Acceptability and feasibility of fecal microBIOME and serum metabolite sample collection in people with end-stage kidney disease and pain being treated with HemoDialysis: A pilot study (BIOME-HDp).

Pain is known to reduce hemodialysis treatment adherence, reduce quality of life, and increase mortality. The absence of effective strategies to treat pain without medications has contributed to poor health outcomes for people with end-stage kidney disease (ESKD) on hemodialysis. It is now recognized that symbiotic microbiota in the gut play a critical role in health and disease, and new evidence sheds light on the role of the microbiome in chronic pain. The pilot study protocol presented here (BIOME-HDp) employs a longitudinal repeated measures design to interrogate the effects of a nonpharmacological pain intervention on the composition and function of the gut microbiome and circulating metabolites. This pilot study is an ancillary study of the HOPE Consortium Trial to reduce pain and opioid use in hemodialysis, which is part of the NIH's Helping to End Addiction Long-term (HEAL) initiative. The BIOME-HDp pilot study will establish clinical microbiome research methods and determine the acceptability and feasibility of fecal microbiome and serum metabolite sample collection.

The Geriatric Forensic Psychiatry Rotation at University of Chicago: Utilization and Educational Benefit of a Subspecialty Rotation in Psychiatric Residency Training.

Ten years ago, the University of Chicago Department of Psychiatry and Behavioral Neuroscience established a geriatric forensic psychiatry rotation for 4th-year psychiatry residents as one option in a required experience in forensic psychiatry. The rotation's primary emphasis was to learn about cases of testamentary capacity and undue influence. The program was supervised by a senior faculty member, an experienced clinician who was board-certified in Geriatric Psychiatry. RESULTS: Over the past decade, three of the 11 residents have pursued career paths in forensic psychiatry, while another has become a geriatric psychiatrist. More than half of the respondents have pursued geriatric and/or forensic work following their graduations, and all believe that what they learned in the rotation applied to their general practice work. All 11 indicated that the rotation increased their interest in and understanding of forensic work. Ten "strongly agreed" that the geriatric forensic psychiatry rotation was a valuable learning experience; one "agreed." On average, trainees worked on 4.64 forensic cases over the course of the rotation and attended 2-3 trials or depositions. Over the last 3 years of the program, all three of the participating residents have chosen to complete a forensic fellowship following the rotation. CONCLUSION: Residents affirm that a geriatric forensic psychiatry rotation is a valuable learning experience, one that has utility after their graduation. The University of Chicago Department of Psychiatry and Behavioral Neuroscience is committed to continuing this rotation as an important part of their forensic experience in resident education and to encourage more interest in the area of geriatric psychiatry.

Epigenesis by experience: Romantic empiricism and non-Kantian biology.

Reconstructions of Romantic-era life science in general, and epigenesis in particular, frequently take the Kantian logic of autotelic "self-organization" as their primary reference point. I argue in this essay that the Kantian conceptual rubric hinders our historical and theoretical understanding of epigenesis, Romantic and otherwise. Neither a neutral gloss on epigenesis, nor separable from the epistemological deflation of biological knowledge that has received intensive scrutiny in the history and philosophy of science, Kant's heuristics of autonomous "self-organization" in the third Critique amount to the strategic capture of epigenesis from nature, for thought, in thought's critical transcendence of nature. This essay looks to Jean-Baptiste Lamarck and his English contemporary Erasmus Darwin to begin to reconstruct the rigorously materialist, naturalist, and empiricist theories of epigenesis (still) marginalized by Kantian argumentation. As theorists of environmental and social collaboration in the ontogeny of viable forms, Lamarck and Darwin illuminate features of our own epigenetic turn obscured by the rhetoric of "self-organization," allowing us to glimpse an alternative Romantic genealogy of the biological present.

Symptom variability, affect and physical activity in ambulatory persons with multiple sclerosis: Understanding patterns and time-bound relationships.

BACKGROUND: Individuals with multiple sclerosis (MS) experience a clinical course that is highly variable with daily fluctuations in symptoms significantly affecting functional ability and quality of life. Yet, understanding how MS symptoms co-vary and associate with physical and psychological health is unclear. OBJECTIVE: The purpose of the study was to explore variability patterns and time-bound relationships across symptoms, affect, and physical activity in individuals with MS. METHODS: The study employed a multivariate, replicated, single-subject repeated-measures (MRSRM) design and involved four individuals with MS. Mood, fatigue, pain, balance confidence, and losses of balance were measured daily over 28 days by self-report. Physical activity was also measured daily over this same time period via accelerometry. Dynamic factor analysis (DFA) was used to determine the dimensionality and lagged relationships across the variables. RESULTS: Person-specific models revealed considerable time-dependent co-variation patterns as well as pattern variation across subjects. Results also offered insight into distinct variability structures at varying levels of disability. CONCLUSION: Modeling person-level variability may be beneficial for addressing the heterogeneity of experiences in individuals with MS and for understanding temporal and dynamic interrelationships among perceived symptoms, affect, and health outcomes in this group.

Time use and food pattern influences on obesity.

The rise of obesity in the United States over the past 25 years has resulted in an increase in the number of research studies published related to the causes, consequences, and possible solutions to the problem. Most would agree that obesity is a multi-dimensional problem that requires a range of solutions related to individual diet and activity, food and built environment, and public policy. Examination of complex relationships between food choice, time use patterns, sociodemographic characteristics and obesity has been limited by data availability and disciplinary focus. Using the theory of the production of health capital, this paper links empirical data from the Consumer Expenditure, Current Population, and American Time Use Surveys to provide estimates of the impacts of food expenditure and time use patterns on obesity in single female headed households of 31-50 years of age.

The effects of elevated carbon dioxide levels on a Vibrio sp. isolated from the deep-sea.

INTRODUCTION: The effect of oceanic CO2 sequestration was examined exposing a deep-sea bacterium identified as Vibrio alginolyticus (9NA) to elevated levels of carbon dioxide and monitoring its growth at 2,750 psi (1,846 m depth). FINDINGS: The wild-type strain of 9NA could not grow in acidified marine broth below a pH of 5. The pH of marine broth did not drop below this level until at least 20.8 mM of CO2 was injected into the medium. 9NA did not grow at this CO2 concentration or higher concentrations (31.2 and 41.6 mM) for at least 72 h. Carbon dioxide at 10.4 mM also inhibited growth, but the bacterium was able to recover and grow. Exposure to CO2 caused the cell to undergo a morphological change and form a dimple-like structure. The membrane was also damaged but with no protein leakage.

Knowledge and exposure to complementary and alternative medicine in paediatric doctors: a questionnaire survey.

BACKGROUND: Complementary and alternative medicines are increasingly used by the general population. A survey was conducted to ascertain the knowledge of Complementary and Alternative Medicines (CAMs) amongst paediatric physicians, and whether seniority increases the likelihood of its use being considered in consultations, or of families discussing it. METHODS: Anonymous survey of general paediatric doctors in a large inner-city district general hospital (DGH) and tertiary children's centre (TC) using a questionnaire. Statistical analysis was calculated using Minitab. RESULTS: 43/49 (88%) questionnaires were returned correctly. 13 (30%, CI 17 - 46%) doctors had personally used CAMs. 24 (56%, CI 40 - 71%) of their families had used CAMs. 13 (30%, CI 17 - 46%) had received formal CAMs education. 21 (49%, CI 40 - 71%) could name a total of 5 types of CAMs. Consultants were significantly more likely to ask about CAM use than middle-grades and juniors (p < 0.05, CI 48 - 93%, 35 - 90%, 8 - 33% respectively) and have had a clinical encounter where they felt it was significant. 32 (74%, CI 59 - 86%) of the clinicians had been asked about CAMs. 33 (77%, CI 61 - 88%) of doctors had successful CAM use reported to them, and 20 (47%, CI 31 - 62%) had failure of CAMs reported to them. CONCLUSION: CAM use is relatively common in paediatric doctors and their families. They have received little formal CAMs education. Consultants were more likely than juniors to ask about CAM use and have had a clinical encounter where it played a significant part. Around half of all doctors irrespective of grade have been asked about CAMs in a clinical encounter.

Acceptability of antenatal diagnosis for sickle-cell disease among Jamaican mothers and female patients

A questionnaire on the need and acceptability of antenatal diagnosis (AND) for sickle-cell disease was given to 112 women with homozgous sickle-cell (SS) disease and 117 AS mothers of patients with SS disease, all aged 15-45 years. AND was favoured by 57 percent of patients and 76 percent of mothers, the option for termination of an affected pregnancy being the reason in 43 percent of patients and in 51 percent of mothers among this group. Fear of the procedure was the commonest reason for not selecting AND. Of the two common methods, chorinonic villus sampling (first trimister) and amniocentesis (second trimester), 74 percent of all women selected the first trimester method, and 93 percent considered these test should be available in Jamaica. Faced with the diagnosis of a foetus with SS disease, 30 percent of patients and 46 percent of mothers stated that they would request termination. (AU)

Parvovirus-associated aplastic crisis in homozygous sickle cell disease - abstract

Aplastic crises in patients with homzygous sickle-cell (SS) disease in Jamaica affect predominantly children and occur in epidemics. Of 67 cases in a cohort study of 314 children with SS disease, 62 were attributable to human parvovirus infection. Affected children were aged 0.5 - 12.5 years, and the incidence rose to 28 percent in 10 years. No recurrences were seen. Symptoms and signs on presentation were attributable to the viraemia, and acute anaemia. Asymptomatic thrombocytopaenia was common. Blood transfusion was given in 54 (87 percent) cases. Thirty-eight (61 percent) children were admitted to hospital, 16 of whom were extremely ill on presentation and one died soon after admission to hospital. Twenty-four (39 percent) were managed as out-patients, 16 of whom were transfused. Parvovirus-associated aplastic crisis is a self-limiting condition with excellent prognosis if diagnosed promptly and appropriately managed (AU)

Parvovirus infection and the aplastic crisis of sickle cell disease - abstract

The aplastic crisis is a temporary self-limited erythropietic maturation arrest which, because of the short red cell survival in homozygous sickle-cell (SS) disease, results in rapid fall in haemoglobin level. These aplastic crises occur in epidemics, predominantly affect children, frequently involve siblings simultaneously, and often follow an upper respiratory tract type of infection. Recent evidence suggests that these events may follow human parvovirus (HPV) infection and the role of HPV infection has been examined in the last three epidemics of aplastic crises observed among SS patients in Jamaica. Eighteen patients were affected in the 1973-1975 epidemics, 45 in the 1979-1981 epidemic, and 41 so far in an epidemic in 1984-1985. Serological studies have been possible in 73 patients and in 69 (95 percent) there was evidence consistent with recent HPV infections. This infection appears to confer long-lasting immunity, and recurrent attacks of aplastic crisis have never been described. These data suggest that a parvovirus vaccine may be beneficial in the prevention of aplastic crises (AU)