A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study.

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road's characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

A wearable patch for continuous monitoring of sweat electrolytes during exertion.

Implementation of wearable sweat sensors for continuous measurement of fluid based biomarkers (including electrolytes, metabolites and proteins) is an attractive alternative to common, yet intrusive and invasive, practices such as urine or blood analysis. Recent years have witnessed several key demonstrations of sweat based electrochemical sensing in wearable formats, however, there are still significant challenges and opportunities in this space for clinical acceptance, and thus mass implementation of these devices. For instance, there are inherent challenges in establishing direct correlations between sweat-based and gold-standard plasma-based biomarker concentrations for clinical decision-making. In addition, the wearable sweat monitoring devices themselves may exacerbate these challenges, as they can significantly alter sweat physiology (example, sweat rate and composition). Reported here is the demonstration of a fully integrated, wireless, wearable and flexible sweat sensing device for non-obtrusive and continuous monitoring of electrolytes during moderate to intense exertion as a metric for hydration status. The focus of this work is twofold: 1- design of a conformable fluidics systems to suit conditions of operation for sweat collection (to minimize sensor lag) with rapid removal of sweat from the sensing site (to minimize effects on sweat physiology). 2- integration of Na+ and K+ ion-selective electrodes (ISEs) with flexible microfluidics and low noise small footprint electronics components to enable wireless, wearable sweat monitoring. While this device is specific to electrolyte analysis during intense perspiration, the lessons in microfluidics and overall system design are likely applicable across a broad range of analytes.

"Living in the moment" among cancer survivors who report life-transforming change.

BACKGROUND: Some cancer survivors say that while coping with their illness they have had what they identify as a highly beneficial, personal, life-transforming change (LTC; a self-subscribed condition among participants in this study, not a researcher-defined construct). Previously we found that the content of LTC was highly individual; but certain features of the LTC process were quite uniform. For example, LTC was driven by a very rational desire to remain genuinely functional as a person in the midst of highly stressful circumstances. Our purpose is to further understand LTC by analysis of participants' critique of questionnaire items on positive subjective outcomes. METHODS: We obtained a set of 67 positive psychosocial questionnaire items from the Psychosocial Impact of Illness (PII) item bank development team of the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information Systems (PROMIS) initiative. The PII items are sourced from a variety of instruments, representing more than one theory of personal growth. This enabled a grounded theory approach, allowing a theory of LTC to emerge from the data. Each of nine cancer survivors participated in a single, two-part session: an hour-long semi-structured qualitative interview regarding their LTC (previously reported), then individually critiquing the 67 items in terms of relevance and importance to their self-reported LTC experience (their critique is analyzed in this article). The PII items were grouped into 20 researcher-defined conceptual themes and average scores for each theme were computed and compared. RESULTS: The theme "living in the moment" (LITM; sometimes referred to as "Being in the moment" in other literature) scored significantly higher than other themes. Qualitative interview transcripts revealed that participants spontaneously used LITM as a coping tactic that reduced worries to manageable levels. These participants noticed subsequently that LITM also produced unexpected substantial benefits in many aspects of their lives unrelated to cancer. This experience motivated increased use of LITM that led to LTC beyond coping with cancer. CONCLUSIONS: LITM can be a practical, effective coping tactic to manage worries and promote adaptation to the challenges of a life-threatening illness. Participant interviews indicated the motivation for LITM is not traumatic experience, but seems to be conservation of their own personal resources for coping with increased stresses. Hobfoll's conservation of resources model appears to be more consistent with LITM among our participants than Tedeshi's posttraumatic growth (PTG) model. Several PII items that represent LITM have unfortunately been removed from the current PROMIS PII item bank, indicating a need for improved of item selection criteria. Further research is needed first to identify or develop assessment items that more effectively capture the precursors and phases of LITM, and then develop interventions that facilitate LITM and LTC for patients.

Quantification of cortisol in human eccrine sweat by liquid chromatography - tandem mass spectrometry.

Cortisol has long been recognized as the "stress biomarker" in evaluating stress related disorders. Plasma, urine or saliva are the current source for cortisol analysis. The sampling of these biofluids is either invasive or has reliability problems that could lead to inaccurate results. Sweat has drawn increasing attention as a promising source for non-invasive stress analysis. A sensitive HPLC-MS/MS method was developed for the quantitation of cortisol ((11ß)-11,17,21-trihydroxypregn-4-ene-3,20-dione) in human eccrine sweat. At least one unknown isomer that has previously not been reported and could potentially interfere with quantification was separated from cortisol with mixed mode RP HPLC. Detection of cortisol was carried out using atmospheric pressure chemical ionization (APCI) and selected reaction monitoring (SRM) in positive ion mode, using cortisol-9,11,12,12-D4 as internal standard. LOD and LOQ were estimated to be 0.04 ng ml(-1) and 0.1 ng ml(-1), respectively. Linear range of 0.10-25.00 ng ml(-1) was obtained. Intraday precision (2.5%-9.7%) and accuracy (0.5%-2.1%), interday precision (12.3%-18.7%) and accuracy (7.1%-15.1%) were achieved. This method has been successfully applied to the cortisol analysis of human eccrine sweat samples. This is the first demonstration that HPLC-MS/MS can be used for the sensitive and highly specific determination of cortisol in human eccrine sweat in the presence of at least one isomer that has similar hydrophobicity as cortisol. This study demonstrated that human eccrine sweat could be used as a promising source for non-invasive assessment of stress biomarkers such as cortisol and other steroid hormones.

New and Future Directions in Integrative Medicine Research Methods with a Focus on Aging Populations: A Review.

This review discusses existing and developing state-of-the-art noninvasive methods for quantifying the effects of integrative medicine (IM) in aging populations. The medical conditions of elderly patients are often more complex than those of younger adults, making the multifaceted approach of IM particularly suitable for aging populations. However, because IM interventions are multidimensional, it has been difficult to examine their effectiveness and mechanisms of action. Optimal assessment of IM intervention effects in the elderly should include a multifaceted approach, utilizing advanced analytic methods to integrate psychological, behavioral, physiological, and biomolecular measures of a patient's response to IM treatment. Research is presented describing methods for collecting and analyzing psychological data; wearable unobtrusive devices for monitoring heart rate variability, activity and other behavioral responses in real time; immunochemical methods for noninvasive molecular biomarker analysis, and considerations and analytical approaches for the integration of these measures. The combination of methods and devices presented in this review will provide new approaches for evaluating the effects of IM interventions in real-life ambulatory settings of older adults, and will extend the concept of mobile health to the domains of IM and healthy aging.

Spirituality in the context of life-threatening illness and life-transforming change.

OBJECTIVE: Individuals with life-threatening illness often engage in some form of spirituality to meet increased needs for meaning and purpose. This study aimed to identify the role of spirituality in persons who had reported positive, life-transforming change in relation to life-threatening cancer or cardiac events, and to connect these roles to palliative and supportive care. METHOD: A purposive sample of 10 cardiac survivors and 9 cancer survivors was recruited. Once the participants had given informed consent and passed screening in relation to life-transforming change and distress, they engaged in a semistructured one-hour qualitative interview on the theme of how their life-transforming change occurred in the context of their life-threatening illness. In the present article, our phenomenological analysis focuses on participants' references to purpose and meaning in their lives, with particular attention to the role and context of participants' spirituality. RESULTS: Participants mentioned spirituality, meaning, and purpose in many contexts, including connecting with family and friends, nature, art, music, and sometimes creating a relationship with God. Participants often accessed spirituality by enhancing connections in their own lives: with a higher power, people, their work, or themselves. These enhanced connections gave participants greater meaning and purpose in their lives, and substantially helped participants to adjust to their life-threatening illnesses. SIGNIFICANCE OF RESULTS: Understanding the roles and contexts of spirituality among patients with a life-threatening illness allows us to develop better palliative and supportive care plans. Spiritually oriented supportive care may include support groups, yoga, meditation, nature, music, prayer, or referral to spiritual or religious counselors. A quantitative scale is needed to help healthcare clinicians assess the spiritual and coping needs of individuals with life-threatening illness.

The nature of life-transforming changes among cancer survivors.

Some cancer survivors report positive subjective changes they describe as "life transforming." We used a grounded theory approach to identify the content, underlying process, and identifying characteristics of self-defined "life-transforming" changes (LTCs) reported by 9 cancer survivors. To actualize their hopes for improvement, participants used a self-guided process centered on pragmatic action: researching options, gaining experience, and frankly evaluating results. Many participants discovered unanticipated personal abilities and resources, and those became highly useful in coping with other challenges apart from cancer. This made the increased personal abilities and resources "life transforming" rather than being substantially limited to reducing cancer-related problems. The action-oriented features and processes of LTCs seemed to be more fully described by experiential learning theory than by posttraumatic growth and coping. Supportive intervention to facilitate positive change processes could decrease suffering and enhance positive psychosocial and spiritual outcomes for cancer survivors.

A novel high electrode count spike recording array using an 81,920 pixel transimpedance amplifier-based imaging chip.

Microelectrode recording arrays of 60-100 electrodes are commonly used to record neuronal biopotentials, and these have aided our understanding of brain function, development and pathology. However, higher density microelectrode recording arrays of larger area are needed to study neuronal function over broader brain regions such as in cerebral cortex or hippocampal slices. Here, we present a novel design of a high electrode count picocurrent imaging array (PIA), based on an 81,920 pixel Indigo ISC9809 readout integrated circuit camera chip. While originally developed for interfacing to infrared photodetector arrays, we have adapted the chip for neuron recording by bonding it to microwire glass resulting in an array with an inter-electrode pixel spacing of 30 µm. In a high density electrode array, the ability to selectively record neural regions at high speed and with good signal to noise ratio are both functionally important. A critical feature of our PIA is that each pixel contains a dedicated low noise transimpedance amplifier (∼0.32 pA rms) which allows recording high signal to noise ratio biocurrents comparable to single electrode voltage amplifier recordings. Using selective sampling of 256 pixel subarray regions, we recorded the extracellular biocurrents of rabbit retinal ganglion cell spikes at sampling rates up to 7.2 kHz. Full array local electroretinogram currents could also be recorded at frame rates up to 100 Hz. A PIA with a full complement of 4 readout circuits would span 1cm and could acquire simultaneous data from selected regions of 1024 electrodes at sampling rates up to 9.3 kHz.

Impedance-based retinal contact imaging as an aid for the placement of high resolution epiretinal prostheses.

An important factor in effective stimulation of the retina is close contact with the retina. The design of the electrode surface and the placement of the electrode against the retina both affect the degree of contact with the retina. We have addressed the design factor by creating a curved surface 3200-electrode array. The placement factor we have addressed by use of an impedance sensitive feedback from the array. The feedback is in the form of an image showing contact with the retina, where greater pixel intensity indicates greater impedance and thus closer contact with the retina. In this paper, we present qualitative and quantitative assessments of the relationship between impedance and the device output as well as an in vivo demonstration of contact imaging. In addition, we evaluated the three-dimensional profile of the stimulation voltage distribution to assess the importance of close retinal contact for high resolution stimulation.

Electrical stimulation of isolated retina with microwire glass electrodes.

The development of high-resolution retinal prostheses fabricated from silicon wafers presents an interesting problem: how to electrically bridge the space between the flat silicon wafer and the curved retinal surface. One potential "bridge" is a microwire glass electrode. In this paper we present our results in evaluating microwire glass electrodes. We stimulated isolated rabbit retina (n = 5) with a 0.0256 cm(2) microwire electrode. The current and pulse duration were varied from 498 to 1660 microA and 0.1 to 3 ms, respectively. We found that short pulses produced more spikes per coulomb and longer pulses produced more spikes per milliamp. The optimal pulse duration range of 0.7-1 ms was identified as a compromise between the advantages of short and long pulses. Stimulation of isolated rabbit retina with microwire glass results in consistent neuronal spike formation at safe charge density, 20.7 +/- 4.3 microC/cm(2). We also examined the response of retinas (n = 6) to stimulation with a smaller microwire electrode, 0.0002 cm(2). We found that less current was required (15 microA versus 756 microA) for a 1 ms pulse, but at the expense of greater charge density (75 microC/cm(2) versus 29.5 microC/cm(2)). Nonetheless, a 128-fold reduction in area resulted in only a 2.7-fold increase in charge density required for a 1 ms pulse duration. The results presented here indicate that microwire glass can be used as a neural stimulating electrode to bridge the gap between flat microelectronic stimulator chips and curved neuronal tissue.