A diffusion decision model analysis of the cognitive effects of neurofeedback for ADHD.

OBJECTIVE: To examine cognitive effects of neurofeedback (NF) for attention-deficit hyperactivity disorder (ADHD) as a secondary outcome of a randomized clinical trial. METHOD: In a double-blind randomized clinical trial (NCT02251743), 133 7-10-year olds with ADHD received either 38 sessions of NF (n = 78) or control treatment (n = 55) and performed an integrated visual and auditory continuous performance test at baseline, mid- and end-treatment. We used the diffusion decision model to decompose integrated visual and auditory continuous performance test performance at each assessment into cognitive components: efficiency of integrating stimulus information (v), context sensitivity (cv), response cautiousness (a), response bias (z/a), and nondecision time for perceptual encoding and response execution (Ter). Based on prior findings, we tested whether the components known to be deficient improved with NF and explored whether other cognitive components improved using linear mixed modeling. RESULTS: Before NF, children with ADHD showed main deficits in integrating stimulus information (v), which led to less accurate and slower responses than healthy controls (p = .008). The NF group showed significantly more improvement in integrating auditory stimulus information (v) than control treatment (significant group-by-time-by-modality effect: p = .044). CONCLUSIONS: NF seems to improve v, deficient in ADHD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Changes in the expression of inflammatory and epigenetic-modulatory genes after an intensive meditation retreat.

Background: Meditation retreats are characterized by intensive or concentrated periods of meditation practice, commonly undertaken in a residential setting. Although research indicates that meditation training can positively influence physical and mental health outcomes, the biological consequences of meditation retreat interventions are relatively understudied. In this study, we examined the influence of a month-long, silent meditation retreat on the expression of genes involved in epigenetic modulation and immune processes. Method: We assessed gene expression changes in experienced meditators attending a month-long Insight meditation retreat (n = 28), as compared to a community control group (n = 34) of experienced practitioners living their everyday lives. Blood samples were collected on day two of the retreat (Time 1) and again 3 weeks later (Time 2). Control participants were also assessed across a 3-week interval, during which they maintained their regular daily routines. Results: As compared to controls, retreat participants showed differential changes in the expression of several genes involved in chromatin modulation and inflammation. The most substantive finding was downregulation of the TNF pathway in retreat participants, which was not observed in controls. Conclusions: These findings indicate that meditation retreat participation may influence some of the inflammatory mechanisms involved in the development of chronic diseases, and that this style of psychosocial intervention may have therapeutic potential, particularly in experienced practitioners.

Selective Metal-Phenolic Assembly from Complex Multicomponent Mixtures.

Selective self-assembly in multicomponent mixtures offers a method for isolating desired components from complex systems for the rapid production of functional materials. Developing approaches capable of selective assembly of "target" components into intended three-dimensional structures is challenging because of the intrinsically high complexity of multicomponent systems. Herein, we report the selective coordination-driven self-assembly of metal-phenolic networks (MPNs) from a series of complex multicomponent systems (including crude plant extracts) into thin films via metal chelation with phenolic ligands. The metal (FeIII) selectively assembles low abundant phenolic components (e.g., myricetrin and quercetrin) from plant extracts into thin films. This selective metal-phenolic assembly is independent of the substrate properties (e.g., size, surface charge, and shape). Moreover, the high selectivity is consistent across different target phenolic ligands in model mixtures, even though each individual component can form thin films from single-component systems. A computational simulation of film formation suggests that the driving force for the selective behavior stems from differences in the number of chelating sites in the phenolic structures. The MPN films are shown to demonstrate improved antioxidant properties compared with the corresponding phenolic compounds in their free form, therefore exhibiting potential as free-standing antioxidant films.

Residential meditation retreats: their role in contemplative practice and significance for psychological research.

Contemporary investigations of mindfulness and meditation have predominately emphasized the short-term effects of brief inductions or standardized, multi-week interventions in people with little to no prior meditation experience. Considerably less is known about the effects of continued or intensive meditation practice as proficiency and expertise are acquired over time. In this article, we describe the form and function of residential retreats, an understudied class of meditation intervention that holds promise for bridging this gap in the empirical literature. We outline a number of design features that distinguish retreats from other meditation-based interventions, and highlight their utility for informing functional and developmental perspectives on meditation, cognition, health, and well-being.

Meditation, stress processes, and telomere biology.

Both theoretical and empirical work support the notion that meditation training can improve telomere regulation, which may ultimately contribute to healthy aging. Yet, the psychological and biological mechanisms underlying these changes remain underspecified, as do the contexts and boundary conditions in which these changes occur. Here we summarize studies investigating the effects of various meditation-based interventions on telomere biology, making suggestions for future research. We then propose a model describing how meditation training may impact acute and habitual stress responses as pathways to improved cell aging.

Insight meditation and telomere biology: The effects of intensive retreat and the moderating role of personality.

A growing body of evidence suggests that meditation training may have a range of salubrious effects, including improved telomere regulation. Telomeres and the enzyme telomerase interact with a variety of molecular components to regulate cell-cycle signaling cascades, and are implicated in pathways linking psychological stress to disease. We investigated the effects of intensive meditation practice on these biomarkers by measuring changes in telomere length (TL), telomerase activity (TA), and telomere-related gene (TRG) expression during a 1-month residential Insight meditation retreat. Multilevel analyses revealed an apparent TL increase in the retreat group, compared to a group of experienced meditators, similarly comprised in age and gender, who were not on retreat. Moreover, personality traits predicted changes in TL, such that retreat participants highest in neuroticism and lowest in agreeableness demonstrated the greatest increases in TL. Changes observed in TRGs further suggest retreat-related improvements in telomere maintenance, including increases in Gar1 and HnRNPA1, which encode proteins that bind telomerase RNA and telomeric DNA. Although no group-level changes were observed in TA, retreat participants' TA levels at post-assessment were inversely related to several indices of retreat engagement and prior meditation experience. Neuroticism also predicted variation in TA across retreat. These findings suggest that meditation training in a retreat setting may have positive effects on telomere regulation, which are moderated by individual differences in personality and meditation experience. (ClinicalTrials.gov #NCT03056105).

Antimicrobial-resistant Faecal Organisms in Algae Products Marketed as Health Supplements.

Dietary supplements are increasingly popular in Irish society. One of these is blue-green algae which is used with a variety health benefits in mind. A batch of Chlorella powder was found to be contaminated with Salmonella species in Ireland in 2015. This prompted additional testing of a total of 8 samples of three different products (Chlorella, Spirulina and Super Greens), for other faecal flora and antimicrobial resistance in any bacteria isolated. All 8 samples cultured enteric flora such as Enterococci, Enterobacteriaceae and Clostridium species. Antimicrobial susceptibility testing revealed one isolate with extended-spectrum ?-lactamase (ESBL) activity and one with carbapenemase activity. Clinicians caring for vulnerable patients should be aware of the potential risk of exposure to antimicrobial resistant bacteria associated with these products.

Management of patients in a combined thyroid eye clinic in secondary care.

The European Group on Graves' Orbitopathy (EUGOGO) recommends the use of specialised multidisciplinary clinics for the management of thyroid eye disease (TED). In the UK, many patients with TED are managed outside of specialised clinics. We describe the organisation of a combined TED clinic in a secondary care setting and present the result of a prospective audit of the patient characteristics and outcomes during the first four years of a combined TED clinic. Of a total of 132 patients referred to the TED clinic, 114 (86 %) had TED (90 females, median age 56 years; range 17-90 years). At presentation, 77 (67 %) were current or ex-smokers and 99 (87 %) were biochemically euthyroid. Median duration of eye symptoms was 12 months. Fifty-two percent, 45 and 3 had mild, moderate-to-severe and sight-threatening TED, respectively. Only 18 % of patients had a clinical activity score (CAS) of ≥3. Sixty-nine patients (61 %) required follow-up appointments in the TED clinic. In those who required follow-up, 43 % (n = 30) received either immunosuppressive or surgical treatment. CAS improved from first to final visit, with 29 % (n = 20) having a CAS of ≥3 at the first visit and 1 % (n = 1) at the final visit (p = 0.0001). There was also a decrease in prevalence of smoking and thyroid dysfunction at the final visit. A multidisciplinary specialised TED clinic offers an optimal setting for managing patients with TED; however, patients are often referred late to a specialist TED clinic.

The use of a respiratory rate biofeedback device to reduce dental anxiety: an exploratory investigation.

Anxiety experienced by individuals visiting the dental office to receive treatment is common. Evidence has shown biofeedback to be a useful modality of treatment for numerous maladies associated with anxiety. The purpose of the current pilot study was to investigate the use of a novel biofeedback device (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and consequently reduce the pain associated with dental injections. Eighty-one subjects participated in this study, forty in the experimental group and forty-one in the control group. Subjects in the experimental group used the biofeedback technique, while those in the control group were not exposed to any biofeedback. All subjects filled out a pre-injection anxiety survey, then received an inferior alveolar injection of local anesthetic. Post-injection, both groups were given an anxiety survey and asked to respond to four questions regarding the injection experience using a Visual Analog Scale (VAS). With the use of the respiratory rate biofeedback device, there was a significant reduction of negative feelings regarding the overall injection experience, as measured by a VAS. Our findings demonstrate that this novel biofeedback technique may be helpful in the amelioration of dental anxiety, and may help produce a more pleasant overall experience for the patient.

Comparison of 4% articaine and 0.5% levobupivacaine/2% lidocaine mixture for sub-Tenon's anaesthesia in phacoemulsification cataract surgery: a randomised controlled trial.

BACKGROUND/AIMS: [corrected] The aim of this study was to compare the efficacy and safety of 4% articaine with a mixture containing equal volumes of 2% lidocaine and 0.5% levobupivacaine without hyaluronidase for sub-Tenon's anaesthesia in phacoemulsification cataract surgery. METHODS: The study was a prospective, randomised double-masked clinical trial of 65 patients allocated to receive either 4% articaine or a mixture containing equal parts of 2% lidocaine and 0.5% levobupivacaine. All patients had pre- and postoperative Hess charting to document ocular motility dysfunction. Ocular and eyelid movements were scored at 2 min intervals from 2 to 10 min after injection of the anaesthetic agent, and at the end of surgery. Complications related to injection, including pain, chemosis and subconjunctival haemorrhage, were recorded. Patients rated pain (none/mild/moderate/severe) during surgery. The operating surgeon masked to the anaesthetic agent assessed proptosis/chemosis at the start of the operation and the degree of ocular akinesia and analgesia at the end of surgery. RESULTS: The articaine group demonstrated a rapid onset of ocular akinesia with a mean time to readiness for surgery (achieving a score of

Dose reduction in double contrast barium enema by use of low fluoroscopic current.

Under standard conditions double contrast barium enema (DCBE) was carried out on a selected patient cohort using either standard (1.5 mA) or low (0.5 mA) fluoroscopic current. A statistically significant (p < or = 0.01) reduction in total dose was achieved by use of low screening current. This reduction was of the order of 40%. Fluoroscopic image quality was analysed both objectively and subjectively, and was found not to be significantly degraded when the lower current was used. On blinded evaluation all examinations were found to be of diagnostic quality. The use of low fluoroscopic current results in a reduction in patient dose, without compromising fluoroscopic image quality or diagnostic standard of the examination. Low fluoroscopic current technique has been adopted as the standard in our department.

Studies in postoperative sequelae. Nausea and vomiting--still a problem.

We collected data on postoperative nausea and vomiting from 3850 patients aged 11-91 years. Thirty-seven percent of the 3244 patients who received a general anaesthetic reported nausea and 23.2% vomited. Twenty percent of the 606 patients who received a local anaesthetic reported nausea and 11.4% vomited. Of the general anaesthetic patients reporting nausea, 72.2% were women, and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 74.0% were women and again the mean age was lower (p < 0.001). Of the local anaesthetic patients reporting nausea, 62.0% were women and the mean age was lower than for those who did not (p < 0.001). Similarly for vomiting, 68.1% were women and again the mean age was lower (p < 0.001). Anxiety before general, but not local, anaesthesia was associated with postoperative nausea (p < 0.001) but not vomiting. Patients from the gynaecological, orthopaedic, ENT and general surgical wards had higher incidences of postoperative nausea and vomiting. Linear visual analogue pain scores were higher in patients with postoperative nausea and vomiting in both general and local anaesthesia groups (p < 0.001).

Tourette's syndrome: an expanded view.

Tourette's syndrome is a disorder of central nervous system functioning in which the most easily recognized symptoms of involuntary movements and vocalizations have been found to be responsive, in many cases, to pharmacotherapy with haloperidol. We have recently evaluated five patients with Tourette's syndrome and have been impressed with the learning difficulties, speech and language problems, and behavioral problems which accompanied the involuntary neuromotor manifestations. These lesser known manifestations were not improved with haloperidol, and in fact, the sleepiness associated with the use of haloperidol was thought to adversely affect school performance in two of our patients. Thus, a holistic approach to the evaluation and treatment of children with Tourette's syndrome is recommended. Early attention to possible speech and language difficulties, appropriate academic help, and counseling regarding behavior management are seen as management issues at least as important as medication management.