bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Lower vs Higher Cell Number of Platelet-Rich Plasma (PRP) on Hair Density and Diameter in Androgenetic Alopecia (AGA): A Randomized, Double-Blinded, Placebo, Parallel-Group Half-Scalp IRB-Approved Study
Authors: Sasaki Gordon H
Published: May 2021

Background

Androgenetic alopecia (AGA) is a common disorder in both males and females and may be improved by platelet-rich plasma (PRP) treatment.

Objectives

The aim of this study was to compare safety, efficacy, and satisfaction following treatment with a lower or higher number of platelets over 6 months.

Methods

This was a prospective randomized, double-blinded, placebo, parallel-group, half-scalp IRB-approved study involving 8 subjects with moderate AGA. Participants received intradermal PRP injections (baseline and Month 3), according to 2 treatment protocols (high vs low platelet numbers) to the frontal and crown portions of the hemiscalp and normal saline to control sites. Phototrichoscans were recorded at baseline and at 6 months, and global photography and subject and investigator satisfaction questionnaires were obtained at baseline, 3, and 6 months.

Results

At the end of 6-month evaluation period, both groups demonstrated absolute increases in total hair density, follicle diameter, and terminal hair density, as well as absolute and percentage changes at the frontal and crown targeted sites compared with baseline. These improvements tended to occur more often in areas treated with higher platelet numbers than with lower numbers. Vellus hair densities did not exhibit any significant changes with either PRP dosages. The investigator and 6 of the subjects were “satisfied” with the results at 3 months and no adverse reactions were associated with the treatments.

Conclusions

Intradermal injections with 2 therapeutic quantities of platelets were equally safe and efficacious for treating men and women with AGA. Higher numbers of platelets may have a greater effect than lower numbers of platelets in regard to hair density, follicle diameter, and terminal hair density but exhibited minimal effects on vellus hair densities at the 6-month evaluation point. Further studies are required to determine whether any significant advantages occur when delivering either lower or higher numbers of platelets in AGA treatments as long as therapeutic levels are administered.

Level of Evidence: 2
Morphological and Age-Related Changes in the Narcolepsy Brain
Authors: Fulong Xiao , Spruyt Karen , Xiaosong Dong , Zhaolong Cao , Jun Zhang , Fang Han
Published: May 2021

Morphological changes in the cortex of narcolepsy patients were investigated by surface-based morphometry analysis in this study. Fifty-one type 1 narcolepsy patients and 60 demographically group-matched healthy controls provided resting-state functional and high-resolution 3T anatomical magnetic resonance imaging scans. Vertex-level cortical thickness (CT), gyrification, and voxel-wise functional connectivity were calculated. Adolescent narcolepsy patients showed decreased CT in bilateral frontal cortex and left precuneus. Adolescent narcolepsy demonstrated increased gyrification in left occipital lobe, left precuneus, and right fusiform but decreased gyrification in left postcentral gyrus, whereas adult narcolepsy exhibited increased gyrification in left temporal lobe and right frontal cortex. Furthermore, sleepiness severity was associated with altered CT and gyrification. Increased gyrification was associated with reduced long-range functional connectivity. In adolescent patients, those with more severe sleepiness showed increased right postcentral gyrification. Decreased frontal and occipital gyrification was found in cases with hallucination. In adult patients, a wide range of regions showed reduced gyrification in those with adolescence-onset compared adult-onset narcolepsy patients. Particularly the frontal lobes showed altered brain morphology, being a thinner cortex and more gyri. The impact of narcolepsy on age-related brain morphological changes may remain from adolescence to young adulthood, and it was especially exacerbated in adolescence.
Sex Differences in Cardiac Troponin I and T and the Prediction of Cardiovascular Events in the General Population
Authors: Kimenai Dorien M , Shah Anoop S V , McAllister David A , Lee Kuan Ken , Tsanas Athanasios , Meex Steven J R , Porteous David J , Hayward Caroline , Campbell Archie , Sattar Naveed , Mills Nicholas L , Welsh Paul
Published: May 2021

Background

Cardiac troponin concentrations differ in women and men, but how this influences risk prediction and whether a sex-specific approach is required is unclear. We evaluated whether sex influences the predictive ability of cardiac troponin I and T for cardiovascular events in the general population.

Methods

High-sensitivity cardiac troponin (hs-cTn) I and T were measured in the Generation Scotland Scottish Family Health Study of randomly selected volunteers drawn from the general population between 2006 and 2011. Cox-regression models evaluated associations between hs-cTnI and hs-cTnT and the primary outcome of cardiovascular death, myocardial infarction, or stroke.

Results

In 19 501 (58% women, mean age 47 years) participants, the primary outcome occurred in 2.7% (306/11 375) of women and 5.1% (411/8126) of men during the median follow-up period of 7.9 (IQR, 7.1–9.2) years. Cardiac troponin I and T concentrations were lower in women than men (P < 0.001 for both), and both were more strongly associated with cardiovascular events in women than men. For example, at a hs-cTnI concentration of 10 ng/L, the hazard ratio relative to the limit of blank was 9.7 (95% CI 7.6–12.4) and 5.6 (95% CI 4.7–6.6) for women and men, respectively. The hazard ratio for hs-cTnT at a concentration of 10 ng/L relative to the limit of blank was 3.7 (95% CI 3.1–4.3) and 2.2 (95% CI 2.0–2.5) for women and men, respectively.

Conclusions

Cardiac troponin concentrations differ in women and men and are stronger predictors of cardiovascular events in women. Sex-specific approaches are required to provide equivalent risk prediction.
Recurrent strokes in an occult case of recurrent Cutibacterium acnes prosthetic valve infective endocarditis: a case report
Authors: Fry Charles , Primus Christopher P , Serafino-Wani Robert , Woldman Simon
Published: May 2021

Background

Infective endocarditis (IE) is a known but uncommon cause of cardioembolic stroke and there are rare but recognized cases of IE without an inflammatory response. Cutibacterium acnes is an increasingly recognized source of invasive infections, including IE, but diagnosis is challenging due to its low virulence and fastidious nature.

Case summary

A 47-year-old man presented with a multi-focal stroke suggestive of a cardioembolic source. Outpatient transoesophageal echocardiography (TOE) was concerning for vegetation or thrombus associated with his previous mitral valve repair. He remained clinically well, with no evidence of an inflammatory response and sterile blood cultures. Computed tomography–positron emission tomography (CT-PET) corroborated the TOE findings, however, given the atypical presentation, he was treated for valvular thrombus. Following discharge, he quickly re-presented with further embolic phenomena and underwent emergency mitral valve replacement. Intraoperative findings were consistent with prosthetic valve IE (PVE) and a 6-week course of antibiotics commenced. C. acnes was identified on molecular testing. Eighteen months later, he re-presented with further neurological symptoms. Early TOE and CT–PET were consistent with IE. Blood cultures grew C. acnes after prolonged incubation. Given the absence of surgical indications, he was managed medically, and the vegetation resolved without valvular dysfunction. He continues to be followed up in an outpatient setting.

Discussion

In patients presenting with multi-territory stroke, IE should be considered despite sterile blood cultures and absent inflammatory response. C. acnes is an increasingly recognized cause of PVE in this context, often requiring surgical intervention. A high index of suspicion and collaboration with an Endocarditis Team is therefore essential to diagnose and treat.
Persisting and reoccurring cyanosis after Fontan operation is associated with increased late mortality
Authors: Schafstedde Marie , Nordmeyer Sarah , Schleiger Anastasia , Nordmeyer Johannes , Berger Felix , Kramer Peter , Ovroutski Stanislav
Published: May 2021

OBJECTIVES

The Fontan operation aims at reducing cyanosis and cardiac volume overload in patients with complex univentricular heart malformations. However, persisting or reoccurring cyanosis is frequently observed. We sought to systematically determine the prevalence and clinical consequences of persisting and secondary cyanosis after Fontan operation.

METHODS

A total of 331 Fontan patients, operated between 1984 and 2016 with a median postoperative follow-up of 7.9 (interquartile range 2.6–15.8) years, were studied retrospectively. Cyanosis was defined as transcutaneous oxygen saturation ≤93% at rest measured by pulse oximetry. Prevalence of cyanosis was analysed at 3 different time points (t1 = post-Fontan operation, t2 = post-Fontan cardiac catheterization, t3 = last follow-up) and the association of cyanosis with mortality was examined.

RESULTS

Prevalence of cyanosis was 50% at t1 and 39% at t3. Fenestration was patent in 71% and 33% of all cyanotic patients at t1 and t3, respectively. In patients with clinical indication for catheterization (t2; n = 178/331), prevalence of cyanosis was 72%. At t2, patent fenestration (33%), veno-venous collaterals (24%) or both (32%) were present. Thirty-six (11%) patients died during follow-up. In a time-varying multivariable Cox regression analysis, cyanosis was the strongest predictor for late mortality (P < 0.001, hazard ratio 12.2, 95% confidence interval 3.7–40.5).

CONCLUSIONS

Prevalence of cyanosis was considerable during long-term follow-up after Fontan operation and—as a surrogate parameter for unfavourable Fontan haemodynamics—is associated with increased late mortality. Accordingly, particular attention should be directed towards the persistence or reoccurrence of cyanosis during follow-up since it may indicate haemodynamic attrition and development of Fontan failure.
Full-length transcriptome analysis of pecan (Carya illinoinensis) kernels
Authors: Zhang Chengcai , Ren Huadong , Yao Xiaohua , Wang Kailiang , Chang Jun
Published: May 2021

Pecan is rich in bioactive components such as fatty acids (FAs) and flavonoids and is an important nut type worldwide. Therefore, the molecular mechanisms of phytochemical biosynthesis in pecan are a focus of research. Recently, a draft genome and several transcriptomes have been published. However, the full-length mRNA transcripts remain unclear, and the regulatory mechanisms behind the quality components biosynthesis and accumulation have not been fully investigated. In this study, single-molecule long-read sequencing technology was used to obtain full-length transcripts of pecan kernels. In total, 37,504 isoforms of 16,702 genes were mapped to the reference genome. The numbers of known isoforms, new isoforms, and novel isoforms were 9013 (24.03%), 26,080 (69.54%), and 2411 (6.51%), respectively. Over 80% of the transcripts (30,751, 81.99%) had functional annotations. A total of 15,465 alternative splicing (AS) events and 65,761 alternative polyadenylation events were detected; wherein, the retained intron was the predominant type (5652, 36.55%) of AS. Furthermore, 1894 long noncoding RNAs and 1643 transcription factors were predicted using bioinformatics methods. Finally, the structural genes associated with FA and flavonoid biosynthesis were characterized. A high frequency of AS accuracy (70.31%) was observed in FA synthesis-associated genes. This study provides a full-length transcriptome data set of pecan kernels, which will significantly enhance the understanding of the regulatory basis of phytochemical biosynthesis during pecan kernel maturation.
Genomics-based discrimination of 2n gamete formation mechanisms in polyploids: a case study in nonaploid Diospyros kaki ‘Akiou’
Authors: Sun Peng , Nishiyama Soichiro , Asakuma Hideaki , Voorrips Roeland E , Fu Jianmin , Tao Ryutaro
Published: May 2021

Unreduced gametes (2n gametes), possessing double the haploid genome, whatever ploidy that happens to be, are a common source of ploidy variation in plant populations. First and second division restitution (FDR and SDR) are the dominant mechanisms of 2n gamete production; all else being equal, FDR gametes have a higher degree of heterozygosity, thus they are advantageous in breeding. The discrimination of these mechanisms from the consequence of hybridization is challenging, especially in higher polyploids, and usually requires information on centromere location. In this study, we propose a genotyping-based strategy to uncover the mechanisms of 2n gamete formation in progeny that has a higher ploidy than its parents. Simulation of 2n gamete production revealed that FDR and SDR pathways can be discriminated based on allele transmission patterns alone without information on centromere location. We applied this strategy to study the formation mechanism of a nonaploid Diospyros kaki ‘Akiou', which was bred via hybridization between D. kaki hexaploid cultivars. The result demonstrated that ‘Akiou' was derived from the fertilization of a normal female gamete by a 2n male gamete and that this 2n gamete was produced through FDR. Consequently, the distinct duplex transmission pattern in the FDR gamete enabled us to infer the genomic characteristics of polyploid persimmon. The method could be tested only for the plant being polypoid, which allows for the ability to discriminate causes of 2n gamete formation using allele dosage in progeny, and will be useful in future studies of polyploid genomics.
Wartime Is Peacetime: Undeclared Armed Conflict in the Late Twentieth and Early Twenty-First Centuries
Authors: Teles Fazendeiro Bernardo
Published: May 2021

War has increasingly concealed itself by way of euphemism and undeclared armed conflict, a practice that has unsettled the distinction between wartime and peacetime. Each of the four books reviewed herein touches upon this topic, either directly or indirectly. Carson addresses the features of and reasons for covert operations over the course of the twentieth century, focusing on concerted concerns over the risk of escalation. Hoffman and Weiss investigate the evolution of the mainstay commitment to humanitarianism in the international arena, and the extent to which it has become increasingly attached to security. Fazal largely agrees with this conclusion, but takes it one step further. She persuasively shows how the proliferation of international humanitarian law led to a decrease in formal declarations of war among states, a practice that contributed to semantic confusion as well as to the growing use of euphemism to account for armed conflict. Schadlow argues consistently for greater conceptual and practical links between war and postconflict governance, pointing, among other things, to how ill-conceived strategy regarding the broader meaning of war leads to unsuccessful military operations. The review essay subsequently links this common thread—particularly the concealed types of warfare, the use of euphemism, and limited conceptions of armed conflict—to ongoing debates on wartime and peacetime and their relationship to the international order. Overall, the international order's specific setup in conjunction with how war is no longer explicitly recognized or declared has resulted in a division of labor among the military, technocrats, and the police. This division of labor has in turn unsettled the traditional distinction between peacetime and wartime to the effect that the latter is no longer explicitly acknowledged.
Effect of microbial and chemical additives on the fermentation and aerobic stability of alfalfa silage ensiled at 2 dry matters and subjected to air stress during storage
Authors: Li Yanbing , da Silva Erica B , Novinski Charles O , Kung Limin
Published: May 2021

We evaluated the effects of different types of additives on the fermentation and aerobic stability of alfalfa (Medicago sativa) ensiled at 2 dry matters (DM). Alfalfa was untreated (CTRL) or treated with sodium benzoate, potassium sorbate, and sodium nitrite (SFE), or microbial inoculants (Lactobacillus plantarum MTD1 [LP] or L. buchneri 40788 and Pediococcus pentocaseus 12455 [LBPP]) at a moderate (38%) and high (46%) DM using a completely randomized design with a 2 × 4 factorial arrangement of treatments. High DM silage was higher (P < 0.01) in pH, had less lactic and acetic acid (P < 0.01) and had more yeasts (P < 0.05) and molds (P < 0.01) than moderate DM silage. Recovery of DM declined (P < 0.01) for CTRL and LP treated silages with increasing DM but was not different between LBPP and SFE treatments. Compared to CTRL, LBPP had a lower (P < 0.01) DM recovery at the moderate DM, but SFE had the greatest (P < 0.01) recovery of all treatments at the high DM. Treatment with LBPP increased (P < 0.05) the concentrations of acetic acid and 1,2 propanediol (PD) compared with other treatments (P < 0.01). Numerically, fewer yeasts were found in additive treated silages compared with CTRL, but they were statistically (P < 0.01) lower only when treated with SFE. Treatment with LP resulted in a small improvement in aerobic stability at the moderate but not high DM. In contrast, treatment with SFE and LBPP markedly improved (P < 0.01) the aerobic stability of alfalfa silage at both DM. Whereas SFE and LBPP were similar in their improvements in aerobic stability at the DM, LBPP was better (P < 0.01) than SFE at the high DM. A higher (P < 0.01) concentration of acetic acid in LBPP compared with other treatments was most likely responsible for better stability. This study showed that LBPP and SFE resulted in increases in the aerobic stability of alfalfa silage and it is the first study showing SFE, can markedly improve the aerobic stability of alfalfa silage.
Increasing Prevalence of Ketamine in Drivers in New York City Including the Identification of 2-Fluoro-Deschloroketamine
Authors: Arango Elba , Toriello Allison , Rosario Zoila , Cooper Gail
Published: May 2021

Ketamine is a dissociative anesthetic used in veterinary and human medicine since the 1970s. Its clinical use has expanded to control of seizures, by pre-hospital emergency medical services (EMS), and is finding new purpose as an analgesic alternative and antidepressant. Ketamine brings hope for effective management of chronic pain in the absence of opioids and decreasing suicidal ideations; however, its persistence as a recreational drug for its hallucinogenic properties remains. In the wake of expanding medicinal purposes, the diversity of New York City’s population was explored to better understand its misuse. This retrospective study looks at the prevalence of ketamine in driver fatalities over a period of 18 years (2003–2020) and cases involving suspected driving under the influence of drugs (DUID) over a period of 6 years (2015–2020). Ketamine was identified in 6 driver fatalities and in 47 DUID cases. None of the driver fatalities were suspected of ketamine misuse, due to administration either in hospital or by EMS. In the DUID cases, an increasing trend was observed over the 6-year study period with 100% (n = 47) of the cases confirmed as non-hospital/non-EMS administered ketamine. Of the DUID cases, 94% were male with the majority between the age of 21 and 39 years (85%) and were predominantly Hispanic (36%) and Asian (34%). Blood concentrations of ketamine ranged from 27 to >2000 ng/mL with polydrug use prevalent. The most common drug classes detected in addition to ketamine were cannabinoids (38%), ethanol (32%), benzodiazepines (26%), cocaine (19%) and amphetamines/3,4-methylenedioxymethamphetamine (15%). In 2019, 2-fluoro-deschloroketamine was identified in two cases for the first time. Despite its increased acceptance for mental health disorders, ketamine’s persistence and misuse as a recreational drug remains and should continue to be monitored by relevant toxicological, clinical and law enforcement communities along with emerging illicit ketamine analogs.
Sublethal Effects of the Microbial-Derived Insecticide Spinetoram on the Growth and Fecundity of the Fall Armyworm (Lepidoptera: Noctuidae)
Authors: Gao Zupeng , Chen Yu , He Kanglai , Guo Jingfei , Wang Zhenying
Published: May 2021

The fall armyworm, Spodoptera frugiperda (J. E. Smith), is one of the most important pests in tropical and subtropical regions of American. S. frugiperda was first detected in Southern China in January 2019, and then subsequently invaded in 26 provinces. Spinetoram widely used for pest management is recommended for S. frugiperda control. The sublethal effects of spinetoram on S. frugiperda were investigated in the present study. The toxicity of spinetoram against S. frugiperda larvae was determined after one oral dose of spinetoram at sublethal concentration. The results showed that spinetoram LC10 and LC30 were 0.011 and 0.044 mg/liter for the larvae, respectively. Spinetoram at sublethal concentration significantly increased developmental time but reduced larval body weight. In addition, spinetoram had a post-exposure effect on pupal weight, but not on pupal duration, pupation rate, emergence rate, eggs number, or adults longevity. In conclusion, the sublethal effects of spinetoram could negatively affect the growth and development of S. frugiperda that have important implications for pest management.
Targeted eHealth Intervention to Reduce Breast Cancer Survivors’ Fear of Recurrence: Results From the FoRtitude Randomized Trial
Authors: Wagner Lynne I , Tooze Janet A , Hall Daniel L , Levine Beverly J , Beaumont Jennifer , Duffecy Jenna , Victorson David , Gradishar William , Leach Joseph , Saphner Thomas , Sturtz Keren , Smith Mary Lou , Penedo Frank , Mohr David C , Cella David
Published: May 2021

Background

Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching.

Methods

BCS (N  = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided.

Results

FCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P < .001).

Conclusions

BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
Wisdom Mind
Authors: Smart Colette M.
Published: May 2021

Wisdom Mind is an empirically supported intervention program for older adults—those who are cognitively healthy, as well as those who may be experiencing some concerns about their thinking abilities, what we refer to as subjective cognitive decline. While mindfulness is already known to benefit a wide variety of individuals, the unique strengths of this program are the ways in which it is tailored specifically to older adults. Session content is grounded in and contextualized with the developmental concerns of older adults (e.g., cognitive slip-ups, loss and grief). Content is further grounded in a clinical-neuropsychological perspective, which incorporates both restitution (i.e., scaffolding mindfulness practices in a sequence of increasing difficulty) and compensation (e.g., strategies to promote learning and integration). The session-by-session Facilitator Guide provides detailed information on how to deliver the program, as well as the reasoning behind why certain practices and strategies are provided at different times and in different ways. In this way, even seasoned mindfulness instructors can benefit from the Guide, which provides integrative guidance on how to deliver mindfulness effectively to older adults. The companion Participant Workbook contains all of the information needed to participate in the program, including written prompts for homework and space for notetaking. A companion website provides downloadable meditation audios that facilitators and participants can access throughout the program. For facilitators who wish to record their own audios, scripts are also provided in the Guide.
Wisdom Mind: Conceptual Foundations and Preparing to Deliver the Program
Authors: Smart Colette M.
Published: May 2021

This chapter provides the background to the Wisdom Mind program—why it was developed, the conceptual foundations on which it is based, and the results from the original empirical evaluation of the program. While the program is broadly influenced by Jon Kabat-Zinn’s mindfulness-based stress reduction, Wisdom Mind stands on its own as a unique program that is grounded in principles of clinical neuropsychology (specifically, cognitive rehabilitation) as well as lifespan developmental psychology. This chapter orients the reader to the overall structure of the program, who the program is designed for, and how to appropriately screen participants and measure outcomes/response to the program.
Session 1: Introduction to the Program
Authors: Smart Colette M.
Published: May 2021

This first session covers the introduction to the program. It establishes the group context and orients participants to what to expect for the remainder of the program. Participants may have had varying levels of exposure to mindfulness, so time is taken to talk about what mindfulness is in the context of this program, and specifically how it is relevant to older adults and late-life cognitive decline. The raisin exercise is used as an in-class example of mindfulness. Information is given on the “attitudes of mindfulness,” aspirational principles that people can bring to their experiences in the program. Participants are introduced to the first homework exercises, and time is taken to troubleshoot when participants will practice and how they will remember to engage in daily practice.
Session 2: Noticing Slip-Ups
Authors: Smart Colette M.
Published: May 2021

The second session involves taking a deeper dive into mindfulness practice. We begin by debriefing participants on their initial experience with mindfulness from the prior week. As this mindfulness might be quite novel for certain participants, there may have been strong opinions or emotional reactions elicited in response to the homework. This material provides a context for the discussion of the experience of cognitive slip-ups as we age and how mindfulness can be one way to offset those slips. The facilitator then introduces the concept of cognitive reserve as a “mental bank account” that can be enhanced through mindfulness.
Session 3: Noticing Slips and Falls
Authors: Smart Colette M.
Published: May 2021

The main focus of the current session is to help participants see the connection between their cognitive slip-ups (which they were asked to track in the prior week’s homework) and the emotional reactions they have to those slip-ups (i.e., “falls,” as in “slips and falls”). Homework is reviewed to provide material for this discussion. This segues into providing psychoeducation on the hierarchy of attention, and Focused Attention mindfulness is again reinforced as a way to decrease slip-ups. Participants are introduced to the first of two Mindful Yoga series as another way to experience present-moment awareness, and as a complement to sitting meditation practice. Tracking pleasant events is also assigned for homework as a way to make the bridge between mindfulness practice and daily activities and life experiences.
Session 4: Paying Attention to the Commentator
Authors: Smart Colette M.
Published: May 2021

The main principle introduced in this session is the idea of a “commentator”, the voice of automatic thoughts that contributes to the emotional reactivity in response to cognitive slip-ups. Through the homework of tracking “slips and falls,” participants are invited to reflect on this aspect of their mind that is constantly commenting on their experience. This, in turn, is connected to the concept of mind-wandering; this is a core concept in most discussions of mindfulness practices, and may become even more of an issue as we age. Participants are given the second of two Mindful Yoga series, and the attention hierarchy is also reinforced and connected to increasing experience with the practice. Tracking unpleasant events is also assigned for homework.
Session 5: Reacting Versus Responding
Authors: Smart Colette M.
Published: May 2021

In this session, a distinction is made between mindfulness (coming to the present moment) and awareness (what we find when we come to this moment). After a discussion of the prior week’s practices, participants are then introduced to Open Monitoring as a way to cultivate awareness and make space for our emotional reactivity. In this context, a discussion is raised about “falling down a hole”—when we have a sustained negative emotional reaction, for example, in response to a cognitive slip-up. Participants are assigned the practice “Emotional Weather” as a way to actively work with emotions. Walking meditation (“Aimless Wandering”) is also provided for home practice.
Session 7: Be Your Own Meditation Instructor and Daylong Retreat
Authors: Smart Colette M.
Published: May 2021

Nearing the end of the program, participants are asked to reflect on how they will sustain their mindfulness practice going forward. This underscores the self-regulatory aspect of mindfulness, as one learns how to “become one’s own meditation instructor.” This chapter also contains information regarding the daylong retreat. Participants are given guidance on how to prepare for this silent day of group mindfulness practice, and time is spent in session addressing any questions or concerns about the retreat. The prior week’s experience tracking reacting versus responding in relationships is discussed, and the final new practice of Loving-Kindness is introduced as a way to cultivate compassion for ourselves and ultimately for others.
Session 8: Final Session: Taking the Practice Forward
Authors: Smart Colette M.
Published: May 2021

This final session provides a time and space for reflection—reflecting on the retreat experiences the participants have just had, their experiences with the program as a whole, and also their plans to take the practice forward. This might include how participants could seek additional support (e.g., joining a local mindfulness group) or even support each other in continued practice. In particular, time is taken to troubleshoot potential difficulties in keeping up with practice, and participants are reminded that, much like exercise, benefits will continue only with continued practice. If the optional booster session(s) will take place, time is spent scheduling and preparing for this.
Session 1: Introduction to the Program
Authors: Smart Colette M.
Published: May 2021

This first session covers the introduction to the program. It establishes the group context and will orient you to what to expect for the remainder of the program. Different people may have had varying levels of exposure to mindfulness, so time is taken to talk about what mindfulness is in the context of this program, and specifically how it is relevant to older adults. Mindfulness is both a practice/skill and also a way of thinking about our life. As such, you will be introduced to the first of several formal practices, as well as the “attitudes of mindfulness,” aspirational principles that you are invited to bring to your experiences in the program. Participants are introduced to the first homework exercises, and time is taken to troubleshoot when you will practice and how you will remember to engage in daily practice.
Session 3: Noticing Slips and Falls
Authors: Smart Colette M.
Published: May 2021

The main focus of the current session is to introduce you to the connection between your cognitive slip-ups (which you were asked to track in the prior week’s homework) and the emotional reactions you have to those slip-ups (i.e., “falls”, as in “slips and falls”). You will have a chance to discuss your experience with the homework and what you learned about the kinds of slip-ups you experience and how that is related to your mood. Building on this, you will learn about the hierarchy of attention, and how Focused Attention mindfulness can help you decrease slip-ups. You will also be introduced to the first of two Mindful Yoga series as another way to experience present-moment awareness, and as a complement to sitting meditation practice. Tracking pleasant events is also assigned for homework as a way to make the bridge between mindfulness practice and daily activities and life experiences.
Session 5: Reacting Versus Responding
Authors: Smart Colette M.
Published: May 2021

In this session, a distinction is made between mindfulness (coming to the present moment) and awareness (what we find when we come to this moment). After a discussion of the prior week’s practices, you will then be introduced to a new practice, “Open Monitoring,” as a way to cultivate awareness and make space for our emotional reactivity. In this context, we will talk about the idea of “falling down a hole”—when we have a sustained negative emotional reaction, for example, in response to a cognitive slip-up. For homework, you will be assigned the practice “Emotional Weather” as a way to actively work with emotions. Walking meditation (“Aimless Wandering”) is provided as a third home practice.
Session 6: Bringing Mindfulness to Our Relationships
Authors: Smart Colette M.
Published: May 2021

In this session, we will take time to review your experiences of “falling down the hole”—having a sustained emotional reaction to something like a cognitive slip-up. This is connected to further cultivation of awareness as a way to track our experience without reacting to it. The discussion of reacting versus responding is broadened to incorporate our experiences with others, and how we communicate with others. We will then discuss different communication styles and for homework, you will be encouraged to track your use of these communication styles, as well as the tendency to respond versus react. Finally, you will continue with Open Monitoring practice and you are invited to track your mindfulness in daily life and to find ways of adding to your mental bank account.
Session 7: Be Your Own Meditation Instructor and Daylong Retreat
Authors: Smart Colette M.
Published: May 2021

As we are nearing the end of the program, you will be invited to reflect on how you might sustain your mindfulness practice going forward (assuming you have found it helpful!). Taking responsibility for our own meditation practice is something we refer to as “becoming our own meditation instructor.” This chapter also contains information regarding the daylong retreat that will occur between this session and the final one. You will be given guidance on how to prepare for this silent day of group mindfulness practice, and time should be spent in session addressing any questions or concerns about the retreat. We will also review your homework experiences from the prior week, tracking reacting versus responding in relationships, and the final new practice of Loving-Kindness is introduced as a way to cultivate compassion for ourselves and ultimately for others.
Session 8: Final Session: Taking the Practice Forward
Authors: Smart Colette M.
Published: May 2021

This final session provides a time and space for reflection – reflecting on the retreat experiences you have just had, your experiences with the program as a whole, and also your plans to take the practice forward. This might include how you could seek additional support (e.g., joining a local mindfulness group) or even how the group itself can support one other in continued practice. In particular, time is taken to troubleshoot potential difficulties in keeping up with practice, and you are reminded that, much like exercise, benefits will continue only with continued practice. If the optional booster session(s) will take place, time is spent scheduling and preparing for this final session.
Counseling Preparation
Authors: Joyce-Beaulieu Diana , Zaboski Brian A.
Published: May 2021

All counselors have to start somewhere, so Chapter 3 opens by describing the broader ethical and legal considerations an effective school-based practitioner must understand before initiating cognitive behavioral therapy (CBT). Special attention is paid to the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA), in addition to the careful attention practitioners must pay to these laws when serving students with medical needs. Chapter 3 highlights important ethical principles that school psychologists often abide by, including confidentiality and mandated reporting. Next, Chapter 3 introduces basic counseling skills that all practitioners can benefit from. These micro skills, like how to build a strong therapeutic alliance and how to listen, observe, and ask questions, are essential to maximizing CBT’s effectiveness.
Culturally Responsive Mental Health Services
Authors: Parker Janise S. , Joyce-Beaulieu Diana , Zaboski Brian A.
Published: May 2021

Chapter 4 guides readers in applying cognitive behavioral therapy within culturally responsive mental health services, a cornerstone to individualizing student mental health services. The chapter begins by identifying who a therapist’s clients are and then delves into the many developmental considerations and stages that children and adolescents progress through to adulthood. The author acknowledges that in addition to a developmental perspective, addressing treatment barriers for youth in the minority also entails more culturally aware practitioners who understand, respect, and value their clients’ cultural strengths. The chapter concludes with two case studies that show readers how these elements coalesce into culturally responsive mental health services.
Core CBT Components
Authors: Reid Erin K. , Taylor Leslie K. , Banneyer Kelly N. , Dominguez Jose , Liu Gary , Williams Laurel L. , Zaboski Brian A. , Schneider Sophie C. , Storch Eric A.
Published: May 2021

Chapter 7 presents another core cognitive behavioral therapy (CBT) skill: CBT with exposure and response prevention, a first-line treatment for obsessive-compulsive and anxiety-related disorders. After briefly highlighting the efficacy research for children and adolescents, this chapter describes the technique’s theoretical framework, explains it in detail, addresses common misconceptions, and guides practitioners in developing customized fear hierarchies for students. Next, the chapter carefully describes the technique’s trauma applications, including trauma narratives and in vivo exposures. Differences between treatments for anxiety and trauma are noted, as well as complexities that arise from complex trauma. The chapter concludes with a discussion of trauma-focused CBT in schools and stepped-care models and provides a detailed case study.
Integrating Technology into School-Based Interventions
Authors: Muller Greg M. , Zaboski Brian A. , Joyce-Beaulieu Diana
Published: May 2021

Cognitive behavioral therapy (CBT) was formulated well before the first cellphone hit the market, but computer- and smartphone-assisted applications are increasingly popular. Chapter 8 reviews the rationale for incorporating technology into CBT and the research supporting it. It includes detailed considerations for selecting mobile apps for behavior change, mindfulness, and therapy/self-help goals and offers advice on how to utilize them with students and teachers. Select apps are described in detail, along with their pros and cons and utility for specific presenting problems. The chapter concludes by acknowledging some limitations of mobile apps and presenting a case study that applies mobile apps in a school-based session.
Prevalence of Polytrauma Clinical Triad Among Active Duty Service Members
Authors: Laughter Sharon , Khan Munziba , Banaag Amanda , Madsen Cathaleen , Koehlmoos Tracey Perez
Published: May 2021

Introduction

The polytrauma clinical triad (PCT), encompassing traumatic brain injury, PTSD, and chronic pain, has been identified as a significant concern in the Military Health System (MHS). Conditions in this triad mutually reinforce one another and can pose a significant challenge to treatment for patients and providers. Polytrauma clinical triad has previously been studied in deployed veterans but remains understudied in the active duty military population. Therefore, this novel study seeks to determine the prevalence of PCT among active duty service members and to identify the subpopulations most at risk for PCT.

Materials and Methods

This cross-section study used the MHS Data Repository in order to retrospectively review all administrative claim data for active duty service members within the Army, Navy, Air Force, and Marine Corps from fiscal years 2010 to 2015. Specific ICD-9 codes were extracted that correlated with traumatic brain injury, PTSD, and chronic pain to determine the risk of PCT. We used logistic regression to compare individuals presenting with the PCT conditions to those service members without any of the PCT diagnoses codes.

Results

The study identified 2,441,698 active duty service members eligible for inclusion. The prevalence of all three conditions of PCT was 5.99 per 1,000 patients. Patients with PCT were most likely to be 20–29 years old (52.15%), male (89.83%), White (59.07%), married (64.18%), Junior Enlisted (55.27%), and serving in the Army (74.71%).

Conclusion

This study is the first to identify the risk of PCT in the active duty military population. Awareness of the risk and subsequent prompt identification of the triad will enable treatment through an integrated, team approach, which should alleviate potential patient suffering and improve the efficiency of care and readiness of service members.
Rectal Bleeding in the Clinic
Authors: Mangalindan Kristin E , Bush Allison , Nguyen Nhu An
Published: May 2021

Anal cancer is a rare malignancy with an estimated 8,580 new cases each year in the USA where hematochezia, a common condition, is often the initial presenting sign. We describe a 51-year-old woman who presented with painful hematochezia, with a delayed diagnosis of anal cancer in the setting of missed and misdiagnosed digital rectal exams in an otherwise low-risk patient. This case highlights the importance of maintaining a broad differential diagnosis for hematochezia and the utility of thorough physical exams.
Impact of Oral Health Status on Perceived Dental Problems Among Japan Maritime Self-Defense Force Personnel
Authors: Sonoda Chikanobu , Sakurai Yutaka , Okoda Manabu , Ebisawa Masato , Nakashima Hiroshi , Tsunoda Masashi
Published: May 2021

Introduction

Dental problems may have a great impact on military mission effectiveness, as such, evidence-based dental classification guidelines are required for minimizing the occurrence of dental problems. The aim of this study is to elucidate the independent contribution of each oral disease to the perception of dental problems among Japan Maritime Self-Defense Force (JMSDF) personnel in order to make the dental classification guidelines more precise for the prediction of future dental problems.

Materials and Methods

Japan Maritime Self-Defense Force personnel who were examined during the annual dental checkup in 2013 answered questions about the experience of dental problems within the last 12 months in 2014. The associations between the items of a dental checkup and the perception of dental problems were examined using multiple logistic regression analysis with a stepwise procedure to calculate odds ratios (ORs) and 95% CIs.

Results

The data of a total of 22,441 subjects were included in the analysis. Those who declared to have perceived dental problems within the last 12 months were 5,088 (22.7%). The multiple logistic regression analysis showed that personnel who had decayed teeth had a higher chance of experiencing dental problems than those who had no dental caries. Personnel whose periodontal disease was judged to be more severe in a dental examination had a greater OR for the perception of dental problems.

Conclusion

These results may become recommendations for operations in the JMSDF dental classification system.
Predictors of Emotional Distress in Combat Military Flight Engineers
Authors: Cohen-Koren Reoot , Garbi Dror , Gordon Shirley , Yavnai Nirit , Erlich Shoham Yifat , Shelef Leah
Published: May 2021

Objective

Exposure to distressing sights (DSs) during combat missions may cause emotional distress. The present study aimed to investigate the association between exposure to DSs involving severe injuries and fatalities during rescue missions and emotional distress, in Israeli Air Force (IAF) helicopter flight engineers (FEs).

Methods

Cross-sectional design using self-report questionnaires. The independent variables included demographics, personal, and military variables—exposure to DSs throughout a whole career service. The dependent variables included Depression (Beck Depression Inventory); State-Trait Anxiety Inventory; Post-traumatic stress disorder (PTSD Checklist—PCL-5); Somatization (Patient Health Questionnaire); Maslach Burnout Inventory; and Coping Strategies (The Brief COPE). The variables PTSD, depression, and anxiety were examined twice: once as dichotomous variables according to the pathology cutoff point and again as a continuous variable to reveal the intensity of symptoms.

Results

Participants were 106 IAF helicopter FEs (mean age = 39.32, SD = 8.75). Linear regression revealed that initial exposure to distressing battlefield sights (i.e., exposure to severe injuries and fatalities) was a predictor of depression symptoms. Career service FEs aged 31–40 were found to be at the highest risk of emotional distress, with a predictive factor for anxiety symptoms. Use of nonadaptive coping strategies was found to predict depressive symptoms, anxiety symptoms, and post-traumatic stress symptoms.

Conclusion

A significant association was found between exposure to DSs involving severe injuries and fatalities during rescue missions and anxiety, depression, somatization, and burnout. This population is generally perceived as tough and resilient, and this study has a unique contribution in identifying its vulnerabilities. Psychological intervention is crucial after participating in such missions.