Statistical parametric mapping of the regional distribution and ontogenetic scaling of foot pressures during walking in Asian elephants (Elephas maximus).

Foot pressure distributions during locomotion have causal links with the anatomical and structural configurations of the foot tissues and the mechanics of locomotion. Elephant feet have five toes bound in a flexible pad of fibrous tissue (digital cushion). Does this specialized foot design control peak foot pressures in such giant animals? And how does body size, such as during ontogenetic growth, influence foot pressures? We addressed these questions by studying foot pressure distributions in elephant feet and their correlation with body mass and centre of pressure trajectories, using statistical parametric mapping (SPM), a neuro-imaging technology. Our results show a positive correlation between body mass and peak pressures, with the highest pressures dominated by the distal ends of the lateral toes (digits 3, 4 and 5). We also demonstrate that pressure reduction in the elephant digital cushion is a complex interaction of its viscoelastic tissue structure and its centre of pressure trajectories, because there is a tendency to avoid rear 'heel' contact as an elephant grows. Using SPM, we present a complete map of pressure distributions in elephant feet during ontogeny by performing statistical analysis at the pixel level across the entire plantar/palmar surface. We hope that our study will build confidence in the potential clinical and scaling applications of mammalian foot pressures, given our findings in support of a link between regional peak pressures and pathogenesis in elephant feet.

A hypnotic paradigm for studying intrusive memories.

Despite the importance of intrusive memories in clinical disorders, research has been limited by a dearth of paradigms that permit experimental study of intrusions. This study describes a hypnotic paradigm for eliciting intrusive memories. Forty-nine highly hypnotisable participants nominated a distressing memory prior to being hypnotised. During hypnosis, they received the suggestion that they would remember the memory in response to a designated cue after the hypnosis session. Half of the participants also received a posthypnotic amnesia suggestion for the source of the memory. Following hypnosis, all participants completed a cognitive task and during the task received the cue to recall the memory. Results demonstrated that memories experienced after posthypnotic amnesia were experienced as more involuntary and more distressing than those that were knowingly retrieved. Participants in the posthypnotic amnesia condition also demonstrated greater interference on the cognitive task after the retrieval cue was given than those who intentionally retrieved the memory. These findings suggest that posthypnotic suggestion provides a useful paradigm to elicit intrusive memories under experimental conditions.

Care coaching: an alternative approach to managing comorbid depression.

PURPOSE AND OBJECTIVES: The management of chronic medical conditions is very costly because of poor response to evidence-based treatment plans. Behavioral health disorders have been shown to impact one's inability to adhere to treatment protocols, thus worsening the course of the comorbid state. Traditional management methods have been unsuccessful in diminishing the costs associated with increased utilization of healthcare services that result from poor adherence to treatment plans and treatment failures that ultimately produce poor clinical outcomes. This article examines the use of an alternative approach on an identified high-risk population of individuals with the primary goal of promoting patient-centric self-efficacy and optimal patient care, thereby improving clinical outcomes resulting in a reduction of overall healthcare utilization. PRIMARY PRACTICE SETTING: Care coaches, in collaboration with primary care physicians, engaged in telephonic consultation with identified participants from one regional health plan to validate and modify treatment plans in order to conform to evidence-based guidelines. FINDINGS/CONCLUSIONS: The approach used in this study demonstrated improved clinical outcomes through decreases in acute care facility admissions, lengths of stay in acute care facilities, and emergency department visits. In addition, a positive return on investment is presented as evidence of the efficacy of this alternative approach. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Predictive modeling and risk stratification methodologies are useful in the identification of individuals at risk for treatment failure and poor outcomes. Individuals who suffer from multiple comorbidities with identified psychosocial issues/barriers have increased health risks and costs that are far greater than those who do not appear to have associated psychopathology or psychosocial factors. Examining the use of the study protocol from a lifetime perspective can further reduce costs in the future and still show a positive return on investment.