Study protocol for the Mindful Moms Study: A randomized controlled trial evaluating a mindful movement intervention for marginalized pregnant people experiencing depression.

More than 1 in 5 pregnant people in the United States experience depressive symptoms. Although treatments exist, many people remain under- or un-treated due to concerns about stigma, side effects, and costs of medications or psychotherapy, particularly those who are marginalized (defined as those who are minoritized, low-income, or with low-educational attainment). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptom etiology. This protocol presents the rationale, design, and status of the two-arm longitudinal parallel group randomized controlled trial - the Mindful Moms Study - which aims to evaluate the effects and mechanisms of a group-based mindful physical activity (yoga) intervention in marginalized pregnant people with depressive symptoms (n = 200) compared to a prenatal education control group. The primary aim is to evaluate effects of group assignment on depressive symptom severity, anxiety, and perceived stress over time from baseline to six weeks postpartum. Secondary aims include understanding the role of social connectedness as a moderator of the effects and to identify genome-wide DNA methylation patterns associated with depressive symptoms and perceived social connectedness at postpartum. A focus on adequate symptom management through non-pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. The successful completion of this study will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied population. Trial registration: NCT04886856.

Nonreplicating vectors in HIV vaccines.

PURPOSE OF REVIEW: We review the broad spectrum of nonreplicating viral vectors which have been studied extensively, from preclinical studies through clinical efficacy trials, and include some of our most promising HIV vaccine candidates. RECENT FINDINGS: The success of the RV144 trial, with a canarypox virus-based regimen, contrasts with the failures of the adenovirus-5 (Ad5)-based regimens in the Step study, the Phambili study [HIV Vaccine Trials Network (HVTN) 503], and the HVTN 505 study which was recently modified to halt vaccinations because of clinical futility. SUMMARY: The safety profile, immunogenicity, and variety of available candidates make the nonreplicating viral vectors attractive in HIV vaccine development. Building from the success of the RV144 study, further studies of Orthopoxvirus-based vaccines, including vaccinia-based vaccines, are ongoing and planned for the future. Despite the failures of the Ad5-based vaccines in clinical efficacy trials, other adenovirus serotypes remain promising candidates, especially in prime-boost combination with other products, and with the potential use of mosaic inserts. Other nonreplicating viral vectors such as the rhabdoviruses, alphaviruses, and the nonhuman adenoviruses, provide additional avenues for exploration.

Protamine sulfate down-regulates thrombin generation by inhibiting factor V activation.

Protamine sulfate is a positively charged polypeptide widely used to reverse heparin-induced anticoagulation. Paradoxically, prospective randomized trials have shown that protamine administration for heparin neutralization is associated with increased bleeding, particularly after cardiothoracic surgery with cardiopulmonary bypass. The molecular mechanism(s) through which protamine mediates this anticoagulant effect has not been defined. In vivo administration of pharmacologic doses of protamine to BALB/c mice significantly reduced plasma thrombin generation and prolonged tail-bleeding time (from 120 to 199 seconds). Similarly, in pooled normal human plasma, protamine caused significant dose-dependent prolongations of both prothrombin time and activated partial thromboplastin time. Protamine also markedly attenuated tissue factor-initiated thrombin generation in human plasma, causing a significant decrease in endogenous thrombin potential (41% +/- 7%). As expected, low-dose protamine effectively reversed the anticoagulant activity of unfractionated heparin in plasma. However, elevated protamine concentrations were associated with progressive dose-dependent reduction in thrombin generation. To assess the mechanism by which protamine mediates down-regulation of thrombin generation, the effect of protamine on factor V activation was assessed. Protamine was found to significantly reduce the rate of factor V activation by both thrombin and factor Xa. Protamine mediates its anticoagulant activity in plasma by down-regulation of thrombin generation via a novel mechanism, specifically inhibition of factor V activation.

Attention to simultaneous unrelated auditory and visual events: behavioral and neural correlates.

The cognitive and neural bases of the ability to focus attention on information in one sensory modality while ignoring information in another remain poorly understood. We hypothesized that bimodal selective attention results from increased activity in corresponding sensory cortices with a suppression of activity in non-corresponding sensory cortices. In a functional magnetic resonance imaging (fMRI) study, we presented melodies and shapes alone (unimodal) or simultaneously (bimodal). Subjects monitored for changes in an attended modality while ignoring the other. Subsequently, memory for both attended and unattended stimuli was tested. Subjects remembered attended stimuli equally well in unimodal and bimodal conditions, and significantly better than ignored stimuli in bimodal conditions. When a subject focused on a stimulus, the blood-oxygen-level-dependent (BOLD) response increased in sensory cortices corresponding to that modality in both unimodal and bimodal conditions. Additionally, the BOLD response decreased in sensory cortices corresponding to the non-presented modality in unimodal conditions and the unattended modality in bimodal conditions. We conclude that top-down attentional effects modulate the interaction of sensory cortical areas by gating sensory input. This interaction between sensory cortices enhances processing of one modality at the expense of the other during selective attention, and subsequently affects memory encoding.

Behavioral and neural correlates of perceived and imagined musical timbre.

The generality of findings implicating secondary auditory areas in auditory imagery was tested by using a timbre imagery task with fMRI. Another aim was to test whether activity in supplementary motor area (SMA) seen in prior studies might have been related to subvocalization. Participants with moderate musical background were scanned while making similarity judgments about the timbre of heard or imagined musical instrument sounds. The critical control condition was a visual imagery task. The pattern of judgments in perceived and imagined conditions was similar, suggesting that perception and imagery access similar cognitive representations of timbre. As expected, judgments of heard timbres, relative to the visual imagery control, activated primary and secondary auditory areas with some right-sided asymmetry. Timbre imagery also activated secondary auditory areas relative to the visual imagery control, although less strongly, in accord with previous data. Significant overlap was observed in these regions between perceptual and imagery conditions. Because the visual control task resulted in deactivation of auditory areas relative to a silent baseline, we interpret the timbre imagery effect as a reversal of that deactivation. Despite the lack of an obvious subvocalization component to timbre imagery, some activity in SMA was observed, suggesting that SMA may have a more general role in imagery beyond any motor component.