Self-Regulated Symmetry Breaking Model for Stem Cell Differentiation.

In conventional disorder-order phase transitions, a system shifts from a highly symmetric state, where all states are equally accessible (disorder) to a less symmetric state with a limited number of available states (order). This transition may occur by varying a control parameter that represents the intrinsic noise of the system. It has been suggested that stem cell differentiation can be considered as a sequence of such symmetry-breaking events. Pluripotent stem cells, with their capacity to develop into any specialized cell type, are considered highly symmetric systems. In contrast, differentiated cells have lower symmetry, as they can only carry out a limited number of functions. For this hypothesis to be valid, differentiation should emerge collectively in stem cell populations. Additionally, such populations must have the ability to self-regulate intrinsic noise and navigate through a critical point where spontaneous symmetry breaking (differentiation) occurs. This study presents a mean-field model for stem cell populations that considers the interplay of cell-cell cooperativity, cell-to-cell variability, and finite-size effects. By introducing a feedback mechanism to control intrinsic noise, the model can self-tune through different bifurcation points, facilitating spontaneous symmetry breaking. Standard stability analysis showed that the system can potentially differentiate into several cell types mathematically expressed as stable nodes and limit cycles. The existence of a Hopf bifurcation in our model is discussed in light of stem cell differentiation.

The impact of ethnic discrimination on chronic pain: the role of sex and depression.

ABSTRACTPerceived ethnic discrimination (PED) is predictive of chronic pain-related outcomes. Less is known about pathways through which these constructs interact. The goal of this study was to test whether PED was predictive of chronic pain-related outcomes (pain interference, pain intensity, and symptoms related to central sensitization), whether depression mediated the relationship between PED and pain outcomes, and if these relationships were maintained across sex in a sample of racially and ethnically minoritized adults (n = 77). PED significantly predicted pain interference, pain intensity, and symptoms related to central sensitization. Sex accounted for a significant proportion of the variance in pain interference only. Depression explained the relationship between PED and pain interference and pain intensity. Sex moderated the indirect pathway, such that for men, the relationship between PED and pain interference and pain intensity was explained via depression. Depression partially explained the relationship between PED and symptoms related to central sensitization. Sex did not moderate this mediational effect. This study provided a unique contribution to the pain literature by providing a contextual analysis of PED and pain. Addressing and validating experiences of lifetime discrimination may be a clinically relevant tool in the management of chronic pain for of racially and ethnically minoritized adults.

A Confirmatory Factor Analysis of the PROMIS Sleep Disturbance Among Law Enforcement Officers.

Law enforcement officers (LEOs) are at increased risk for sleep disorders relative to the general population. Common LEO occupational stressors, including critical incidents and shift work, predict sleep disturbance, which in turn negatively impacts health, performance, and community safety. The Patient-Reported Outcomes Measurement Information System-Sleep Disturbance 4-item (PROMIS SD4) was developed to assess self-reported sleep quality, satisfaction, and difficulties falling asleep. Previous studies suggest PROMIS-SD short-forms (4-, 6-, and 8-item) have good psychometric properties; however, evaluation of this easily-administered measure in high-stress, frontline populations is limited. The primary goal of this study was to evaluate the validity and reliability of the PROMIS-SD4 in a sample of LEOs (N = 111). A confirmatory factor analysis suggests that the original one-factor solution, with a correlated error-term, provides an excellent fit to the data, SBχ2(2) = 1.62, p = .23, CFI = .99, RMSEA = .12, SRMR = .01. The PROMIS SD4 demonstrated good reliability (α = .85) and evidence of convergent validity correlations in the expected direction with domains of psychological distress, positive health outcomes, reactivity, and body experience (all p's < .05). Results suggest that the PROMIS-SD4 is a valid and reliable measure of sleep disturbance among LEOs.

Adaptive body awareness predicts fewer central sensitization-related symptoms and explains relationship between central sensitization-related symptoms and pain intensity: A cross-sectional study among individuals with chronic pain.

BACKGROUND: Central sensitization (CS), defined as the amplification of neural signaling within the CNS that elicits pain hypersensitivity, is thought be a characteristic of several chronic pain conditions. Maladaptive body awareness is thought to contribute and maintain CS. Less is known about the relationship between CS and adaptive body awareness. PURPOSE: This cross-sectional study investigated relationships among self-reported adaptive body awareness (Multidimensional Interoceptive Awareness Scale-2; MAIA-2), CS-related symptoms (Central Sensitization Inventory; CSI), and pain intensity and further delineate potential direct and indirect links among these constructs. METHODS: Online surveys were administered to 280 individuals with chronic pain reporting elevated CSI scores. Strategic sampling targeted respondents to reflect the 2010 census. Pearson's correlations characterized overall relationship between variables. Multiple regression analyses investigated potential direct links. A path analysis assessed mediational effects of CS-related symptoms on the relationship between adaptive body awareness and pain intensity. RESULTS: CSI demonstrated strong, inverse correlations with some MAIA-2 subscales, but positive correlations with others. Higher CSI scores predicted greater pain intensity (b = 0.049, p ≤ 0.001). Two MAIA-2 subscales, Not-Distracting (b = -0.56, p ≤ 0.001) and Not-Worrying (b = -1.17, p ≤ 0.001) were unique predictors of lower CSI. Not-Distracting (b = -0.05, p = 0.003) and Not-Worrying (b = -0.06, p = 0.007) uniquely predicted lower pain intensity. CSI completely mediated the relationship between adaptive body awareness and pain intensity [point estimate = -0.04; 95% bootstrap confident intervals (CI) = -0.05 to -0.02]. CONCLUSIONS: Findings also support future research to explore causal relationships of variables. Findings suggest that frequency of attention to bodily sensations is distinct from cognitive-affective appraisal of bodily sensation, and the two distinct higher order processes may have divergent influences on perceived pain and CS-related symptoms. Results also support future research to explore causal relationships of variables.

Compassion, communication, and the perception of control: a mixed methods study to investigate patients' perspectives on clinical practices for alleviating distress and promoting empowerment during awake craniotomies.

PURPOSE: To inquire into clinical practices perceived to mitigate patients' intraoperative distress during awake craniotomies. METHODS: This mixed-methods study involved administration of Amsterdam Preoperative Anxiety and Information Scale and PTSD Checklist prior to the awake craniotomy to evaluate anxiety and information-seeking related to the procedure and symptoms of PTSD. Generalized Anxiety Disorder Scale and Depression Module of the Patient Health Questionnaire were administered before and after the procedure to evaluate generalized anxiety and depression. Patient interviews were conducted 2-weeks postprocedure and included a novel set of patient experience scales to assess patients' recollection of intraoperative pain, overall distress, anxiety, distress due to noise, perception of empowerment, perception of being well-prepared, overall satisfaction with anaesthesia management, and overall satisfaction with the procedure. Qualitative data were analysed using conventional content analysis. RESULTS: Participants (n = 14) had undergone an awake craniotomy for tissue resection due to primary brain tumours or medically-refractory focal epilepsy. Validated self-report questionnaires demonstrated reduced levels of generalized anxiety (pre mean = 8.66; SD = 6.41; post mean= 4.36; SD = 4.24) following the awake craniotomy. Postprocedure interviews revealed very high satisfaction with the awake craniotomy and anaesthesia management and minimal levels of intraoperative pain, anxiety, and distress. The most stressful aspects of the procedure included global recognition of medical diagnosis, anxiety provoked by unfamiliar sights, sounds, and sensations, a perception of a lack of information or misinformation, and long periods of immobility. Important factors in alleviating intraoperative distress included the medical team's ability to promote patient perceptions of control, establish compassionate relationships, address unfamiliar intraoperative sensations, and deliver effective anaesthesia management. CONCLUSION: Compassion, communication, and patient perception of control were critical in mitigating intraoperative distress. Clinical practice recommendations with implications for all clinicians involved in patient care during awake craniotomies are provided. Use of these interventions and strategies to reduce distress are important to holistic patient care and patient experiences of care and may improve the likelihood of optimal brain mapping procedures to improve clinical outcomes during awake craniotomies.

Translation, Cross-Cultural Adaptation, and Psychometric Validation of the English Version of the Postural Awareness Scale.

PURPOSE: The Postural Awareness Scale (PAS) was developed among a sample of German speakers to measure self-reported awareness of body posture. The first aim of this study was to conduct an English translation and cross-cultural adaptation of the PAS. The second aim was to assess psychometric properties of the English version of the PAS. METHODS: Forward and backward translations were conducted. The translated scale was then pretested in a small sample of English-speaking adults (n = 30), followed by cognitive interviews. Finally, consensus of the translated scale was achieved among an expert committee (n = 5), resulting in the Postural Awareness Scale-English Version (PAS-E). Psychometric properties of the PAS-E were investigated among a sample of individuals with chronic pain (n = 301) by evaluating factor structure, reliability, and construct validity. Analyses of variance were conducted to calculate differences in PAS-E scores between specific subgroups (pain conditions, sex, and history of mindfulness practice). Linear regression analyses investigated whether the scores on the PAS-E predicted levels of pain, stress, and mood. RESULTS: The results obtained from an exploratory factor analysis showed a two-factor solution and were supported by a confirmatory factor analysis. The scale demonstrated good internal consistency and satisfactory construct validity. No significant differences related to sex at birth or pain duration were found. CONCLUSION: PAS-E demonstrated good psychometric properties, and therefore, can and should be used both for research and clinical practice.

Relative Impact of Mindfulness, Self-Compassion, and Psychological Flexibility on Alcohol Use and Burnout Among Law Enforcement Officers.

Objectives: In the present study, we investigated the relative impact of improvements in mindfulness, self-compassion, and psychological flexibility in predicting decreased burnout and alcohol use in a sample of law enforcement officers (LEOs) participating in a mindfulness-based intervention (MBI). Design: This study is a secondary analysis of pre/post data collected as part of a larger randomized controlled trial of mindfulness-based resilience training (MBRT). Subjects: This secondary analysis comprises pre/post data from 28 LEOs recruited from a metropolitan area and its outlying regions in the Pacific Northwest. Intervention: MBRT is a MBI tailored specifically to the culture and needs of LEOs and other first responders. Outcome measures: All included data were obtained through self-report measures. Mindfulness was assessed by the Five Facet Mindfulness Questionnaire-Short Form, self-compassion was assessed by the Self-Compassion Scale-Short Form, psychological flexibility was assessed by the Acceptance and Action Questionnaire-II, alcohol use was measured by the PROMIS® (v1.0) Alcohol Use-Short Form, and burnout was assessed by the Oldenburg Burnout Inventory. Results: In the first regression, only increases in mindfulness significantly predicted decreased postintervention problematic alcohol use. In the second regression, only increases in self-compassion significantly predicted decreased postintervention burnout. Conclusions: This study builds upon a growing body of literature on the relative impact of mindfulness, self-compassion, and psychological flexibility in predicting outcomes among high-stress cohorts. Results suggest that different components of MBIs may be emphasized to achieve unique benefits. The Clinical Trial Registration number for the parent study is NCT02521454.