Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder.

BACKGROUND: Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans. METHODS: Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). KEY RESULTS: The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aORIBS  = 3.12, 95% CI: 1.93-5.05; aORGERD  = 2.04, 95% CI: 1.44-2.90; aORCP  = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aORIBS  = 4.38, 95% CI: 1.55-12.36; aORGERD  = 2.51 95% CI: 1.63-3.87; aORCP  = 2.57, 95% CI: 1.53-4.32). CONCLUSIONS & INFERENCES: GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.

Effects of Linear Periodization Training on Performance Gains and Injury Prevention in a Garrisoned Military Unit.

PURPOSE: Performing well in combat requires military service members to be in peak physical shape. Although each branch of the United States military has fitness guidelines and assessments, there are no exact prescriptions for physical training programs. The absence of a standardised approach may lead to suboptimal physical performance and increased risk of musculoskeletal injury. To address this gap, we evaluated the feasibility of a pilot combat conditioning program based on linear periodisation. METHODS: Twenty-nine garrisoned US Marine Corps service members (25 men, 4 women; 23.5±4.4 years) enrolled in our 11-week conditioning program that was supervised by a strength and conditioning professional. Military-specific (physical/combat fitness tests) and general (treadmill-based maximal exercise test) assessments were performed at baseline and 11 weeks. Training and injury logs were maintained throughout the duration of the program. RESULTS: Approximately 80% (23/29) of service members completed the entire program. Cardiorespiratory fitness (Peak VO2; +8.10±10.9%; p=0.011), upper-body strength (pull-ups; +47.0±58.2%; p<0.001) and core strength (abdominal crunches; +9.2±23.3%; p=0.029) significantly increased from pre- to post-training. No statistically significant improvement or worsening was noted in any other performance assessment measure. Eight (28%) participants reported minor musculoskeletal concerns, of which only one required medical attention (injury rate 1.3 injuries/100 person-months). CONCLUSION: A protocolised linear periodisation training program was feasible and demonstrated improvements in fitness in a group of garrisoned Marines with low injury rates. Other military units may benefit from a similar approach.

Suspended Liquid Subtractive Lithography: One-step generation of 3D channel geometries in viscous curable polymer matrices.

The miniaturization of synthesis, analysis and screening experiments is an important step towards more environmentally friendly chemistry, statistically significant biology and fast and cost-effective medicinal assays. The facile generation of arbitrary 3D channel structures in polymers is pivotal to these techniques. Here we present a method for printing microchannels directly into viscous curable polymer matrices by injecting a surfactant into the uncured material via a steel capillary attached to a 3D printer. We demonstrate this technique using polydimethylsiloxane (PDMS) one of the most widely used polymers for the fabrication of, e. g. microfluidic chips. We show that this technique which we term Suspended Liquid Subtractive Lithography (SLSL) is well suited for printing actuators, T-junctions and complex three dimensional structures. The formation of truly arbitrary channels in 3D could revolutionize the fabrication of miniaturized chips and will find broad application in biology, chemistry and medicine.

Working Memory and Neurofeedback.

Impairments in working memory are typically associated with impairments in other cognitive faculties such as attentional processes and short-term memory. This paper briefly introduces neurofeedback as a treatment modality in general, and, more specifically, we review several of the current modalities successfully used in neurofeedback (NF) for the treatment of working memory deficits. Two case studies are presented to illustrate how neurofeedback is applied in treatment. The development of Low Resolution Electromagnetic Tomography (LORETA) and its application in neurofeedback now makes it possible to specifically target deep cortical/subcortical brain structures. Developments in neuroscience concerning neural networks, combined with highly specific yet practical NF technologies, makes neurofeedback of particular interest to neuropsychological practice, including the emergence of specific methodologies for treating very difficult working memory (WM) problems.

Evidence-based practice: extending the search to find material for the systematic review.

BACKGROUND: Cochrane-style systematic reviews increasingly require the participation of librarians. Guidelines on the appropriate search strategy to use for systematic reviews have been proposed. However, research evidence supporting these recommendations is limited. OBJECTIVE: This study investigates the effectiveness of various systematic search methods used to uncover randomized controlled trials (RCTs) for systematic reviews. Effectiveness is defined as the proportion of relevant material uncovered for the systematic review using extended systematic review search methods. The following extended systematic search methods are evaluated: searching subject-specific or specialized databases (including trial registries), hand searching, scanning reference lists, and communicating personally. METHODS: Two systematic review projects were prospectively monitored regarding the method used to identify items as well as the type of items retrieved. The proportion of RCTs identified by each systematic search method was calculated. RESULTS: The extended systematic search methods uncovered 29.2% of all items retrieved for the systematic reviews. The search of specialized databases was the most effective method, followed by scanning of reference lists, communicating personally, and hand searching. Although the number of items identified through hand searching was small, these unique items would otherwise have been missed. CONCLUSIONS: Extended systematic search methods are effective tools for uncovering material for the systematic review. The quality of the items uncovered has yet to be assessed and will be key in evaluating the value of the systematic search methods.

Clinical utility of CKMB isoform determinations in patients who present to the emergency department with continuous or resolved chest pain.

The object of this investigation was to demonstrate that the enhanced sensitivity of the diagnosis of acute myocardial infarction (AMI) using a more-inclusive criterion of CKMB Isoforms may detect earlier stages of AMI (designated Isoform Type 2) than the currently accepted marker for AMI by CKMB Isoform (designated Isoform Type 1) in a busy, urban Emergency Department (ED). Two features characterized the study of CKMB Isoforms in a prospective cohort of 223 ED patients: first, nontraumatic chest pain within 12 h before presentation, thought to be of ischemic etiology; and second, normal or nondiagnostic electrocardiogram (EKG). Patients were further divided into two groups characterized as either recent but resolved chest pain at ED visit, or ongoing or staccato chest pain. Sensitivity (S), specificity (SP), positive (PPV) and negative (NPV) predictive values, and 95% confidence intervals (CI) for AMI diagnosis were determined. Two criteria for AMI diagnosis by CKMB Isoforms were tested. The first and currently recommended criterion was identified as Isoform Type 1. An AMI diagnosis by Type 1 criterion requires both CKMB2> or =2.6 IU/L and CKMB2/CKMB1> or =1.7. The second criterion for AMI diagnosis was identified as Isoform Type 2, which is defined as either CKMB2> or =2.6 IU/L or CKMB2/CKMB1> or =1.7. Both Isoform types are predictive of AMI by the gold standard, and addition of EKG changes results in a small improvement. Type 1 demonstrates SP 0.94 (CI 0.90, 0.97) and NPV 0.90 (CI 0.86, 0.94), and Type 2 demonstrates S 0.90 (CI 0.80, 0.97) and NPV 0.97 (CI 0.93, 0.99) for AMI diagnosis. Type 2 criteria can confidently exclude the immediate risk of AMI in patients with resolved chest pain whereas in patients with continuous chest pain, Type 1 criteria may identify those at high risk for AMI.

Implementing corporate wellness programs: a business approach to program planning.

1. Support of key decision makers is critical to the successful implementation of a corporate wellness program. Therefore, the program implementation plan must be communicated in a format and language readily understood by business people. 2. A business approach to corporate wellness program planning provides a standardized way to communicate the implementation plan. 3. A business approach incorporates the program planning components in a format that ranges from general to specific. This approach allows for flexibility and responsiveness to changes in program planning. 4. Components of the business approach are the executive summary, purpose, background, ground rules, approach, requirements, scope of work, schedule, and financials.

Learning needs of hospitalized and recently discharged patients.

Patients' perceptions about the importance of health information they receive during hospitalization and their satisfaction with this information was investigated in a study of hospitalized and recently discharged patients. Results show that information about medications, treatment and complications, and enhancing quality of life are most valued by hospitalized patients followed by information concerning activities of living, community follow-up, skin care, and feelings about condition. For recently discharged patients, the importance of most health information increases, rather than diminishes. These recently discharged patients show high levels of satisfaction with the information they received during hospitalization. These results suggest that hospital-based nurses prioritize patient learning needs and diversify teaching strategies to address patient knowledge deficits both in the hospital and immediately post-discharge.

Role for the submandibular gland in modulating pulmonary inflammation following induction of systemic anaphylaxis.

Previous studies have shown that bilateral decentralization of the superior cervical ganglia (SCG; decentralization) attenuates allergen-induced pulmonary inflammatory responses in male rats sensitized to the nematode Nippostrongylus brasiliensis. The present report examines the neuronal and glandular mechanisms mediating the protection against pulmonary inflammation afforded by decentralization. Tissues and organs innervated by the SCG are responsible for this protection since, in a manner similar to decentralization, bilateral removal of the SCG (ganglionectomy) reduced anaphylaxis-induced accumulation of inflammatory cells in bronchoalveolar lavage fluid. Removal of the submandibular gland (sialadenectomy) did not modify the severity of the pulmonary inflammation, but concurrent sialadenectomy and decentralization abolished the protective effect of decentralization. Thus, we postulate that cervical sympathetic nerves tonically inhibit release of anti-inflammatory factors from submandibular glands. No relationship was found between noradrenaline and serotonin content of submandibular glands and the degree of protection against pulmonary inflammation offered by decentralization and ganglionectomy. Both decentralization and ganglionectomy appeared to increase the level of transcripts that encode immunomodulatory growth factors (nerve growth factor and epidermal growth factor) in submandibular glands, but these denervations evidently did not modify the transcripts for TGF beta 2. Systemic inflammatory events are regulated by the central nervous system at a level superior to the SCG probably through modulation of immunoregulatory factors in submandibular glands.

Patient selection factors in angiographic studies: a conceptual formulation and empirical test.

Studies using coronary angiography patients as the study population to assess etiologic relationships are vulnerable to bias produced by patient selection factors, but the direction and magnitude of the bias in any particular study are uncertain. Partly for this reason, some authors have questioned the use of angiography data for studies of etiology. Nevertheless, this type of data continues to be used in etiologic studies. Therefore, in this paper a conceptual framework is described to quantify the degree of bias under different assumptions about the process whereby patients are selected for angiography. The direction and degree of bias depend on the pattern of patient selection, as well as the measure of association used (e.g., the risk ratio or odds ratio). One method is then described, based on assessing how physicians refer patients to angiography, which estimates the degree of bias produced by selection factors. This study is limited to the situation of a two-level risk factor (e.g., type A/B behavior) in relation to a two-level outcome measure (e.g., significant coronary artery occlusion versus no significant coronary artery occlusion). While type A/B behavior is used as an example in this paper, the concepts apply to any behavioral or nonbehavioral predictor variable.

Hostility and coronary artery disease.

Studies of the association between type A behavior and coronary heart disease have yielded inconsistent findings. A possible explanation for these inconsistent findings is that type A behavior is simply a marker for other behaviors that are truly related to coronary heart disease. Hostility is one such behavior that has been found in several recent studies to predict coronary heart disease and coronary atherosclerosis; however, several other studies have found null results. In the present study, the predictive power of hostility was tested in a study population of hospitalized men (n = 118) and women (n = 40) scheduled for coronary angiography. Potential coronary risk behaviors were assessed in the angiography patients and they were given the type A Structured Interview. Hostility was measured with the Cook-Medley Hostility Inventory and the Behavior Pattern Hostility Index, a measure of hostility derived from the type A Structured Interview. No significant positive associations were found for either Cook-Medley hostility or behavior pattern hostility and coronary occlusion. This was true whether hostility or coronary occlusion was treated as a dichotomous variable or as a continuous variable. In fact, most of the observed associations were opposite to the predicted direction, although none was statistically significant. Replicating cutpoints of the Cook-Medley Hostility Inventory used in other studies that have reported positive associations with coronary heart disease also yielded null findings. The association between hostility and coronary occlusion was slightly modified by age and sex, but the interaction coefficients were not significant. The sample size yielded adequate statistical power to detect the hypothesized associations, and there was no evidence that selection bias, measurement error, or unexamined confounding accounted for the null findings. These results failed to confirm some earlier reports showing a positive association between hostility and coronary artery disease.

Cannibalism in the neolithic.

Cannibalism is a provocative interpretation put forth repeatedly for practices at various prehistoric sites, yet it has been so poorly supported by objective evidence that later, more critical reviews almost invariably reject the proposal. The basic data essential to a rigorous assessment of a cannibalism hypothesis include precise contextual information, analysis of postcranial and cranial remains of humans and animals, and detailed bone modification studies. Such data are available from the Neolithic levels of the Fontbrégoua Cave (southeastern France) where several clusters of human and animal bones have been excavated. The analysis of these bones strongly suggests that humans were butchered, processed, and probably eaten in a manner that closely parallels the treatment of wild and domestic animals at Fontbrbégoua.