Feasibility and Safety of Tethered Capsule Endomicroscopy in Patients With Barrett's Esophagus in a Multi-Center Study.

BACKGROUND & AIMS: Tethered capsule endomicroscopy (TCE) involves swallowing a small tethered pill that implements optical coherence tomography (OCT) imaging, procuring high resolution images of the whole esophagus. Here, we demonstrate and evaluate the feasibility and safety of TCE and a portable OCT imaging system in patients with Barrett's esophagus (BE) in a multi-center (5-site) clinical study. METHODS: Untreated patients with BE as per endoscopic biopsy diagnosis were eligible to participate in the study. TCE procedures were performed in unsedated patients by either doctors or nurses. After the capsule was swallowed, the device continuously obtained 10-µm-resolution cross-sectional images as it traversed the esophagus. Following imaging, the device was withdrawn through mouth, and disinfected for subsequent reuse. BE lengths were compared to endoscopy findings when available. OCT-TCE images were compared to volumetric laser endomicroscopy (VLE) images from a patient who had undergone VLE on the same day as TCE. RESULTS: 147 patients with BE were enrolled across all sites. 116 swallowed the capsule (79%), 95/114 (83.3%) men and 21/33 (63.6%) women (P = .01). High-quality OCT images were obtained in 104/111 swallowers (93.7%) who completed the procedure. The average imaging duration was 5.55 ± 1.92 minutes. The mean length of esophagus imaged per patient was 21.69 ± 5.90 cm. A blinded comparison of maximum extent of BE measured by OCT-TCE and EGD showed a strong correlation (r = 0.77-0.79). OCT-TCE images were of similar quality to those obtained by OCT-VLE. CONCLUSIONS: The capabilities of TCE to be used across multiple sites, be administered to unsedated patients by either physicians or nurses who are not expert in OCT-TCE, and to rapidly and safely evaluate the microscopic structure of the esophagus make it an emerging tool for screening and surveillance of BE patients. Clinical trial registry website and trial number: NCT02994693 and NCT03459339.

Use of immersive virtual reality to assess episodic memory: A validation study in older adults.

Virtual reality (VR) allows for the creation of ecological environments that could be used for cognitive assessment and intervention. This study comprises two parts that describe and assess an immersive VR task, the Virtual Shop, which can be used to measure episodic memory. Part 1 addresses its applicability in healthy older adults by measuring presence, motivation, and cybersickness symptoms. Part 2 addresses its construct validity by investigating correlations between performance in the VR task and on a traditional experimental memory task, and by measuring whether the VR task is sensitive to age-related memory differences. Fifty-seven older and 20 younger adults were assessed in the Virtual Shop, in which they memorised and fetched 12 familiar items. Part 1 showed high levels of presence, higher levels of motivation for the VR than for the traditional task, and negligible cybersickness symptoms. Part 2 indicates that memory performance in the VR task is positively correlated with performance on a traditional memory task for both age groups, and age-related differences were found on the VR and traditional memory tasks. Thus, the use of VR is feasible in older adults and the Virtual Shop is a valid task to assess and train episodic memory in this population.

Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load.

OBJECTIVES: Lesbian, gay, and bisexual (LGB) individuals-particularly those who have not disclosed their sexual orientation-are believed to experience increased chronic stress in comparison with heterosexuals. This interdisciplinary study assessed whether psychiatric symptoms (self-rated anxiety, depression, and burnout), stress hormone profiles (diurnal cortisol), and physiological dysregulations (allostatic load [AL]) would differ for a) LGBs versus heterosexuals and b) disclosed LGBs versus nondisclosed LGBs. METHODS: The study included 87 healthy participants (mean [SD] age=24.6 [0.6] years; LGB n=46, 43% women; and heterosexual n=41, 49% women). Diurnal cortisol sampled at five time points was averaged for 2 days. AL indices were based on an algorithm incorporating 21 biomarkers representing neuroendocrine, immune/inflammatory, metabolic, and cardiovascular functioning. Psychological measures were assessed with well-validated questionnaires. RESULTS: Between-group results revealed no significant differences in symptoms of anxiety and burnout, nor among diurnal cortisol levels between sexual orientations. By contrast, gay/bisexual men unexpectedly had lower depressive symptoms (p=.003) and AL levels (p=.043) compared with heterosexual men. Within-group results revealed that disclosed LGBs had fewer psychiatric symptoms (p values<0.01) and lower cortisol levels +30 minutes upon awakening (p=.004) compared with nondisclosed LGBs. Disclosure was not significantly related to AL levels. CONCLUSIONS: LGBs did not manifest more stress-related problems than did heterosexuals. Life transitions like disclosing to one's family and friends may be protective against psychopathologies and hyperactive cortisol awakening responses. Our novel findings underline the roles disclosure processes have on positive health and well-being for sexual minorities.

Activation changes induced by cognitive training are consistent with improved cognitive reserve in older adults with subjective cognitive decline.

Functional magnetic resonance imaging (fMRI) was used to assess the effect of cognitive training on brain activation as a function of the learning phase and level of education. Forty older adults with subjective cognitive decline (SCD) received 6 1-hour memory training sessions with the method of loci. Brain imaging (N = 29) was measured during word list encoding and retrieval before training (PRE), after 3 training sessions (POST3), and after 6 training sessions (POST6). Participants showed increased activation of the left inferior pre-frontal gyrus from PRE to POST6 during encoding and reduced bilateral frontostriatal activation from PRE to POST3 during retrieval, regardless of education. Activation changes from PRE to POST3 varied as a function of education in 2 regions of the right temporal lobe: participants with lower education showed increased activation, while those with higher education showed decreased activation. These regions were initially less active in people with lower education. Results suggest a strategic shift in people with lower education and expertise building in those with higher education, along with a restoration of initial education-related differences.

Using Virtual Reality to Assess and Promote Transfer of Memory Training in Older Adults With Memory Complaints: A Randomized Controlled Trial.

In this proof-of-concept study, we assessed the potential for immersive virtual reality (VR) to measure transfer following strategic memory training, and whether efficacy and transfer are increased when training is complemented by practice in an immersive virtual environment. Forty older adults with subjective memory complaints were trained with the method of loci. They were randomized to either a condition where they practiced the strategy in VR (n = 20) or a control condition where they were familiarized with VR using a non-memory task (n = 20). Training efficacy was measured with word recall, and transfer of the training benefit was measured with a recall task completed in two VR tasks (primary outcomes) as well as a self-report memory questionnaire (secondary outcomes). Testing was administered before (PRE), midway (POST 3), and after (POST 6) training. Participants improved their scores on word recall. Regarding transfer measures, participants improved their performance in the two VR recall tasks but not on the self-report memory questionnaire. No significant group effect was observed. Improvement was found when comparing PRE to POST 3 with no further improvement at POST 6. Thus, strategic memory training improved the memory of seniors with memory complaints on word recall and a transfer task relying on a VR scenario that resembles real-life. However, no evidence supporting an increase in transfer effects was found when enriching training with VR memory exercises.

Computerized attentional training and transfer with virtual reality: Effect of age and training type.

OBJECTIVE: The aims of this study were to assess whether computerized attentional training improves dual-tasking abilities in older adults and whether its effect and transfer are modulated by age and the type of training provided. This study also used virtual reality (VR) as a proxy to measure transfer in a real life related context. METHOD: Sixty participants (30 older and 30 younger adults) were randomized to either: (a) single-task training (two tasks practiced in focused attention; visual detection and alphanumeric equation task); or (b) divided attention variable-priority training (varying the amount of attention to put on each task when performed concurrently). Training effects were assessed at pre- and post-training with tasks similar to the one used in training. Transfer was measured with the virtual car ride, an immersive dual-task scenario and a self-reported questionnaire. RESULTS: In older adults, variable-priority improved attentional control abilities and led to better transfer in the VR dual-task scenario compared with single-task. Younger adults benefited equally from the two types of training and transfer was found on the Alpha span task when performed concurrently in VR. Single-task improved the ability of all participants to carry out the tasks in the focused attention condition. No transfer effects were found on the self-reported measure for either training type or age. CONCLUSION: Attention remains plastic in old age and programs designed to improve attentional control might be beneficial to older adults. Importantly, training can produce transfer to more real life related tasks and transfer remains possible throughout the life span. (PsycINFO Database Record

The Virtual Shop: A new immersive virtual reality environment and scenario for the assessment of everyday memory.

BACKGROUND: Assessing and predicting memory performance in everyday life is a common assignment for neuropsychologists. However, most traditional neuropsychological tasks are not conceived to capture everyday memory performance. NEW METHOD: The Virtual Shop is a fully immersive task developed to assess memory in a more ecological way than traditional neuropsychological assessments. Two studies were undertaken to assess the feasibility of the Virtual Shop and to appraise its ecological and construct validity. In study 1, 20 younger and 19 older adults completed the Virtual Shop task to evaluate its level of difficulty and the way the participants interacted with the VR material. The construct validity was examined with the contrasted-group method, by comparing the performance of younger and older adults. In study 2, 35 individuals with subjective cognitive decline completed the Virtual Shop task. Performance was correlated with an existing questionnaire evaluating everyday memory in order to appraise its ecological validity. To add further support to its construct validity, performance was correlated with traditional episodic memory and executive tasks. RESULTS: All participants successfully completed the Virtual Shop. The task had an appropriate level of difficulty that helped differentiate younger and older adults, supporting the feasibility and construct validity of the task. COMPARISON WITH EXISTING METHOD(S): The performance on the Virtual Shop was significantly and moderately correlated with the performance on the questionnaire and on the traditional memory and executive tasks. CONCLUSIONS: Results support the feasibility and both the ecological and construct validity of the Virtual Shop.

Retrospective coping strategies during sexual identity formation and current biopsychosocial stress.

BACKGROUND: Lesbian, gay men, and bisexual individuals (LGBs) often experience distress related to the recognition, self-acceptance, and disclosure of their sexual orientation. OBJECTIVES AND DESIGN: Retrospectively reported coping strategies enacted during sexual identity formation among LGBs were assessed in relation to current stress indices measured using environmental (frequency of perceived daily hassles), psychological (perceived distress), and biological (allostatic load [AL] levels representing physiological dysregulations) perspectives. METHODS: Forty-six healthy LGBs between the ages of 18 and 45 (M = 23.91, SE = .80) participated. Questionnaires included the Ways of Coping Checklist adapted to disclosure milestones, Daily Hassles Inventory, and Perceived Stress Scale. AL was calculated using 21 biomarkers of neuroendocrine, immune, cardiovascular, and metabolic functioning. RESULTS: Avoidance coping during sexual identity formation was positively associated with frequency of daily hassles (ß = .598, p < .001), perceived stress (ß = .361, p = .015), and AL (ß = .405, p = .006). By contrast, seeking social support was negatively associated with perceived stress (ß = -.598, p = .048). CONCLUSIONS: Emotion-focused coping strategies during LGB sexual identity development are associated with current indices of biopsychosocial stress.