stress using the VAS, psychological stress increased significantly between the exposure to the stimuli and the TSST-F(1.28, 53) = 42.76, P = .01, partial η2 = 0.44. The change in stress levels for the intervention group, however, was not significantly different from that of the control group at any time point F(1.28, 53) = 1.03, P = .33, partial η2 = 0.02. With respect to the evaluation of physiological response to stress using the HRV, the changes in HF HRV between the 4, five-minute segments during stimulus exposure were not significantly different between the groups F(3, 55) = 0.90, P = .44, partial η2 = 0.02. A significantly greater change-F(1, 55) = 4.84, P = .03 partial η2 = 0.08-in the HF HRV occurred over the TSST period for the intervention group compared to the control group suggesting that on average across the TSST stress tasks, those in the intervention group demonstrated higher HF signals.

CONCLUSIONS

The current study found that the intervention group, who listened to TBBs, had greater parasympathetic dominance during TSST than the control group. This suggests that TBB exposure may dampen subsequent stress responses to an acute, psychological stressor. This finding, however, should be interpreted with caution, because further research and independent replication are warranted.

EXAMINATION OF TRUST IN THE HEALTH CARE SYSTEM AMONG OLDER IMMIGRANTS RESIDING IN THE MIDWEST

Ethnic minority populations, such as immigrants, have demonstrated lower levels of trust in the health care system and their health care providers compared with non-migrant populations (Navaza et al., 2012; Renzaho, Polonsky, McQuilten, & Waters, 2013). This medical mistrust may adversely influence older adult immigrants’ use of and satisfaction with health services (Hong et al., 2018a; Jang, Kim, & Chiriboga, 2005). Thus, the current project aimed to characterize influences of medical mistrust (healthcare system and healthcare providers) in older adult immigrant populations living in the United States of America (U.S.). We interviewed 142 older adult immigrants and refugees (aged 60+ years) who identified as Bosnian, Chinese, Indian, Korean, Latino, and Vietnamese about their perceptions on living in the U.S., of the healthcare system, and healthcare utilization as a part of the Successful Aging among Immigrants in Midlife (SAIM) project. Linear regression models predicting trust in the healthcare system and trust in healthcare providers were tested with healthcare knowledge (measured with a single item about flu shots) , acculturation, length of time in the U.S. , and age as predictors. We found that older age and healthcare knowledge was predictive of higher levels of trust in healthcare providers for Chinese. Although healthcare knowledge was predictive of trust in the health care system for the Chinese participants, greater length of time and higher acculturation were associated with higher trust in the healthcare system among Indian participants. The implications of the different predictive variables in each of the hypothesized models will be discussed.

CHALLENGES AND IMPERFECT SOLUTIONS FOR COGNITIVE SCREENING WITH OLDER IMMIGRANTS

Cultural diversity among older adults is increasing and with this comes challenges in health care needs, including the detection of cognitive impairment. Cognitive impairments manifests in many ways, with early symptoms often difficult to detect. Detecting cognitive dysfunction is typically facilitated with brief, portable screening tools. Scores on screening tools may be influenced by culture, education, and verbal abilities; in particular, these are acute issues for screening older immigrants from linguistically and culturally diverse backgrounds. The consequences of improper screening are high and, as such, finding practical, cost-effective solutions is of critical importance. In this project, we qualitatively examined the usability of different cognitive screening tools with the ultimate goal of improving the detection and classification of cognitive dysfunction among older adult immigrants. We extended our previous work by piloting adaptation guidelines for the Saint Louis University Mental Status (SLUMS) exam for use with linguistically and culturally diverse persons. We recruited 23 older immigrants (6 non-English speaking) and 14 U.S. born participants to explore the usability and test-retest reliability of the SLUMS exam administered with and without the adaptation guidelines. Our attempts to improve the flexibility of the SLUMS exam did not achieve the level of success as anticipated. Although this pilot work had low power, when coupled with our past work on developing adaptation guidelines, sheds critical light on the layered complexity that arises at the intersections of education, culture, race, gender, socioeconomic status, and intercultural interactions and the resulting potential directions for future work will be discussed.

Prospective Memory and Resource Depletion: The Effect of Target Cue Types

Although theoretical accounts suggest prospective memory to be adversely affected when cognitive resources are subjected to depletion, previous research has not consistently supported this notion. It is possible that the inconsistencies are due in part to retrieval demands resulting from different target cue types. The primary aim of these studies was to determine resource depletion effects across different prospective memory target cue types that are hypothesized to involve varying levels of cognitive control. Given that recent theoretical accounts of how depletion effects involve consideration of motivational shifting, a secondary exploratory aim was to evaluate whether exposure to resource-depleting conditions would result in changes in intrinsic motivation. Both studies resulted in no convincing evidence that prospective memory performance after depletion exposure varied by target cue types. However, there was a small effect of depletion on 1 aspect of intrinsic motivation, perceived competency, in Study 1, but this effect was not replicated in Study 2. The results are in line with previous studies that have found no evidence that resource depletion affects prospective memory performance under controlled conditions but offer preliminary evidence that changes in motivation may be an important factor.

The association between pediatric injury risks and parenting behaviours

BACKGROUND

Unintentional injuries are the leading cause of death in children ages 1-18 years. Many of these injuries to young children occur in their own homes. Although research has explored injury risk prevention strategies, historically, much of this research has focused on environmental changes and teaching safety practices. Currently, there appears to be a gap in current research exploring how parenting influences children's risk of injury.

METHODS

Mothers (n = 119) of children 5 years and younger were recruited from a paediatric clinic as a part of a larger study and completed measures of parenting challenges, developmentally sensitive parenting, child neglect, parental efficacy, and risk of potential injury situations. Hierarchical logistic regression was used to explore the extent to which developmentally insensitive parenting behaviours put parents at higher risk for behaviours that lead to unintentional injury in children and whether developmentally sensitive parenting behaviours protects children from injury. The association between demographic characteristics and injury risk behaviours was also examined.

RESULTS

Parents who reported more frequent insensitive parenting behaviours (i.e., yelling, spanking, and putting child in time out) were more likely to report putting their child in an incorrect car seat or taking their child out of a car seat while the car is still moving. In addition, younger parents were at greater risk of storing cleaners and medications unsafely.

CONCLUSION

Results from this study highlight the importance of supporting younger mothers and educating parents on effective parenting strategies when trying to prevent unintentional injury risks.

Management of adult patients with buttock and perineal burns: The Ross Tilley Burn Centre experience

BACKGROUND

Perineal and buttock burns are challenging wounds to heal for several reasons because of the contamination risk and shear stress that is always present. Because of the nature of the wound bed, pathogens can have ready access to create systemic infections and complications. Prolonged healing times also delay the recovery for patients and add to their discomfort and psychological stress from the injury. The ideal treatment approach is not well defined, and the aims of this study were to conduct a literature review of current treatment suggestions and to look at our own patient population to determine how our center treated these challenging patients.

METHODS

This is a retrospective review of all patients treated between 2010 and 2013 at our center. Patients that received care for burns to the perineum or buttocks were evaluated. Mortalities within 24 hours of admission and transfers before completion of their care were excluded. All patients older than 18 years were included in the study. The primary outcome studied was a cause for graft revision. Secondary outcomes included benefits and risks of fecal management devices, risk of infection, and mortality.

RESULTS

The literature review did not show consensus on how to best manage this patient population. Our results however demonstrated that patients treated with the fecal management device Flexi-seal (Convatec, Skillman, NJ) were at increased risk of developing an infection involving an enteric pathogen and requiring revision procedures. The patient population that was treated with this device was also older and had larger burns. The patients within this group that were treated initially with allograft required fewer revisions when compared with patients that received autograft in this group (23% vs. 34%, p > 0.05).

CONCLUSION

After our data and the literature had been reviewed, the lack of evidence-based treatment protocols led us to create recommendations for burn surgeons with regard to the initial management of this complicated area. Certain key features include avoiding autograft at the primary excision if they have an increased revised Baux score and minimizing the amount of liquid stool contaminating the wound bed to increase success.

LEVEL OF EVIDENCE

Epidemiologic study, level IV. Therapeutic study, level V.

Accuracy of personal breast cancer risk estimation in cancer-free women during primary care visits

To determine the accuracy of personal breast cancer risk estimation, interviews were conducted of 110 women between November 2004 and May 2005 during primary care visits. The average age of the women was 39 years. Considering their lifetime breast cancer risk, 49% of women perceived their risk to be low, 35% average, and 11% high. Compared to Gail-model lifetime risk scores, 62% of women were inaccurate and underestimated or overestimated risk. Factors affecting accuracy of risk prediction were race, family history of cancer, alcohol use and exercise. Our study highlights the need for personalized breast cancer education between an individual woman and her health care provider.

Patient and graft survival implications of simultaneous pancreas kidney transplantation from old donors

We investigated graft and patient survival implications of simultaneous pancreas kidney (SPK) transplant from old donors. Data describing patients with type 1 diabetes mellitus listed for an SPK transplant from 1994 to 2005 were drawn from Organ Procurement and Transplant Network registries. Allograft survival, patient survival and long-term survival expectations among SPK recipients from young (age <45 years) and old (age >/=45 years) donors were modeled by multivariate regression. We also examined predictors of reduced early access to young donor transplants. Of 16 496 eligible SPK candidates, 8850 patients (53.6%) received an SPK transplant and 776 (8.8%) of these transplants were from old donors. Reasonable 5-year, death-censored kidney (77.8 %) and pancreas (71.3%) survivals were achieved with old donors. SPK transplantation from both young and old donors predicted lower mortality compared to continued waiting. An additional expected wait of 1.5 years for a young donor equalized long-term survival expectations to that achieved with use of old donors. Early allocation of young donor transplants declined in the more recent era and varied by region, candidate age, blood type and sensitization. We conclude that old SPK donors should be considered for patients with decreased access to young donor transplants. Prospective evaluation of this practice is needed.

The impact of human leukocyte antigen matching on transplant complications and immunosuppression dosage

Administrative claims data facilitate ascertainment of outcomes not collected by the transplant registry and provide the opportunity to examine prescribed doses of immunosuppressive medications. Here, we examine the impact of human leukocyte antigen (HLA) matching on traditional outcomes, rejection and survival, and use novel methods to examine immunosuppresion doses and complication rates. The central hypothesis tested in this analysis is that HLA-matched recipients receive lower doses of immunosuppression and have fewer posttransplant complications. We break from tradition by examining HLA matching in both living and deceased donor kidney transplants. As secondary aims, we compare the relative impact of class I and II mismatches and describe outcomes achieved with older donors. Medicare claims linked to the United States Renal Data System database for 23,443 kidney transplants were included in the study. A total of 15,793 transplants were DR mismatched (DRMM), 5,340 manifested no DR mismatches (NODRMM), and 2,310 manifested no ABDR mismatches (NOABDRMM). Patients with NOABDRMM experienced lower adjusted risk of rejection (0.66, 95% confidence interval 0.59-0.74, P < 0.001) and lower hazard of graft loss (0.69, 0.61-0.77, P < 0.001) and death (0.76, 0.63-0.92, P < 0.001) compared with those with DRMM. The hazard of cardiac and diabetic complications was similar between recipients of NOADRMM and DRMM transplants, but the hazard of diarrhea was significantly lower (0.82, 0.73-0.92, P < 0.001) in patients with NOABDRMM. The 6-month dose of mycophenolate mofetil was lower in patients with NOABDRMM. This study validates previous studies that indicated significantly lower risks of rejection, graft loss, and death among patients with 0 HLA-A,B,DR mismatches. Use of administrative claims revealed similar rates of cardiovascular complications. However, HLA-matched deceased donor recipients received lower dosages of mycophenolate mofetil and manifested a lower risk of developing posttransplant diarrhea.

Frontal Lobe Dysfunction and False Memory Susceptibility in Older Adults

The study reported here was conducted to examine the role of frontal lobe function in false memory susceptibility in older adults, as little research has specifically examined this question in older adults. False recognition was compared in three groups of older adults (one with no evidence of cognitive impairment, one with evident frontal impairment but no other dysfunction, and an Alzheimer's dementia group) to a single group of young adults. Results indicate that false memory susceptibility was highest in the frontally impaired group, with young and older control participants performing similarly. In contrast, Alzheimer's dementia patients showed relatively low levels of false memory susceptibility, likely due to overall poor memory for list items, indicating that general memory impairments are not likely to be driving false memory susceptibility. Potential mechanisms underlying these effects are discussed.

Neuroanaesthetists' experience of workload-related issues and long-duration cases

A survey of the members of the Neuroanaesthesia Society of Great Britain and Ireland was conducted to examine issues arising from the management of long cases. Replies were received from 47% of neuroanaesthetists. The survey highlights that consultants are working for prolonged periods without adequate rest. This may compromise patient safety, job satisfaction and recruitment to the specialty. These pressures are likely to increase as the European Working Time Directive reduces the availability of trainees, and because of expansion in neurosurgery and neuroradiology. Similar concerns are likely to extend into other anaesthetic specialties with long-duration cases and may apply to our surgical colleagues.

Apolipoprotein E ε4 Allele and Lorazepam Effects on Memory in High-Functioning Older Adults

CONTEXT

The apolipoprotein E (APOE) epsilon4 allele has been implicated as a significant risk factor in the development of late-onset Alzheimer disease, but the evidence of cognitive sequelae in healthy individuals has been mixed.

OBJECTIVE

To determine if the APOE epsilon4 allele increases susceptibility to lorazepam-induced verbal learning impairment in nondemented older adults.

DESIGN

A placebo-controlled crossover design.

SETTING

A community-based sample of subjects.

PARTICIPANTS

Sixty-four cognitively intact and highly educated (>12 years) adults. Twenty-four subjects (mean age, 66.3 years) were carriers of an APOE epsilon4 allele (epsilon4 positive) and 40 (mean age, 66.0 years) were not (epsilon4 negative).

INTERVENTIONS

All subjects received a single oral dose of placebo and lorazepam (0.5 and 1.0 mg) 1 week apart.

MAIN OUTCOME MEASURE

We used the Buschke Selective Reminding Test to assess verbal learning during a 5-hour period after placebo or lorazepam administration.

RESULTS

We found a time-related, dose-dependent effect of lorazepam, with long-term recall generally decreasing with higher doses of lorazepam at up to 2.5 hours. At 5 hours, the epsilon4-negative group showed significant improvement in long-term memory, but the epsilon4-positive group demonstrated a persistent deficit. Subsequent analysis revealed that the poor performance at 5 hours was found in an epsilon4-positive subgroup with lower baseline performance.

CONCLUSIONS

In cognitively intact, older adults, the effect of the APOE epsilon4 allele is not necessarily seen in the immediate response to benzodiazepine challenge. Rather, the APOE epsilon4 allele appears to affect the carrier's ability to recover from a cognitive challenge in a normal fashion, at least in a subgroup of subjects with relatively low baseline performance. This suggests that although carrying an APOE epsilon4 allele increases the risk for cognitive toxic effects, allele status alone is not a sufficient predictor of such effects. Studying the response to and the recovery from cognitive challenges may provide insights into the role of the APOE epsilon4 allele and its interaction with other factors in the development of Alzheimer disease and other age-related cognitive problems.

Application of diagnostic classification algorithms to identify the most common causes of post-transplant complications

ICD-9-CM diagnoses for hospitalizations occurring during the first 6 post-transplant months were summarized into Clinical Classifications System (CCS) categories. Of the 28,900 patients examined, 54% had at least one hospitalization. There were 2.39 hospitalizations per patient-year at risk. The total Medicare inpatient costs were $339 million and mean length of stay was 8.3 days. The most common and costly CCS diagnosis was complications of a kidney transplant followed by infections, circulatory system disease, gastrointestinal disease and endocrine complications. The CCS is a useful tool to summarize the complexity of claims information in the USRDS and could prove useful in further claims research.

A randomized trial of a somatostatin analog for preserving beta cell function in children with insulin dependent diabetes mellitus

In an attempt to rest the beta cells of newly diagnosed children with type I diabetes mellitus (IDDM) and thus possibly preserve beta cell function, ten children were given Octreotide, a somatostatin analog, for the first 21 days after diagnosis. Ten age-matched diabetic children served as controls. Although there were no differences in either insulin requirements or in hemoglobin A1 levels, there were significant increases in the glucagon-stimulated C-peptide levels of the experimental group at six and 12 months after diagnosis, compared to control patients.

Osseous expansion of the cranial vault by craniotasis

A study of cranial vault lengthening using a custom expandable fixation-distraction (craniotatic) appliance was performed in the young-adult rabbit model. Ten 24-week-old rabbits underwent circumferential suturectomy plus expansion (expanded group), 10 underwent circumferential suturectomy without expansion (sham control group), and 10 served as normal controls. The appliance was lengthened at a rate of 2.5 mm per week for 5 weeks. Serial lateral cephalometry, comparative dry-skull anthropometric measurements, and histologic examinations were performed. The expanded group demonstrated a significantly longer skull, cranial vault, anterior cranial base, posterior face, and orbit as compared with the control groups (p less than 0.05). Callus bone filled the distracted suturectomy and united the frontofacial complex to the posterior cranium. In conclusion, skull lengthening by distraction osteogenesis is possible in the rabbit model and offers a new technique for future investigation in the treatment of coronal synostosis.

Metathesis Polycondensation Chemistry as a Route to Unsaturated Elastomers

Acyclic diene metathesis (ADMET) polymerization offers a new opportunity to generate a wide variety of elastic structures using room temperature reaction conditions. It also offers the opportunity to modify existing elastomer structures through trans-metathesis copolymerization reactions. ADMET depolymerization could have tremendous significance if, in fact, the reaction can be applied to the recovery of commercial vulcanized elastomers. All of these opportunities are presently being investigated in our laboratory.

Components of variability of umbilical arterial Doppler velocimetry--a prospective analysis

This study prospectively analyzed the components of variance and error contributions of umbilical arterial Doppler indices in a normal pregnant population (308 women) with gestational ages ranging from 27 to 40 weeks. A continuous-wave Doppler instrument with a 4 MHz transducer was used. The Doppler indices measured were systolic/diastolic ratio, diastolic/average ratio, pulsatility index, and resistance index. The contributions of gestational age, fetal heart rate, location of measurement, interobserver variability, and intraobserver variability on the variance were studied. The investigation demonstrated that the gestational age and fetal heart rate contributed to 33% to 46% and 15% to 18% of the variance, respectively. The location of the Doppler measurement contributed to 29% to 46% of the error variance. Additionally, the interobserver and intraobserver error variance amounted to 10% to 14% and 5% to 9%, respectively. Of these various factors, the interobserver and intraobserver variance were related to the nonhemodynamic phenomena and therefore represented error components. It is obvious that these factors that affect the variance of the Doppler indices should be considered before the diagnostic reliability of this technique can be critically evaluated.

Argon laser trabeculoplasty in a residency program

The following article discusses the outcome of 60 eyes with various forms of glaucoma undergoing resident-performed argon laser trabeculoplasty (ALT). The majority (46/60) of eyes had primary open-angle glaucoma. Decrease in intraocular pressure (IOP) was not as great as reported in the literature. Our results suggest that initially treating 180 degrees of the angle is associated with improved overall results. ALT has proved to be a safe and effective alternative to conventional surgery for glaucoma in a residency training setting.