Creating shared goals and experiences as a pathway to peace

Glowacki offers many new directions for understanding and even eliminating the problem of war, especially creating positive interdependencies with out-group members. We develop Glowacki's intriguing proposition that in-group dynamics provide a route to peace by describing a prosocial motivational system, the caregiving system, that aligns individual interests and eliminates the need to use coercion to achieve mutually beneficial outcomes.

Definition and Diagnosis of Oligometastatic Bladder Cancer: A Delphi Consensus Study Endorsed by the European Association of Urology, European Society for Radiotherapy and Oncology, and European Society of Medical Oncology Genitourinary Faculty

BACKGROUND

In contrast to other cancers, the concept of oligometastatic disease (OMD) has not been investigated in bladder cancer (BC).

OBJECTIVE

To develop an acceptable definition, classification, and staging recommendations for oligometastatic BC (OMBC) spanning the issues of patient selection and the roles of systemic therapy and ablative local therapy.

DESIGN, SETTING, AND PARTICIPANTS

A European consensus group of 29 experts, led by the European Association of Urology (EAU), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Medical Oncology (ESMO), and including members from all other relevant European societies, was established.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

A modified Delphi method was used. A systematic review was used to build consensus questions. Consensus statements were extracted from two consecutive surveys. The statements were formulated during two consensus meetings. Agreement levels were measured to determine if consensus was achieved (≥75% agreement).

RESULTS AND LIMITATIONS

The first survey included 14 questions and the second survey had 12. Owing to a considerable lack of evidence, which was the major limitation, definition was limited in the context of de novo OMBC, which was further classified as synchronous OMD, oligorecurrence, and oligoprogression. A maximum of three metastatic sites, all resectable or amenable to stereotactic therapy, was proposed as the definition of OMBC. Pelvic lymph nodes represented the only "organ" not included in the definition of OMBC. For staging, no consensus on the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography was reached. A favourable response to systemic treatment was proposed as the criterion for selection of patients for metastasis-directed therapy.

CONCLUSIONS

A consensus statement on the definition and staging of OMBC has been formulated. This statement will help to standardise inclusion criteria in future trials, potentiate research on aspects of OMBC for which consensus was not achieved, and hopefully will lead to the development of guidelines on optimal management of OMBC.

PATIENT SUMMARY

As an intermediate state between localised cancer and disease with extensive metastasis, oligometastatic bladder cancer (OMBC) might benefit from a combination of systemic treatment and local therapy. We report the first consensus statements on OMBC drawn up by an international expert group. These statements can provide a basis for standardisation of future research, which will lead to high-quality evidence in the field.

Results of a pilot risk-based lung cancer screening study: outcomes and comparisons to a Medicare eligible cohort

PURPOSE

Risk-based lung cancer screening holds potential to detect more cancers and avert more cancer deaths than screening based on age and smoking history alone, but has not been widely assessed or implemented in the United States. The purpose of this study was to prospectively identify patients for lung cancer screening based on lung cancer risk using the PLCOm2012 model and to compare characteristics, risk profiles, and screening outcomes to a traditionally eligible screening cohort.

METHODS

Participants who had a 6 year lung cancer risk score ≥ 1.5% calculated by the PLCOm2012 model and were ineligible for screening under 2015 Medicare guidelines were recruited from a lung cancer screening clinic. After informed consent, participants completed shared decision-making counseling and underwent a low-dose CT (LDCT). Characteristics and screening outcomes of the study population were compared to the traditionally eligible Medicare cohort with Fisher's Exact, t-tests, or Brown Mood tests, as appropriate.

RESULTS

From August 2016 to July 2019, the study completed 48 baseline LDCTs. 10% of LDCTs recommended further pulmonary nodule evaluation (Lung-RADs 3 or 4) with two early-stage lung cancers diagnosed in individuals that had quit smoking > 15 years prior. The study population was approximately 5 years older (p = 0.001) and had lower pack years (p = 0.002) than the Medicare cohort.

CONCLUSION

Prospective application of risk-based screening identifies screening candidates who are similar to a traditionally eligible Medicare cohort and future research should focus on the impact of risk calculators on lung cancer outcomes and optimal usability in clinical environments. This study was retrospectively registered on clinicaltrials.gov (NCT03683940) on 09/25/2018.

Pulmonary inflammation promoted by type-2 dendritic cells is a feature of human and murine schistosomiasis

Schistosomiasis is a parasitic disease affecting over 200 million people in multiple organs, including the lungs. Despite this, there is little understanding of pulmonary immune responses during schistosomiasis. Here, we show type-2 dominated lung immune responses in both patent (egg producing) and pre-patent (larval lung migration) murine Schistosoma mansoni (S. mansoni) infection. Human pre-patent S. mansoni infection pulmonary (sputum) samples revealed a mixed type-1/type-2 inflammatory cytokine profile, whilst a case-control study showed no significant pulmonary cytokine changes in endemic patent infection. However, schistosomiasis induced expansion of pulmonary type-2 conventional dendritic cells (cDC2s) in human and murine hosts, at both infection stages. Further, cDC2s were required for type-2 pulmonary inflammation in murine pre-patent or patent infection. These data elevate our fundamental understanding of pulmonary immune responses during schistosomiasis, which may be important for future vaccine design, as well as for understanding links between schistosomiasis and other lung diseases.

A Prospective Pilot Study of Lung Cancer Screening in Patients at High Risk for Lung Cancer Who do not Meet Current Screening Guidelines

Purpose: To describe the results of a lung cancer screening (LCS) study of high-risk individuals ineligible for screening by Medicare (CMS) guidelines and prospectively selected by 6-year risk score. Methods: Study inclusion criteria included individuals 40–82 years old, with a 6-yr risk score of ≥1.5% for <77 years or age or >4% for 78–82 years of age, calculated by the PLCOm2012 model, no symptoms of lung cancer, and willingness to sign a consent form. Enrollment was offered to eligible individuals referred for screening through the University of Colorado Hospital LCS program that did not meet CMS screening guidelines (55–77 years old, ≥30 pack year smoking history, current smoker or quit within the past 15 years). Enrolled participants completed a shared design making visit with a LCS clinic provider, underwent a LDCT read in Lung-RADs (LR) by thoracic radiologists, and received follow-up and additional referrals, if indicated, from the LCS clinic. Individuals could undergo up to 3 LDCTs as part of the study. Results: The study completed 66 LDCTs on 48 participants. Screened individuals were 52% male, 85% white, 52% former smokers, had a mean baseline age of 69(±9) years, and a mean 6-year risk score of 5.6%(±5.9%). LR results of the index LDCTs included 46% LRs 1, 44% LRs 2, 4% LRs 3, and 6% LRs 4. 35% of screened participants had a significant incidental finding; 59% were coronary calcifications. Reasons screened individuals were ineligible by CMS guidelines included: 12% <55 years, 21% >77 years, 27% <30 pack year smoking history, and 40% quit smoking >15 years prior. The study diagnosed two lung cancers, a stage 1A adenocarcinoma diagnosed in 74 yr old white female with a 3.3% 6-yr risk score and a carcinoid diagnosed in a 77 yr old white male with a risk score of 7.5%. Both individuals had quit smoking >15 years prior. Conclusions: Early stage lung cancers can be detected in asymptomatic individuals who are prospectively selected by risk calculators and fall outside current CMS guidelines. However, the two cancers were diagnosed in people that would not qualify for the proposed expanded US Preventive Service Task Force guidelines, lowering eligibility to 50 years of age and tobacco exposure to 20 pack years.

Impact of a Hybrid Lung Cancer Screening Model on Patient Outcomes and Provider Behavior

BACKGROUND

Lung cancer screening (LCS) implementation is complicated by the Centers for Medicare and Medicaid Services reimbursement requirements of shared decision-making and tobacco cessation counseling. LCS programs can utilize different structures to meet these requirements, but the impact of programmatic structure on provider behavior and screening outcomes is poorly described.

PATIENTS AND METHODS

In a retrospective chart review of 624 patients in a hybrid structure, academic LCS program, we compared characteristics and outcomes of primary care provider (PCP)- and specialist-screened patients. We also assessed the impact of the availability of an LCS specialty clinic and best practice advisory (BPA) on PCP ordering patterns using electronic medical record generated reports.

RESULTS

During the study period of July 1, 2014 through June 30, 2018, 48% of patients were specialist-screened and 52% were PCP-screened; there were no clinically relevant differences in patient characteristics or screening outcomes between these populations. PCPs demonstrate distinct practice patterns when offered the choice of specialist-driven or PCP-driven screening. Increased exposure to a LCS BPA is associated with increased PCP screening orders. The addition of a nurse navigator into the LCS program increased documentation of shared decision-making and tobacco cessation counseling to > 95% and virtually eliminated screening of ineligible patients.

CONCLUSIONS

Systematic interventions including a BPA and nurse navigator are associated with increased screening and improved program quality, as evidenced by reduced screening of ineligible patients, increased lung cancer risk of the screened population, and improved compliance with LCS guidelines. Individual PCPs demonstrate clear preferences regarding LCS that should be considered in program design.

Ethnic and gender-specific incidence rates for hip fractures in South Africa: A multi-centre study

BACKGROUND

Limited data exist on the incidence of hip fractures in South Africa (SA). We report gender and ethnic specific incidence rates of hip fractures in SA.

METHODS

In a multicentre prospective study, conducted in geographically defined municipalities of three provinces in SA, a structured questionnaire was administered to all subjects aged 40 years and over, presenting with a new atraumatic hip fracture, from 1 April 2017 to 31 March 2018. Gender and ethnic specific incidence rates (IR) of hip fractures were calculated using population statistics from Statistics SA.

FINDINGS

Of the 2767 subjects enrolled, 1914 (69·2%) were women and 853 (30·8%) were men. The majority of subjects were from the White population (40·9%) followed by those from the African (26·4%), Coloured (18·7%) and Indian (13·9%) populations. Men with hip fractures were significantly younger than women in the total group (69 [IQR 59-79] versus 77 years [IQR 68-84], p < 0·001) and in each ethnic group. White subjects were significantly older (p < 0·0001) and Africans significantly younger (p < 0·0001) than the other ethnic groups. In women, the highest IR was noted in the White population (176·0 per 100,000), followed by that in the Indian (147·7 per 100,000), Coloured (73·2 per 100,000) and African populations (43·6 per 100,000). A similar pattern was seen in men albeit at lower rates, with the highest rate in White men at 76·5 per 100,000. In the total study population and the African population, the IR was higher in men compared to women in subjects under 60 years. In the White population, the IR was higher in men compared to women in the 40-44 years age group. While in the Coloured and Indian populations the IR was higher in men compared to women in the 40-49 years and 45-54 years age groups, respectively. There was an increase in the relative risk ratios with age in the total study population, and in all ethnic groups in both women and men.

INTERPRETATION

Hip fractures occur in all ethnic groups in South Africa with higher IRs in the White and Indian populations compared to the Coloured and African populations. Consistent with the published literature, the overall hip fracture IR was higher in women than in men, except in the younger age groups, and increased with age.

FUNDING

South African Medical Research Council and the University of KwaZulu-Natal Competitive Research Grant.

Reduced mortality rates among caregivers: Does family caregiving provide a stress-buffering effect?

Multiple studies have confirmed a seemingly paradoxical finding that family caregivers have lower mortality rates than comparable samples of noncaregivers. Caregivers are often also found to report more symptoms of depression and higher stress levels, but psychological distress and mortality are rarely examined in the same study. This study tests a possible mechanism for the mortality effect by applying a theoretical model that posits psychological and physiological stress-buffering benefits from prosocial helping behaviors. Participants in the population-based REasons for Geographic and Racial Differences in Stroke (REGARDS) study included 3,580 family caregivers who were individually matched to 3,580 noncaregivers on 15 demographic, health history, and health behavior variables using a propensity score matching algorithm. Baseline measures of depressive symptoms and perceived stress levels were also collected. The results indicated that caregivers reported significantly more depressive symptoms and higher perceived stress levels than propensity-matched noncaregivers (ps < .0001). However, consistent with our previous analysis (Roth et al., 2013), an analysis of 7-year survival rates showed that caregivers had a 16.5% lower mortality rate than noncaregivers (hazard ratio = 0.835, 95% CI = 0.719, 0.970). Significant caregiving*psychological distress interaction effects supported the stress-buffering hypothesis. Both depressive symptoms and perceived stress scores were significant predictors of mortality for the matched noncaregivers (ps < .0001), but not for the caregivers (ps > .49). Family caregiving appears to be similar to other prosocial helping behaviors in that it provides stress-buffering adaptations that ameliorate the impact of stress on major health outcomes such as mortality. (PsycINFO Database Record

The use of diet diaries in general dental practice in England

Objectives

Diet diaries are recommended as a tool to support behaviour change in dental patients at high risk of dental diseases. However, little is known about their use in dental practice. This study aimed to investigate whether and how general dental practitioners (GDPs) use diet diaries and identify factors which influence their use.

Methods

A postal questionnaire was sent to a stratified random sample of general dental practitioners. The questionnaire asked about demographic and professional characteristics of the GDPs and their practices regarding diet advice, collection of dietary information, diet diaries usage (e.g. frequency, considerations and barriers), and interpretation of diet diaries. Descriptive, bivariate and multivariate analyses were conducted.

Results

From 972 eligible GDP participants, 250 (26%) responses were received. Whilst almost all of these GDPs reported giving diet advice to patients routinely, and 40% reported also referring to dental care professionals in the practice to deliver dietary advice, only 28% (70) reported that they are involved in using diet diaries. GDPs appeared to target patients for dietary advice: GDPs reported they personally gave diet advice to an estimated 63% of their patients, and referred patients to DCPs for diet advice for 11% of their (GDPs') patients. GDPs used diet diaries more often for child than adult patients. Diet diaries usage was lower among younger dentists and in practices with higher percentages of NHS patients (p⟨0.05). Perceived insufficient remuneration for time involved in using diet diaries was the main reason given for their lack of use.

Conclusion

Although recommended as best practice, most English GDPs do not frequently use diet diaries to collect diet information in dental practice, mainly due to perceived financial and time constraints. Development of a more efficient tool to assess the dietary habits of dental patients is needed.

Spouses' daily feelings of appreciation and self-reported well-being

OBJECTIVE

Research shows that active support provision is associated with greater well-being for spouses of individuals with chronic conditions. However, not all instances of support may be equally beneficial for spouses' well-being. The theory of communal responsiveness suggests that because spouses' well-being is interdependent, spouses benefit most from providing support when they believe their support increases their partner's happiness and is appreciated. Two studies tested this hypothesis.

METHOD

Study 1 was a 7-day ecological momentary assessment (EMA) study of 73 spouses of persons with dementia (74%) and other conditions. In Study 1, spouses self-reported active help, perceptions of how happy the help made the partner and how much the help improved the partner's well-being, and spouses' positive and negative affect at EMA time points. Study 2 was a 7-day daily assessment study of 43 spouses of persons with chronic pain in which spouses reported their emotional support provision, perceived partner appreciation, and their own physical symptoms.

RESULTS

Study 1 showed that active help was associated with more positive affect for spouses when they perceived the help increased their partner's happiness and improved their partner's well-being. Study 2 showed that emotional support provision was associated with fewer spouse reported physical symptoms when perceptions of partner appreciation were high.

CONCLUSION

Results suggest that interventions for spouses of individuals with chronic conditions take into account spouses' perceptions of their partners' positive emotional responses. Highlighting the positive consequences of helping may increase spouses' well-being. (PsycINFO Database Record

Endovascular abdominal aortic aneurysm sealing: A systematic review of early outcomes

Objectives

There has been a clear move towards endovascular repair of abdominal aortic aneurysms owing to better peri-operative outcomes compared with open surgical repair. However, follow-up has continued to reveal relatively high rates of endoleaks and re-interventions. Improvements in endovascular stent-grafts aim to decrease these complications. This systematic review aims to determine the early outcomes of abdominal aortic aneurysm sealing.

Methods

Standard PRISMA guidelines were followed. A literature search was performed with the aim to extract any publication related to the endovascular aneurysm sealing device.

Results

The total number of patients in this systematic review of 11 studies is 684, with a mean age of 73.2 years, and 587 (88.0%) males. The majority were undergoing elective procedures ( n = 606, 91.0%), the remainder as emergencies ( n = 30, 4.5% as ruptures, n = 30, 4.5% as symptomatic). Technical success rate including emergency cases was 99.1%. Thirty-day mortality rate was 2.6% ( n = 17) including all cases, and 1.0% ( n = 6) including elective cases only. Thirty -day endoleak detection rate was 4.7% ( n = 31) including all cases, and 4.8% ( n = 29) including elective cases only. Thirty-day aneurysm-related re-intervention rate was 5.7% ( n = 38) including all cases, and 4.6% ( n = 28) including elective cases only. There was no conversion to open surgery within 30 days post-op in the elective cases. There were three delayed conversions to open surgery within 30 days and one report of stent migration causing rupture in the emergency setting.

Conclusions

This novel endovascular aneurysm-sealing device for abdominal aortic aneurysm repair has shown respectable early outcomes. Good technical success rates, in both elective and emergency settings, low rates of all-type endoleaks and low re-intervention rates have all been demonstrated. It is proving to be a safe alternative to open and endovascular aneurysm repair; however, longer term follow-up results are needed to assess the safety and effectiveness of the device in the long term.

Endovascular Repair of Ruptured Popliteal Artery Aneurysms: A Case Report and Review of the Literature

OBJECTIVE/BACKGROUND

The objectives were to report the management and outcomes of a 96-year-old man who presented with an acutely swollen right leg due to a ruptured popliteal aneurysm, and to review the relevant literature.

METHODS

A ruptured popliteal artery aneurysm is a rare diagnosis and is one that is often missed at time of presentation. Previous case reports have documented successful outcomes following surgical repair, and a smaller number following endovascular repair. This is a case report of a 96-year-old man who eventually underwent endovascular repair of a ruptured popliteal artery aneurysm after a delay in diagnosis. A literature review was performed to analyse published data in this field.

RESULTS

The patient underwent an uncomplicated endovascular repair with a GORE^® VIABAHN^® stent. A 15-week follow-up ultrasound demonstrated biphasic flow in a patent stent-graft with an unchanged aneurysm sac size and no evidence of an endoleak. A review of the literature demonstrated nine cases of ruptured non-mycotic popliteal artery aneurysms treated endovascularly. Seven cases survived the postoperative period, three had no follow-up recorded, and four cases had patent stent-grafts at time of follow-up.

CONCLUSION

Safe and effective endovascular repair of a ruptured popliteal artery aneurysm with endograft patency seen at the 15-week follow-up is reported. Review of the literature suggests that open repair remains the first-line management choice; however, endovascular repair is a valuable alternative. There is a further need for longer-term monitoring of endograft patency following endovascular repair.

In search of an adult attachment stress provocation to measure effect on the oxytocin system: a pilot validation study

BACKGROUND

Oxytocin is a promising biomarker for psychiatric conditions arising from early relational trauma, childhood maltreatment, and attachment dysregulation, including posttraumatic stress and dissociative disorders.

OBJECTIVE

This exploratory pilot study examined plasma oxytocin as a biomarker for alterations in the attachment system.

DESIGN

We used a single group, repeated-measures design with 15 women. The protocol used a film clip previously validated as a provocation to the hypothalamic-pituitary-adrenal axis.

RESULTS

The repeated-measures ANOVA showed differences in oxytocin across the three time points. Correlations with oxytocin indicated that measures of dissociation and somatization correlated most strongly with higher levels of oxytocin measured during exposure to the film's bonding scene and posttraumatic stress disorder correlated most strongly with lower levels at the film's abandonment scene. Post hoc analyses revealed differences in oxytocin response related to psychopathology.

CONCLUSION

Replication studies should characterize participants on a range of psychiatric conditions associated with attachment dysregulation.

Trajectories of loneliness during childhood and adolescence: predictors and health outcomes

The present study employed latent growth mixture modeling to discern distinct trajectories of loneliness using data collected at 2-year intervals from age 7-17 years (N = 586) and examine whether measures taken at age 5 years were good predictors of group membership. Four loneliness trajectory classes were identified: (1) low stable (37% of the sample), (2) moderate decliners (23%), (3) moderate increasers (18%), and (4) relatively high stable (22%). Predictors at age 5 years for the high stable trajectory were low trust beliefs, low trusting, low peer acceptance, parent reported negative reactivity, an internalizing attribution style, low self-worth, and passivity during observed play. The model also included outcome variables. We found that both the high stable and moderate increasing trajectories were associated with depressive symptoms, a higher frequency of visits to the doctor, and lower perceived general health at age 17. We discuss implications of findings for future empirical work.

Giving to others and the association between stress and mortality

OBJECTIVES

We sought to test the hypothesis that providing help to others predicts a reduced association between stress and mortality.

METHODS

We examined data from participants (n = 846) in a study in the Detroit, Michigan, area. Participants completed baseline interviews that assessed past-year stressful events and whether the participant had provided tangible assistance to friends or family members. Participant mortality and time to death was monitored for 5 years by way of newspaper obituaries and monthly state death-record tapes.

RESULTS

When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62).

CONCLUSIONS

Helping others predicted reduced mortality specifically by buffering the association between stress and mortality.

Parenting and Beyond: Common Neurocircuits Underlying Parental and Altruistic Caregiving

Interpersonal relationships constitute the foundation on which human society is based. The infant-caregiver bond is the earliest and most influential of these relationships. Driven by evolutionary pressure for survival, parents feel compelled to provide care to their biological offspring. However, compassion for non-kin is also ubiquitous in human societies, motivating individuals to suppress their own self-interests to promote the well-being of non-kin members of the society. We argue that the process of early kinship-selective parental care provides the foundation for non-exclusive altruism via the activation of a general Caregiving System that regulates compassion in any of its forms. We propose a tripartite structure of this system that includes (1) the perception of need in another, (2) a caring motivational or feeling state, and (3) the delivery of a helping response to the individual in need. Findings from human and animal research point to specific neurobiological mechanisms including activation of the insula and the secretion of oxytocin that support the adaptive functioning of this Caregiving System.

Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study

OBJECTIVES

To compare the characteristics and outcomes of caregivers of adults with dementia with those of caregivers of adults with cognitive impairment, not dementia (CIND).

DESIGN

Cross-sectional.

SETTING

In-home assessment for cognitive impairment and self-administered caregiving questionnaire.

PARTICIPANTS

One hundred sixty-nine primary family caregivers of participants in the Aging, Demographics, and Memory Study (ADAMS). ADAMS participants were aged 71 and older drawn from the nationally representative Health and Retirement Study.

MEASUREMENTS

Neuropsychological testing, neurological examination, clinical assessment, and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics.

RESULTS

Dementia caregivers spent approximately 9 hours per day providing care, compared with 4 hours per day for CIND caregivers (P=.001). Forty-four percent of dementia caregivers exhibited depressive symptoms, compared with 26.5% of CIND caregivers (P=.03). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Behavioral problems (P=.01) and difficulty with instrumental activities of daily living (P=.01) in persons with CIND partially explained emotional strain experienced by CIND caregivers. For those with dementia, behavioral problems predicted caregiver emotional strain (P<.001) and depressive symptoms (P=.01).

CONCLUSION

Although support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the U.S. population may therefore be greatly underestimated if people who have reached the diagnostic threshold for dementia are focused on exclusively.

Does a helping hand mean a heavy heart? Helping behavior and well-being among spouse caregivers

Being a caregiver for an ill or disabled loved one is widely recognized as a threat to the caregiver's quality of life. Nonetheless, research indicates that helping behavior, broadly construed, promotes well-being. Could helping behavior in a caregiving context promote well-being as well? In the present study, we used ecological momentary assessment to measure active helping behavior and both positive and negative affect in 73 spouse caregivers. Results indicate that when controlling for care recipient illness status and functional impairment and caregiver "on call" caregiving time, active helping predicted greater caregiver positive affect--especially for individuals who perceived themselves as interdependent with their spouse. In addition, although both helping and on-call time predicted greater negative affect for caregivers who perceived low interdependence, helping was unrelated to negative affect among caregivers perceiving high interdependence. Helping valued loved ones may promote caregivers' well-being.

Impact of Early Spring Weather Factors on the Risk of Tomato Spotted Wilt in Peanut

Peanut growers in the southeastern United States have suffered significant economic losses due to spotted wilt caused by Tomato spotted wilt virus (TSWV). The virus is transmitted by western flower thrips, Frankliniella occidentalis, and tobacco thrips, F. fusca, and was first reported in the southeast in 1986. The severity of this disease is extremely variable in individual peanut fields, perhaps due to the sensitivity of the vector population to changing weather patterns. The objective of this study was to investigate the impact of early spring weather on spotted wilt risk in peanut. On-farm surveys of spotted wilt severity were conducted in Georgia peanut fields in 1998, 1999, 2002, 2004, and 2005. The percent spotted wilt intensity (%) for cv. Georgia Green was recorded and categorized into three intensity levels: low, moderate, and high. Meteorological data were obtained from the Georgia Automated Environmental Monitoring Network for the period between March 1 and April 30. Statistical analysis was conducted to identify weather variables that had significant impact on spotted wilt intensity. The results indicated a high probability of spotted wilt if the number of rain days during March was greater than or equal to 10 days and planting was before 11 May or after 5 June. The total evapotranspiration in April (>127 mm) and the average daily minimum temperature in March (>6.8°C) similarly increased the risk of spotted wilt. Knowing in advance the level of spotted wilt risk expected in a peanut field could assist growers with evaluating management options and significantly improve the impact of their decisions against spotted wilt risk in peanut.

Happiness unpacked: positive emotions increase life satisfaction by building resilience

Happiness-a composite of life satisfaction, coping resources, and positive emotions-predicts desirable life outcomes in many domains. The broaden-and-build theory suggests that this is because positive emotions help people build lasting resources. To test this hypothesis, the authors measured emotions daily for 1 month in a sample of students (N = 86) and assessed life satisfaction and trait resilience at the beginning and end of the month. Positive emotions predicted increases in both resilience and life satisfaction. Negative emotions had weak or null effects and did not interfere with the benefits of positive emotions. Positive emotions also mediated the relation between baseline and final resilience, but life satisfaction did not. This suggests that it is in-the-moment positive emotions, and not more general positive evaluations of one's life, that form the link between happiness and desirable life outcomes. Change in resilience mediated the relation between positive emotions and increased life satisfaction, suggesting that happy people become more satisfied not simply because they feel better but because they develop resources for living well.

Social closeness increases salivary progesterone in humans

We examined whether interpersonal closeness increases salivary progesterone. One hundred and sixty female college students (80 dyads) were randomly assigned to participate in either a closeness task with a partner versus a neutral task with a partner. Those exposed to the closeness induction had higher levels of progesterone relative to those exposed to the neutral task. Across conditions, progesterone increase one week later predicted the willingness to sacrifice for the partner. These results are discussed in terms of the links between social contact, stress, and health.

Caregiving behavior is associated with decreased mortality risk

Traditional investigations of caregiving link it to increased caregiver morbidity and mortality, but do not disentangle the effects of providing care from those of being continuously exposed to an ailing loved one with serious health problems. We explored this possible confound in a national, longitudinal survey of elderly married individuals (N= 3,376). Results showed that spending at least 14 hr per week providing care to a spouse predicted decreased mortality for the caregiver, independently of behavioral and cognitive limitations of the care recipient (spouse), and of other demographic and health variables. These findings suggest that it may be premature to conclude that health risks for caregivers are due to providing active help. Indeed, under some circumstances, caregivers may actually benefit from providing care.

Empirical support for an evolutionary model of self-destructive motivation

We tested predictions generated from an evolutionary account of self-destructive motivation in two survey studies of 18-24-year-old university students. As hypothesized, hierarchical regressions showed that the positive relationship between perceived burden to family and suicide ideation was amplified for participants with low measured health and romantic relationship satisfaction, and for participants with relatively young mothers. The moderating effect of maternal age was also observed in logistic regressions of suicide attempts. These effects occurred independently of depression, hopelessness, and other relevant extraneous variables. Results have implications for understanding self-destructive motivation, assessing suicide risk, and preventing suicidal thinking and behavior.

A predictive model for spotted wilt epidemics in peanut based on local weather conditions and the tomato spotted wilt virus risk index

Tomato spotted wilt virus (TSWV), a member of the genus Tospovirus (family Bunyaviridae), is an important plant virus that causes severe damage to peanut (Arachis hypogaea) in the southeastern United States. Disease severity has been extremely variable in individual fields in Georgia, due to several factors including variability in weather patterns. A TSWV risk index has been developed by the University of Georgia to aid peanut growers with the assessment and avoidance of high risk situations. This study was conducted to examine the relationship between weather parameters and spotted wilt severity in peanut, and to develop a predictive model that integrates localized weather information into the risk index. On-farm survey data collected during 1999, 2002, 2004, and 2005 growing seasons, and derived weather variables during the same years were analyzed using nonlinear and multiple regression analyses. Meteorological data were obtained from the Georgia Automated Environmental Monitoring Network. The best model explained 61% of the variation in spotted wilt severity (square root transformed) as a function of the interactions between the TSWV risk index, the average daily temperature in April (TavA), the average daily minimum temperature between March and April (TminMA), the accumulated rainfall in March (RainfallM), the accumulated rainfall in April (RainfallA), the number of rain days in April (RainDayA), evapotranspiration in April (EVTA), and the number of days from 1 January to the planting date (JulianDay). Integrating this weather-based model with the TSWV risk index may help peanut growers more effectively manage tomato spotted wilt disease.

Coping with spousal loss: potential buffering effects of self-reported helping behavior

The present study examined the role of self-reported helping behavior in attenuating the helper's depression following spousal loss. Using archival data from the Changing Lives of Older Couples sample (N = 289), the study shows that among bereaved participants who had experienced high loss-related grief, helping behavior (providing instrumental support to others) was associated with an accelerated decline in depressive symptoms for the helper from 6 months to 18 months following spousal loss. This relationship between giving help and recovery from depression was independent of support received, as well as measured health, and interpersonal and demographic factors. Implications of these results for theoretical approaches to the study of close relationships and well-being are discussed.

Coping with spousal loss: potential buffering effects of self-reported helping behavior

The present study examined the role of self-reported helping behavior in attenuating the helper's depression following spousal loss. Using archival data from the Changing Lives of Older Couples sample (N = 289), the study shows that among bereaved participants who had experienced high loss-related grief, helping behavior (providing instrumental support to others) was associated with an accelerated decline in depressive symptoms for the helper from 6 months to 18 months following spousal loss. This relationship between giving help and recovery from depression was independent of support received, as well as measured health, and interpersonal and demographic factors. Implications of these results for theoretical approaches to the study of close relationships and well-being are discussed.

The effects of prolonged rose odor inhalation in two animal models of anxiety

AIM

To investigate the anxiolytic effects of prolonged rose odor exposure, mature gerbils were exposed to acute (24 h), chronic (2 week) rose odor, or a no odor condition. Anxiolytic effects were assessed using the elevated plus maze and black white box. Rose odor profiles were compared with diazepam (1 mg/kg) i.p. The Jonckheere-Terpstra test was used, with the Mann-Whitney U test to examine significant group differences. In the elevated plus maze, spatiotemporal measures, altered by diazepam, were unaffected by rose oil, whereas exploration, increased (headdip frequency: acute U=100, p<0.001; chronic U=13, p<0.001). In the black white box, rose oil had anxiolytic spatiotemporal and exploratory behavior effects: latency to move from the white to the black compartment (acute U=182, p<0.01, chronic U=179, p<0.05), percentage time in the white compartment (acute U=168, p<0.01, chronic U=149, p<0.01) and exploration, rear-sniff frequency white (acute U=100, p<0.001; chronic U=99, p<0.001) increased. The percentage of time in the dark area decreased (acute U=160, p<0.01, chronic U=178, p<0.05). This anxiolytic profile strengthened after chronic exposure to rose odor, transitions between the compartments (U=167, p<0.01) and percentage of time moving around the arena (U=154, p<0.001) increased.

CONCLUSION

This profile was more representative of modern anxiolytics, for example some serotonergic agents, rather than benzodiazepine type drugs.

Field test of in situ soil amendments at the Tar Creek National Priorities List Superfund site

A range of soil amendments including diammonium phosphate fertilizer (DAP), municipal biosolids (BS), biosolids compost, and Al- and Fe-based water treatment residuals were tested on Pb-, Zn-, and Cd-contaminated yard soils and tailings at the Tar Creek NPL site in Oklahoma to determine if amendments could restore a vegetative cover and reduce metal availability in situ. For the yard soils, all amendments reduced bioaccessible (assessed with a physiologic-based extraction method) Pb, with reductions ranging from 35% (BS+Al, DAP 0.5%, DAP+Compost+Al) to 57% (Compost+Al). Plant Zn (Cynadon dactylon L.) and NH4 NO3-extractable Cd and Zn were also reduced by a number of amendments. For the tailings, all amendments excluding BS reduced bioaccessible Pb, with the largest reductions observed in the DAP 3% and DAP3%+BS treatments (75 and 84%). Plant growth was suppressed in all treatments that contained DAP for the first season, with the highest growth in the treatments that included compost and biosolids. In the second year, growth was vigorous for all treatments. Plant Zn and Cd and extractable metal concentration were also reduced. A number of treatments were identified that reduced bioaccessible Pb and sustained a healthy plant with reduced metal concentrations. For the yard soil, Compost+Al was the most effective treatment tested. For the tailings, BS+DAP 1% was the most effective treatment tested. These results indicate that in situ amendments offer a remedial alternative for the Tar Creek site.

Anxiolytic effects of Lavandula angustifolia odour on the Mongolian gerbil elevated plus maze

Lavender is a popular treatment for stress and mild anxiety in Europe and the USA. The present study investigated the effects of (Lavandula angustifolia Mill. (Lamiaceae)) lavender odour inhalation over 2 weeks or 24 h periods, on gerbil behaviour in the elevated plus maze in mature male and female gerbils, and compared results with the effects of diazepam (1 mg/kg) i.p. after 30 min and 2-week administration. Traditional measures of open entries showed an increasing trend over the 2 weeks exposure, whereas ethological measures indicative of anxiety; stretch-attend frequency and percentage protected head-dips, were significantly lower. Exploratory behaviour, total head-dip frequency, increased after 24 h lavender and 2 weeks exposure. These results are comparable with diazepam administration. There were sex differences in protected head-dip an ethological indicator of anxiety: females showed a significant decrease in protected head-dips compared to both males and to female controls. In conclusion exposure to lavender odour may have an anxiolytic profile in gerbils similar to that of the anxiolytic diazepam. In addition, prolonged, 2-week lavender odour exposure increased exploratory behaviour in females indicating a further decrease in anxiety in this sex.

Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy

The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy. We first define and characterize these constructs, review empirical evidence supporting the distinct role of suffering and compassion in the context of caregiving, and then present a conceptual model linking patient suffering with caregiver compassion. We conclude with a discussion of implications and future directions for clinical intervention, research, and policy.

Estrogen modulates place learning through estrogen receptors in the hippocampus

Moderate elevations in circulating estradiol enhance learning in tasks that tap place learning strategies such as those requiring the use of extramaze cues. Use of place learning strategies is particularly impaired by damage to the hippocampus, a structure shown to be sensitive to estrogen treatments. We have shown that direct estrogen infusions into the dorsal hippocampus, and not the dorsolateral striatum, enhance place learning, suggesting that the hippocampus may be an important modulatory site for the effects of estrogen on place learning. The current experiment tested whether the hippocampus is indeed a critical site of estrogen modulation through classical estrogen receptors. Young adult female Sprague-Dawley rats were ovariectomized for 21 days and given systemic injections (0.1 ml) of sesame oil (OIL) or 10 microg of 17beta-estradiol-benzoate (E2), 48 and 24 h before being trained on a place task. Twenty-four hours prior to the first systemic injection, separate groups of rats received bilateral hippocampal implants of either the antiestrogen ICI 182,780 (ICI) or cholesterol vehicle. Implants were maintained until and throughout training. Intrahippocampal ICI reversed the enhancement in place learning seen with systemic E2 treatment. Unexpectedly, intrahippocampal ICI in OIL-treated rats also enhanced place learning. These data suggest that ICI may have some mixed agonist and antagonist effects in the hippocampus and that estrogen enhances place learning through activation of estrogen receptors located in the hippocampus.

Polyethylene Glycol (Molecular Weight 400 DA) Vehicle Improves Gene Expression of Adenovirus Mediated Gene Therapy

PURPOSE

A significant limitation of adenoviral mediated suicide gene therapy is poor gene distribution in vivo. The choice of vehicle has been demonstrated to affect the level of adenoviral delivered gene transduction. We examined the hypotheses that 1) adenovirus suspended in PEG400 improves gene expression in the naïve canine prostate model, 2) improved transgene expression with PEG400 results in improved tumor control and 3) vehicle affects the initial adenoviral spread from a single intratumor injection.

MATERIALS AND METHODS

The magnitude and volume of gene expression were measured 24 hours following intraprostatic injection of adenovirus suspended in PEG400 (12.5% weight per volume) or saline as vehicle. Tumor growth delay was measured in mice bearing human tumor xenografts following the injection of adenovirus in PEG400 and saline. The initial spread of adenovirus was measured by confocal microscopy following a single injection of fluorescently labeled adenoviral particles in human tumor xenografts using each vehicle.

RESULTS

Adenovirus suspended in PEG400 provided an average of twice the level of gene expression in the canine prostate and significantly better tumor control relative to saline in preclinical tumor models (p = 0.046 and 0.036, respectively). The initial spread of adenovirus with PEG400 was superior to that of adenovirus in saline and the latter was largely limited to the needle tract.

CONCLUSIONS

Adenoviral gene therapy vectors suspended in PEG400 results in improved tumor control because of greater initial adenoviral spread, and the increased volume and magnitude of gene expression in vivo.

Effect of intravascular-to-extravascular water exchange on the determination of blood-to-tissue transfer constant by magnetic resonance imaging

Water exchange across capillary walls couples intra- and extravascular (IV-EV) protons and their magnetization. A bolus i.v. injection of an extracellular MRI contrast agent (MRCA) causes a large increase in the spin-lattice relaxation rate, R1, of water protons in the plasma and blood cells within the capillaries and changes the effective relaxation rate R1eff in tissue via IV-EV water exchange. An analysis of the effect of plasma-red cell and IV-EV water exchange on the MRI-measured influx and permeability of capillaries to the MRCA is presented and focused on the brain and the blood-brain barrier. The effect of arrival of a bolus of an MRCA in the capillary on the relaxation rate R1eff in tissue via IV-EV water exchange occurs more rapidly than the MRCA uptake in tissue and can dominate the initial time curve of the R1eff change before the MRCA uptake in tissue becomes significant. This raises the possibility that (tissue dependent) IV-EV rate of exchange of water molecules can affect estimates of MRCA transfer constant. We demonstrate that an approach that considers IV-EV water exchange and uses the theoretical model of blood-brain tracer distribution developed by Patlak et al. (J Cereb Blood Flow Metab 1983;3:1-7) can lead to an accurate estimate of the MRI-determined influx rate constant of the MRCA and to an underestimation of the tissue blood volume.

Religion and emotional compensation: results from a prospective study of widowhood

Based on recent applications of attachment theory to religion, the authors predicted that the loss of a spouse would cause widowed individuals to increase the importance of their religious/spiritual beliefs. This hypothesis was examined using the Changing Lives of Older Couples sample from which preloss measures of religiosity were available for widowed individuals and matched controls. A total of 103 widowed individuals provided follow-up data, including reports of religious beliefs and grief, at 6 months, 24 months, and 48 months after the loss. Results indicated that widowed individuals were more likely than controls to increase their religious/spiritual beliefs. This increase was associated with decreased grief but did not influence other indicators of adjustment such as depression. Finally, insecure individuals were most likely to benefit from increasing the importance of their beliefs. Results are discussed in terms of the potential value of applying psychological theory to the study of religion.

Comments on "Implications of Hormesis for Industrial Hygiene"

Although demonstrated evidence for hormesis of an agent could be important in setting occupational exposure limits (OELs) for industrial hygiene, several practical problems may limit the utility of toxicologic testing for hormesis. This commentary responds to the lead article of this section, in which Jayjock and Lewis propose using the results of tests for hormesis to guide the establishment of OELs. The principal difficulties may include: a different mechanism or even a different effect leading to the conclusion of hormesis; distinction between a threshold for a health effect and a crossover point in the dose response relationship; estimation of threshold or crossover point from limited test data and estimation of slope at this point; sensitivity of tests for hormesis; and cost of testing. Nevertheless, the proposals of Jayjock and Lewis have considerable merit, and exploratory testing could be useful.

Combined effect of arsenic trioxide and sulindac sulfide in A549 human lung cancer cells in vitro

Arsenic trioxide has shown substantial efficacy in treating patients with relapsed or refractory acute promyelocytic leukemia (APL) as well as solid tumors. Arsenic can act through a considerable number of different pathways including mitochondrial respiration and tubulin formation, affecting growth, blood flow, differentiation, and apoptosis. Recent studies on the apoptotic potential of arsenic trioxide have elucidated some of its causal mechanisms, including elevation of intracellular H2O2, inhibition of NF-kappaB activity, and inhibition of GTP-induced polymerization of tubulin. Because of the variety in cellular approaches available to arsenic, it has been hypothesized that the combination of arsenic trioxide and other chemotherapeutic agents may result in cytotoxic synergy. Recent studies have proven this true, with all-trans retinoic acid, IFN-alpha, and ascorbic acid all yielding promising results when used in conjunction with arsenic trioxide. In this study we tested sulindac sulfide, a nonsteroidal anti-inflammatory drug (NSAID) to test its effects with arsenic. Sulindac was used because it functions by some of the same pathways as arsenic, including the mitochondrial apoptotic pathway and the NF-kappaB pathway. Our results show that sulindac sulfide enhances cytotoxicity when combined with arsenic trioxide, and that further studies on the exact mechanisms of their interaction are needed.

Sickle red blood cells accumulate in tumor

The preferential accumulation of sickle blood cells in tumor vasculature is demonstrated noninvasively using MRI and sickle red blood cells loaded with Gd-DTPA and invasively by two other techniques. The distribution of red blood cells in rat brain tumors relative to normal brains were measured using three separate techniques: MRI of Gd-DTPA loaded cells, fluorescent microscopy detection of Oregon Green 488 fluorescence conjugated to a streptavidin-biotin complex that binds to red blood cell surface proteins, and autoradiography using a technetium (99m)Tc-labeling kit. Labeled red cells were infused intravenously in rats with brain tumors. Sickle cells preferentially accumulated in tumor relative to normal brain, with highest concentrations near the tumor / normal tissue boundary, whereas control normal red cells did not preferentially aggregate at the tumor periphery. This demonstrates the potential of sickle red blood cells to accumulate in the abnormal tumor vessel network, and the ability to detect their aggregation noninvasively and at high spatial resolution using MRI. The application of the noninvasive measurement of sickle cells for imaging tumor neovasculature, or as a delivery tool for therapy, requires further study.