Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT.

BACKGROUND: Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA. METHODS: A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants' steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed. RESULTS: Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time. CONCLUSIONS: In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed. TRIAL REGISTRATION: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

The effects of personality and aging attitudes on well-being in different life domains.

OBJECTIVES: Personality plays a major role in determining the way people adjust to life experiences, ultimately affecting life satisfaction. Aging attitudes also impact well-being, but there is little research on whether these personality and attitudinal effects reflect the same mechanism. The purpose of this study was to examine whether aging attitudes mediate the relationship between personality and well-being across seven different domains of everyday functioning, and whether this effect depends on age. METHODS: Data from 563 adults ranging in age from 30 to 89 were used. Sociodemographic information as well as the Big Five Inventory, aging attitudes, and well-being (i.e. current self-views and life satisfaction) in seven different life domains was assessed. RESULTS: The mediating effect of aging attitudes in the relationship between personality and well-being was strong for neuroticism, conscientiousness, and agreeableness and varied across domains. Significant mediation effects were limited for openness and extraversion. Significant moderated mediations were rather limited but the effects were stronger in later life. DISCUSSION: These results suggest that personality influences aging attitudes, which in turn affect well-being. Further, our results indicate that such relationships are context-specific, suggesting that the global assessments of attitudes and well-being may not fully characterize significant aging outcomes.

Course of a SARS-COV-2 pneumonia in a middle-aged male patient.

The SARS-CoV-2 infection has recently been declared a pandemic by the WHO. Most fatalities occur in elderly people with comorbidities. However, SARS-CoV-2 pneumonias do also occur in younger patients with no comorbidities or risk factors at all. We report here on one of the "early" cases that occurred in Germany. A 57-year-old man was infected and developed pneumonia after a skiing vacation in Northern Italy. Other members of the travel group also fell ill, but only showed flu-like symptoms. Only a few if any infections originated from the affected person; at this point in time the infection situation in the region could still be grasped. Under supportive measures, the disease developed positively despite impressive radiological findings. The positive course is likely also due to the age of the person affected and the lack of any risk factors. The case does also exemplify that a good health condition does not necessarily protect from acquiring a moderately severe SARS-CoV-2 infection.

Severe metabolic syndrome and primary amenorrhea as main pathophysiological features in a subtype of turner syndrome (46, X, del (X) Q 21).

Turner syndrome can be manifest with a considerable genetic and phenotypic variability. This merely accounts for about 50% of patients who do not have the "classic" 45 X genotype. We report the case of a 42-year-old female patient with a 46, X, del (X) q 21 genotype (deletion on the second X chromosome on the long arm). As the patient displayed a non-typical phenotype and was infertile, a diagnosis was established at the age of 24 with no follow-up treatment. As part of our therapy of the individual due to newly manifested diabetes mellitus, our diagnostic workup revealed a severe metabolic syndrome encompassing fatty liver disease, obstructive sleep apnea syndrome and hyperuricemia. Our observations should sensitize physicians treating female patients for one or more aspects of the metabolic syndrome and its presence in Turner syndrome. These patients have an unfavorable cardiovascular profile, in part due to the metabolic syndrome, but also due to factors intrinsic to Turner syndrome.

Neural mechanisms underlying subsequent memory for personal beliefs:An fMRI study.

Many fMRI studies have examined the neural mechanisms supporting emotional memory for stimuli that generate emotion rather automatically (e.g., a picture of a dangerous animal or of appetizing food). However, far fewer studies have examined how memory is influenced by emotion related to social and political issues (e.g., a proposal for large changes in taxation policy), which clearly vary across individuals. In order to investigate the neural substrates of affective and mnemonic processes associated with personal opinions, we employed an fMRI task wherein participants rated the intensity of agreement/disagreement to sociopolitical belief statements paired with neural face pictures. Following the rating phase, participants performed an associative recognition test in which they distinguished identical versus recombined face-statement pairs. The study yielded three main findings: behaviorally, the intensity of agreement ratings was linked to greater subjective emotional arousal as well as enhanced high-confidence subsequent memory. Neurally, statements that elicited strong (vs. weak) agreement or disagreement were associated with greater activation of the amygdala. Finally, a subsequent memory analysis showed that the behavioral memory advantage for statements generating stronger ratings was dependent on the medial prefrontal cortex (mPFC). Together, these results both underscore consistencies in neural systems supporting emotional arousal and suggest a modulation of arousal-related encoding mechanisms when emotion is contingent on referencing personal beliefs.

Impact of a Surgical Sealing Patch on Lymphatic Drainage After Axillary Dissection for Breast Cancer: The SAKK 23/13 Multicenter Randomized Phase III Trial.

BACKGROUND: Several studies and a meta-analysis showed that fibrin sealant patches reduced lymphatic drainage after various lymphadenectomy procedures. Our goal was to investigate the impact of these patches on drainage after axillary dissection for breast cancer. METHODS: In a phase III superiority trial, we randomized patients undergoing breast-conserving surgery at 14 Swiss sites to receive versus not receive three large TachoSil® patches in the dissected axilla. Axillary drains were inserted in all patients. Patients and investigators assessing outcomes were blinded to group assignment. The primary endpoint was total volume of drainage. RESULTS: Between March 2015 and December 2016, 142 patients were randomized (72 with TachoSil® and 70 without). Mean total volume of drainage in the control group was 703 ml [95% confidence interval (CI) 512-895 ml]. Application of TachoSil® did not significantly reduce the total volume of axillary drainage [mean difference (MD) -110 ml, 95% CI -316 to 94, p = 0.30]. A total of eight secondary endpoints related to drainage, morbidity, and quality of life were not improved by use of TachoSil®. The mean total cost per patient did not differ significantly between the groups [34,253 Swiss Francs (95% CI 32,625-35,880) with TachoSil® and 33,365 Swiss Francs (95% CI 31,771-34,961) without, p = 0.584]. In the TachoSil® group, length of stay was longer (MD 1 day, 95% CI 0.3-1.7, p = 0.009), and improvement of pain was faster, although the latter difference was not significant [2 days (95% CI 1-4) vs. 5.5 days (95% CI 2-11); p = 0.2]. CONCLUSIONS: TachoSil® reduced drainage after axillary dissection for breast cancer neither significantly nor relevantly.

Effect of counselling during pulmonary rehabilitation on self-determined motivation towards physical activity in people with chronic obstructive pulmonary disease - protocol of a mixed methods study.

BACKGROUND: Physical activity promotion in people with Chronic Obstructive Pulmonary Disease (COPD) is focus of research and public health. Patient-centred interventions like counselling are promising approaches to help patients reducing sedentary behaviour. Aim of the present study is to investigate if a physical activity counselling program during pulmonary rehabilitation increases physical activity level in daily life in people with COPD. METHODS: A two-armed, single blind randomised controlled trial including 56 people with COPD will be conducted in an outpatient pulmonary rehabilitation. Patients will participate in a 12-week-rehabilitation program; individuals randomized to the interventional group will additionally participate in five counselling sessions with a physiotherapist, based on the principles of motivational interviewing. The participants' physical activity level will be measured using an accelerometer (SenseWear Pro®) before, directly and 3 months after pulmonary rehabilitation. Semi-structured interviews will be conducted to learn more about barriers and facilitators regarding daily physical activity. DISCUSSION: If the strategy successfully improves the physical activity level in people with COPD, counselling might be implemented in pulmonary rehabilitation. TRIAL REGISTRATION: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).

Age-Related Effects on Memory for Social Stimuli: The Role of Valence, Arousal, and Emotional Responses.

Background/Study Context: Previous research (Hess et al., 2013, Psychology and Aging, 28, 853-863) suggested that age-based positivity effects in memory were attenuated with social stimuli. This research examined the degree to which this generalized across arousal levels associated with social images. Variations in approach and avoidance responses to individual images were also examined, along with age differences in their relationship to memory performance. METHODS: In Experiment 1, young (22-43 years) and older (65-85 years) adults recalled positive and negative social scenes that were high or low in arousal. In Experiment 2, young (20-40 years) and older (65-83 years) adults viewed and recalled the same scenes under instructions designed to alter arousal, and approach and avoidance ratings for each image were recorded. RESULTS: In Experiment 1, age differences in recall were confined to high-arousal, negative images, with young adults exhibiting superior memory relative to older adults. There was no evidence of an age-related positivity effect for low-arousal social scenes. This result was replicated in Experiment 2, but distancing instructions minimized the age difference in recall for high-arousal, negative images. Approach and avoidance ratings differentially predicted recall across age groups, with stronger associations in the young. CONCLUSION: The results are consistent with emerging evidence demonstrating that valence-based biases associated with aging (e.g., positivity effect) are specific to the context and stimulus characteristics. Differences in prediction of recall responses from approach and avoidance ratings across age groups suggested that the observed effects in memory reflected differences in responses to the characteristics of stimuli.

Successful Therapy of Severe Pseudomembranous Clostridium difficile Colitis Using a Combination of Fecal Microbiota Therapy and Fidaxomicin.

OBJECTIVE: The aim of this work was to describe the use of a combination of fidaxomicin and fecal microbiota therapy (FMT) in Clostridium difficile infection (CDI). CLINICAL PRESENTATION AND INTERVENTION: A 78-year-old female, who was admitted for surgery due to acute diverticulitis caused by postoperative complications and broad antibiotic therapy, developed CDI-induced colitis. Despite the introduction of metronidazole and vancomycin therapy, her clinical condition continued to deteriorate. She was transferred to the intensive care unit where FMT followed by fidaxomicin were performed because her C-reactive protein and leucocyte levels remained elevated. Further clinical improvement and the resolution of colitis was observed. CONCLUSION: In this case, severe CDI colitis was successfully treated with the combination of FMT and fidaxomicin.

Intermittent midline suprasternal neck mass caused by superior herniation of the thymus.

Neck masses in infants and children have a wide differential diagnosis. However, neck masses apparent only during raised intrathoracic pressure are rare with a limited number of causes, including superior herniation of the normal thymus, apical lung herniation, jugular phlebectasia and laryngocoele. These conditions can easily be differentiated from one another by imaging. We present an infant with intermittent suprasternal neck mass visible only during increased intrathoracic pressure, produced either by crying or straining. Diagnosis of superior herniation of the thymus into the neck was confirmed by ultrasonography with the characteristic sonographic appearances of the normal thymus as well as its shape, size and location. Ultrasonography should be the first imaging modality of choice. Management of superior herniation of the thymus into the neck should be conservative as the thymus naturally involutes with increasing age. Awareness of the differential diagnosis of neck swelling present only on Vasalva manoeuvre or increased intrathoracic pressure is important to prevent unnecessary tests, avoid radiation, biopsy and surgery.

Mechanisms of motivation-cognition interaction: challenges and opportunities.

Recent years have seen a rejuvenation of interest in studies of motivation-cognition interactions arising from many different areas of psychology and neuroscience. The present issue of Cognitive, Affective, & Behavioral Neuroscience provides a sampling of some of the latest research from a number of these different areas. In this introductory article, we provide an overview of the current state of the field, in terms of key research developments and candidate neural mechanisms receiving focused investigation as potential sources of motivation-cognition interaction. However, our primary goal is conceptual: to highlight the distinct perspectives taken by different research areas, in terms of how motivation is defined, the relevant dimensions and dissociations that are emphasized, and the theoretical questions being targeted. Together, these distinctions present both challenges and opportunities for efforts aiming toward a more unified and cross-disciplinary approach. We identify a set of pressing research questions calling for this sort of cross-disciplinary approach, with the explicit goal of encouraging integrative and collaborative investigations directed toward them.

Bone marrow micrometastases do not impact disease-free and overall survival in early stage sentinel lymph node-negative breast cancer patients.

BACKGROUND: The presence of lymph node metastases is the most important prognostic factor in early stage breast cancer. Whether bone marrow micrometastases (BMM) impact the prognosis in sentinel lymph node (SLN)-negative breast cancer patients remains a matter of debate. Therefore, the objective of this study was to assess the impact of BMM on 5-year disease-free and overall survival among those patients. METHODS: We analyzed 410 patients with early stage breast cancer (pT1 and pT2 ≤ 3 cm, cN0) who were prospectively enrolled into the Swiss Multicenter Sentinel Lymph Node Study in Breast Cancer between January 2000 and December 2003. All patients underwent bone marrow aspiration followed by SLN biopsy. All SLN were stained with hematoxylin and eosin and immunohistochemistry (Lu-5, CK-22). Cancer cells in the bone marrow were identified after staining with monoclonal antibodies A45-B/B3 against CK-8, -18, and -19. RESULTS: Negative SLN were found in 67.6% (277 of 410) of the enrolled patients. Of those, BMM status was negative in 75.8% (210 of 277) and positive in 24.2% (67 of 277) patients. Median follow-up was 61 (range 11-96) months. Five-year disease-free survival was 93.6% (95% confidence interval [CI] 89.1-96.0) in BMM-negative and 92.2% (95% CI 82.5-96.2) in BMM-positive patients (p = 0.50). Five-year overall survival was 92.7% (95% CI 87.9-95.8) for the BMM-negative and 92.5% (95% CI 83.4-96.2) for the BMM-positive group (p = 0.85). CONCLUSIONS: This is one of the first prospective studies to examine 5-year disease-free and overall survivals in SLN-negative patients in correlation to their BMM status. Although BMM are identified in one of four SLN-negative patients, they do not impact disease-free and overall survival.

Selective Engagement in Preparations for Aging.

OBJECTIVES: Preparing for old age is an adaptive behavior with positive consequences on well-being. This study examined; (a) the degree to which the importance associated with positive outcomes within specific domains of everyday functioning (e.g., social relationships, health) varies across ages and cultures; (b) the impact of importance on preparing for old age; and (c) whether the effects of importance were greater in later life. METHODS: Using data from adults aged 30-85 years in Germany (n = 623), Hong Kong (n = 317), and the United States (n = 313) collected over 5 years, we examined variations in importance ratings across age, cultures, and behavioral domains, and the extent to which age and importance predicted preparations. RESULTS: Importance ratings were found to vary with age, time of test, domains, and culture, reflecting the expected contextual effects. Importance also was a positive predictor of preparations, with the strength of prediction being somewhat greater in old age. DISCUSSION: The results provide evidence that the perceived importance of functioning within domains is affected by a number of contextual factors, including the domain of everyday function and culture. Given that importance also predicts preparations, such variation may help explain differences in preparations across contexts. In line with selective engagement theory, some support was also obtained for the prediction that older adults are more selective in engaging resources in support of preparations. Such selectivity can be viewed as an adaptive response to diminishing personal resources in later life.

A quantitative analysis of Final Palaeolithic/earliest Mesolithic cultural taxonomy and evolution in Europe.

Archaeological systematics, together with spatial and chronological information, are commonly used to infer cultural evolutionary dynamics in the past. For the study of the Palaeolithic, and particularly the European Final Palaeolithic and earliest Mesolithic, proposed changes in material culture are often interpreted as reflecting historical processes, migration, or cultural adaptation to climate change and resource availability. Yet, cultural taxonomic practice is known to be variable across research history and academic traditions, and few large-scale replicable analyses across such traditions have been undertaken. Drawing on recent developments in computational archaeology, we here present a data-driven assessment of the existing Final Palaeolithic/earliest Mesolithic cultural taxonomy in Europe. Our dataset consists of a large expert-sourced compendium of key sites, lithic toolkit composition, blade and bladelet production technology, as well as lithic armatures. The dataset comprises 16 regions and 86 individually named archaeological taxa ('cultures'), covering the period between ca. 15,000 and 11,000 years ago (cal BP). Using these data, we use geometric morphometric and multivariate statistical techniques to explore to what extent the dynamics observed in different lithic data domains (toolkits, technologies, armature shapes) correspond to each other and to the culture-historical relations of taxonomic units implied by traditional naming practice. Our analyses support the widespread conception that some dimensions of material culture became more diverse towards the end of the Pleistocene and the very beginning of the Holocene. At the same time, cultural taxonomic unit coherence and efficacy appear variable, leading us to explore potential biases introduced by regional research traditions, inter-analyst variation, and the role of disjunct macroevolutionary processes. In discussing the implications of these findings for narratives of cultural change and diversification across the Pleistocene-Holocene transition, we emphasize the increasing need for cooperative research and systematic archaeological analyses that reach across research traditions.

Esophagoprotection mediated by exogenous and endogenous melatonin in an experimental model of reflux esophagitis.

Reflux esophagitis is a common clinical entity in western countries with approximately 30% of the population experiencing the symptoms at least once every month. The imbalance between the protective and aggressive factors leads to inflammation and damage of the esophageal mucosa. We compared the effect of exogenous melatonin and melatonin derived endogenously from L-tryptophan with that of pantoprazole or ranitidine in acid reflux esophagitis due to ligation of the rat pylorus and the limiting ridge between the forestomach and the corpus. Four hours after the induction of gastric reflux, an increase in mucosal lesions associated with edema of the submucosa and with the infiltration of numerous neutrophils and the fall in esophageal blood flow (EBF) were observed. Both melatonin and L-tryptophan or pantoprazole significantly reduced the lesion index (LI) and raised the EBF. Pinealectomy that significantly decreased plasma melatonin levels aggravated LI and these effects were reduced by melatonin and L-tryptophan. Luzindole, the MT2 receptor antagonist, abolished the melatonin-induced reduction in LI and the rise in EBF. L-NNA and capsaicin that augmented LI and decreased EBF, also significantly reduced melatonin-induced protection and hyperemia; both were restored with L-arginine and calcitonin gene-related peptide (CGRP) added to melatonin. Upregulation of IL-1ß and TNF-α mRNAs and plasma IL-1ß and TNF-α levels were significantly attenuated by melatonin and L-tryptophan. We conclude that melatonin protects against acid reflux-induced damage via activation of MT2 receptors mediated by NO and CGRP released from sensory nerves and the suppression of expression and release of TNF-α and IL-1ß.

Cognitive performance in high-altitude climbers: a comparative study of saccadic eye movements and neuropsychological tests.

Impairment of cognitive performance during and after high-altitude climbing has been described in numerous studies and has mostly been attributed to cerebral hypoxia and resulting functional and structural cerebral alterations. To investigate the hypothesis that high-altitude climbing leads to cognitive impairment, we used of neuropsychological tests and measurements of eye movement (EM) performance during different stimulus conditions. The study was conducted in 32 mountaineers participating in an expedition to Muztagh Ata (7,546 m). Neuropsychological tests comprised figural fluency, line bisection, letter and number cancellation, and a modified pegboard task. Saccadic performance was evaluated under three stimulus conditions with varying degrees of cortical involvement: visually guided pro- and anti-saccades, and visuo-visual interaction. Typical saccade parameters (latency, mean sequence, post-saccadic stability, and error rate) were computed off-line. Measurements were taken at a baseline level of 440 m and at altitudes of 4,497, 5,533, 6,265, and again at 440 m. All subjects reached 5,533 m, and 28 reached 6,265 m. The neuropsychological test results did not reveal any cognitive impairment. Complete eye movement recordings for all stimulus conditions were obtained in 24 subjects at baseline and at least two altitudes and in 10 subjects at baseline and all altitudes. Measurements of saccade performances showed no dependence on any altitude-related parameter and were well within normal limits. Our data indicates that acclimatized climbers do not seem to suffer from significant cognitive deficits during or after climbs to altitudes above 7,500 m. We demonstrated that investigation of EMs is feasible during high-altitude expeditions.

Maximizing microbial perchlorate degradation using a genetic algorithm: consortia optimization.

Microorganisms in consortia perform many tasks more effectively than individual organisms and in addition grow more rapidly and in greater abundance. In this work, experimental datasets were assembled consisting of all possible selected combinations of perchlorate reducing strains of microorganisms and their perchlorate degradation rates were evaluated. A genetic algorithm (GA) methodology was successfully applied to define sets of microbial strains to achieve maximum rates of perchlorate degradation. Over the course of twenty generations of optimization using a GA, we saw a statistically significant 2.06 and 4.08-fold increase in average perchlorate degradation rates by consortia constructed using solely the perchlorate reducing bacteria (PRB) and by consortia consisting of PRB and accompanying organisms that did not degrade perchlorate, respectively. The comparison of kinetic rates constant in two types of microbial consortia additionally showed marked increases.

Pyoderma gangrenosum of the vaginal vault after vaginal hysterectomy: only the correct diagnosis of a rare entity can prevent long-term morbidity.

INTRODUCTION: Pyoderma gangrenosum (PG) is a rare ulcerative skin disease characterized by a wide variety in its clinical presentation and outcome. The etiology is unknown and the pathogenesis is poorly understood, but autoimmune mechanisms have been suggested. Gynecological reports about PG are particularly scarce. As gynecologists rarely encounter this disorder, the correct diagnosis can easily be missed. PATIENTS AND METHODS: This paper presents the first case to our knowledge of an idiopathic PG of the vaginal vault as a late complication after vaginal hysterectomy. CONCLUSION: We demonstrate how PG, a rare disorder, might be misdiagnosed and how only the correct diagnosis and treatment involving systemic glucocorticoids and wound care can spare the patients from long-term morbidity.

The first petrographic characterisation of a prehistoric rock crystal mine in the Swiss Alps.

Over the past decades, there has been increasing evidence for the prehistoric use of rock crystal in mountainous environments, including craft specialisation and long-distance exchange. Yet there are only a few known sites where the mineral was quarried in sustainable quantities. One of them is situated near Fiescheralp in the Upper Valais (Switzerland) and dates to the Early Mesolithic and a final stage of the Neolithic. Here we present the first petrographic characterisation of a prehistoric rock crystal mine in the Swiss Alps, involving a combination of different methods. The article provides a detailed description of the fluid inclusions within the quartz crystals and an overview over the related mineral paragenesis. This gives interesting new insights into the formation of the analysed fissure and allows comparing rock crystal artefacts found in other archaeological sites to this particular source. The results form the basis for further investigations concerning the circulation and distribution of the raw material in the past.

Contact With Older Adults Is Related to Positive Age Stereotypes and Self-Views of Aging: The Older You Are the More You Profit.

OBJECTIVES: Past studies showed that intergenerational contact is beneficial in improving attitudes toward older people. To date, however, research on the benefits of contact with older adults focused on younger adults (intergenerational contact), overlooking the effects for older adults (contact with same-age peers). In this study, we investigated the association between contact with older adults and views of the self in old age in a domain-specific way among younger and older adults. METHODS: The sample (n = 2,356) comprised younger (39-55 years) and older (65-90 years) adults who participated in the aging as future study and were from China (Hong Kong and Taiwan), the Czech Republic, Germany, and the United States. We used moderated mediation models for data analysis. RESULTS: Contact with older adults was related to more positive views of the self in old age and this effect was mediated by more positive stereotypes of older people. These relations were stronger for older adults. Beneficial effects of contact with older adults emerged mostly in the domains of friends and leisure, but less in the family domain. DISCUSSION: Having interactions with other older adults may help favorably shape how younger adults and particularly older adults view their own aging, especially in relation to friends and leisure activities. From the perspective of older adults, having regular contacts with other older adults may increase the heterogeneity of exposure to different aging experiences, thus encouraging the formation of more differentiated stereotypes of older people and of their views of themselves in old age.