Sharing pain and relief: neural correlates of physicians during treatment of patients.

Patient-physician interactions significantly contribute to placebo effects and clinical outcomes. While the neural correlates of placebo responses have been studied in patients, the neurobiology of the clinician during treatment is unknown. This study investigated physicians' brain activations during patient-physician interaction while the patient was experiencing pain, including a 'treatment', 'no-treatment' and 'control' condition. Here, we demonstrate that physicians activated brain regions previously implicated in expectancy for pain-relief and increased attention during treatment of patients, including the right ventrolateral and dorsolateral prefrontal cortices. The physician's ability to take the patients' perspective correlated with increased brain activations in the rostral anterior cingulate cortex, a region that has been associated with processing of reward and subjective value. We suggest that physician treatment involves neural representations of treatment expectation, reward processing and empathy, paired with increased activation in attention-related structures. Our findings further the understanding of the neural representations associated with reciprocal interactions between clinicians and patients; a hallmark for successful treatment outcomes.

Fracture risk and antiresorptive medication use in older women in the USA.

UNLABELLED: Risk of fragility fractures in older women appears to be under-recognized and under treated. Analysis of a national sample of older US women reveals that over 5 million are at high risk of fracture; only one third of these report being told they have osteoporosis and one quarter are receiving appropriate treatment. INTRODUCTION: Substantial numbers of older women in the United States suffer fragility fractures each year. Although risk for these fractures can be readily identified from clinical characteristics, many women may not be receiving treatments demonstrated to reduce risk. Our objective was to estimate the extent of fracture risk among older white US women and assess patterns of use of pharmacologic agents in response to that risk. METHODS: Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) for 1999-2000 and 2001-2002 were combined to enumerate risk factors for fracture and use of antiresorptive prescription medications for all white women 65 years of age and older. The FRACTURE Index (FI), developed from the Study of Osteoporotic Fractures (SOF), which combines subjects' characteristics to estimate five-year fracture risk, was applied to these national data. RESULTS: Of more than 15 million US women in this age group almost 40% have one risk factor in addition to age that predisposes to fracture; 20% have two or more. More than 5 million women are in the highest category of FI risk; 26% of these will have a nonvertebral fracture and 10% will have a vertebral fracture in the next five years. Antiresorptive medications are being taken by less than 50% of women in most risk categories when all antiresorptives, including estrogen replacement, are included; only 17% of older women who have sustained a prior fracture and 13% in the highest category of FI risk are receiving agents specifically intended to reduce bone loss. CONCLUSIONS: Millions of older US women are at high risk for fragility fractures. Levels of treatment with antiresorptive medications are low and are not commensurate with fracture risk.

A new method for extraction of extracellular polymeric substances from biofilms and activated sludge suitable for direct quantification of sorbed metals.

A method for extraction of extracellular polymeric substances (EPSs) with a dicyclohexyl-18-crown-6 ether was developed to determine levels of organic and inorganic contaminants sorbed to EPS. The crown ether selectively binds alkaline and alkaline earth metals but not heavy metals. The effectiveness of the extraction procedure was higher than that of 2 other methods tested and comparable with that of a method based on a cation exchange resin. On average it was possible to extract 20% of the TOC, 12% of the total protein content, and 4% of the total carbohydrate content of sludge or biofilm biomass. Metal sorption studies in activated sludge showed no influence of exposure time on the fractionation of metals within the biomass. Metals sorbed mostly to cellular material. In biofilms 12.2% of the cadmium and 9.1% of the zinc added was found in the EPS. In activated sludge EPS contained only 2.9% zinc. The distribution of metals within the biomass was dose dependent. The percentage of metals found in EPS decreased with increasing metal concentration. This indicates a higher affinity of metals for cellular binding sites. Time course experiments in a rotating biofilm annular reactor, which consisted of an external cylinder with removable slides and an internal solid drum, revealed a gradual change in zinc concentration associated with EPS, although the total zinc concentration in the biomass remained constant. Concurrently, the amount of extractable EPS decreased. This was a consequence of a microbial population shift, with bacterial counts decreasing and algal and fungal biomass increasing. Using confocal laser scanning microscopy and the fluorescent metal complexing agent Newport Green for in situ detection of zinc it was shown that metals were bound to algae and fungi in the latter part of the experiment. The biofilm became more and more heterogeneous coinciding with a decrease in EPS. To summarize, the observed sorption behavior of metals cannot be explained with the conventional paradigm of EPS as hydrophilic gel. Obviously, different binding mechanisms must be invoked to explain the role of EPS in the sorption and removal of toxic substances in activated sludge and biofilm systems. It is important to consider the microbial population to understand differences in sorption in different matrices.