High ventilation breathwork practices: An overview of their effects, mechanisms, and considerations for clinical applications.

High Ventilation Breathwork (HVB) refers to practices employing specific volitional manipulation of breathing, with a long history of use to relieve various forms of psychological distress. This paper seeks to offer a consolidative insight into potential clinical application of HVB as a treatment of psychiatric disorders. We thus review the characteristic phenomenological and neurophysiological effects of these practices to inform their mechanism of therapeutic action, safety profiles and future clinical applications. Clinical observations and data from neurophysiological studies indicate that HVB is associated with extraordinary changes in subjective experience, as well as with profound effects on central and autonomic nervous systems functions through modulation of neurometabolic parameters and interoceptive sensory systems. This growing evidence base may guide how the phenomenological effects of HVB can be understood, and potentially harnessed in the context of such volitional perturbation of psychophysiological state. Reports of putative beneficial effects for trauma-related, affective, and somatic disorders invite further research to obtain detailed mechanistic knowledge, and rigorous clinical testing of these potential therapeutic uses.

Interdisciplinary Occupational and Physical Therapy Approach to Treating Constipation and Fecal Incontinence in Children.

AIMS: This case series was completed to determine the effectiveness of an interdisciplinary (occupational and physical therapy) approach to treating constipation and fecal incontinence in children. Non-pharmacological therapies for treating constipation and incontinence are showing potential benefits, especially for children not responding to standard medical treatment, which involves oral laxatives for fecal dis-impaction (cleanout) and maintenance dosing to prevent further impaction. METHODS: A retrospective chart review, surface electromyography (sEMG) biofeedback, and parent and child reports of progress was completed for two children ages 4 and 10 years old. Progress toward goals was measured using a therapy plan of care and progress updates every 60 days. Focus of goals included, pelvic floor muscle coordination and activation, education of anatomy and physiology of digestive system, emotional regulation, functional training in the bathroom, and hygiene. RESULTS: Notable improvements in pelvic floor function, emotional regulation, and defecation dynamics contributed to decreased constipation and fecal incontinence as well as improved emotional regulation and confidence in both participants over a 6-month period. CONCLUSION: A coordinated physical therapy and occupational therapy approach to treating children with constipation and fecal incontinence can be successful in reaching full continence and support children have not responded to standard medical treatment.

Student Self-Efficacy in Pediatrics: Evaluation and Modification of the Pediatric Communication and Handling Self-Efficacy Scale.

PURPOSE: Our purpose was to examine the reliability and validity of the Pediatric Communication and Handling Self-Efficacy Scale (PCHSES) and develop a shorter, modified PCHSES. METHODS: With 92 students, the reliability of the PCHSES was assessed by determining the internal consistency of each construct (Communication; Patient Handling). Construct validity, responsiveness, and convergent validity were assessed to determine the validity. RESULTS: Internal consistency was high for the Communication and Patient Handling constructs. Construct validity analysis produced 2 factors that explained 93% of the variance and a modified PCHSES that explained 96% of the variance in students' PCHSES scores. There were significant changes with large effect sizes over time for the Communication and the Patient Handling constructs. There were no-to-small relationships between PCHSES scores and clinical performance ratings. CONCLUSIONS: The PCHSES and modified PCHSES are reliable and valid instruments to assess students' self-efficacy with the pediatric population. What this adds to the evidence: The PCHSES or modified PCHSES should be used to assess students' self-efficacy and facilitate education research.

Fluorescence Imaging-Based Discovery of Membrane Domain-Associated Proteins in Mycobacterium smegmatis.

Mycobacteria spatially organize their plasma membrane, and many enzymes involved in envelope biosynthesis associate with a membrane compartment termed the intracellular membrane domain (IMD). The IMD is concentrated in the polar regions of growing cells and becomes less polarized under nongrowing conditions. Because mycobacteria elongate from the poles, the observed polar localization of the IMD during growth likely supports the localized biosynthesis of envelope components. While we have identified more than 300 IMD-associated proteins by proteomic analyses, only a few of these have been verified by independent experimental methods. Furthermore, some IMD-associated proteins may have escaped proteomic identification and remain to be identified. Here, we visually screened an arrayed library of 523 Mycobacterium smegmatis strains, each producing a Dendra2-FLAG-tagged recombinant protein. We identified 29 fusion proteins that showed polar fluorescence patterns characteristic of IMD proteins. Twenty of these had previously been suggested to localize to the IMD based on proteomic data. Of the nine remaining IMD candidate proteins, three were confirmed by biochemical methods to be associated with the IMD. Taken together, this new colocalization strategy is effective in verifying the IMD association of proteins found by proteomic analyses while facilitating the discovery of additional IMD-associated proteins. IMPORTANCE The intracellular membrane domain (IMD) is a membrane subcompartment found in Mycobacterium smegmatis cells. Proteomic analysis of purified IMD identified more than 300 proteins, including enzymes involved in cell envelope biosynthesis. However, proteomics on its own is unlikely to detect every IMD-associated protein because of technical and biological limitations. Here, we describe fluorescent protein colocalization as an alternative, independent approach. Using a combination of fluorescence microscopy, proteomics, and subcellular fractionation, we identified three new proteins associated with the IMD. Such a robust method to rigorously define IMD proteins will benefit future investigations to decipher the synthesis, maintenance, and functions of this membrane domain and help delineate a more general mechanism of subcellular protein localization in mycobacteria.

A systematic review of geographic indices of disadvantage with implications for older adults.

BACKGROUNDNeighborhood-level socioeconomic disadvantage has wide-ranging impacts on health outcomes, particularly in older adults. Although indices of disadvantage are a widely used tool, research conducted to date has not codified a set of standard variables that should be included in these indices for the United States. The objective of this study was to conduct a systematic review of literature describing the construction of geographic indices of neighborhood-level disadvantage and to summarize and distill the key variables included in these indices. We also sought to demonstrate the utility of these indices for understanding neighborhood-level disadvantage in older adults.METHODSWe conducted a systematic review of existing indices in the English-language literature.RESULTSWe identified 6021 articles, of which 130 met final study inclusion criteria. Our review identified 7 core domains across the surveyed papers, including income, education, housing, employment, neighborhood structure, demographic makeup, and health. Although not universally present, the most prevalent variables included in these indices were education and employment.CONCLUSIONIdentifying these 7 core domains is a key finding of this review. These domains should be considered for inclusion in future neighborhood-level disadvantage indices, and at least 5 domains are recommended to improve the strength of the resulting index. Targeting specific domains offers a path forward toward the construction of a new US-specific index of neighborhood disadvantage with health policy applications. Such an index will be especially useful for characterizing the life-course impact of lived disadvantage in older adults.

Using a 3D-Printed Prosthetic to Improve Participation in a Young Gymnast.

BACKGROUND AND PURPOSE: The purpose of this case report was to investigate the application of a 3-dimensional (3D)-printed prosthetic hand to improve a child's participation, confidence, and satisfaction in gymnastic classes, specifically, horizontal bar-related skills. SUMMARY OF KEY POINTS: A 9-year-old child was unable to participate in horizontal bar-related gymnastic skills due to a congenital hand deficiency. A prosthetic hand was designed, 3D printed, modified repeatedly, and incorporated into a program, which resulted in improvements in the child's ability to participate in gymnastics. CONCLUSIONS: Using a 3D-printed upper limb prosthetic hand improved the child's participation, confidence, and satisfaction in her gymnastic classes permitting use of horizontal bar. To progress to higher-intensity activities, further safety measures and testing of the prosthetic hand are needed. WHAT THIS CASE ADDS TO EVIDENCEBASED PRACTICE: A 3D-printed prosthetic hand was manufactured and customized allowing closely monitored, gradually increased, participation in horizontal bar gymnastics.

Physical Therapy for a Child With Encopresis: A Case Report.

PURPOSE: To describe the implementation and effectiveness of a multimodal therapeutic approach used to successfully treat a child with encopresis. SUMMARY OF KEY POINTS: The child demonstrated chronic constipation, poor pelvic floor muscle awareness, weakness, and incoordination during voiding. He participated in 8 sessions of physical therapy intervention including pelvic floor muscle awareness, strengthening and coordination exercises, behavioral adaptations, diet modification, and use of media, art, and interactive visualization activities. CONCLUSIONS: The child improved pelvic floor muscle strength and coordination and became fully continent of bowel in home and community settings. WHAT THIS CASE ADDS TO EVIDENCE-BASED PRACTICE: This case report demonstrates that pediatric age-appropriate educational and motivational tools (media, art, and interactive visualization activities) are readily available, economical, and effective when used in conjunction with current practice to decrease impairments and improve active participation and compliance during treatment of retentive encopresis in the pediatric population.

Changes in Perceived Self-efficacy of Physical Therapist Students Following a Pediatric Experiential Learning Opportunity.

PURPOSE: Physical therapists (PT) must be competent to treat patients across the lifespan, from pediatrics through geriatrics. Increasing the amount of experiential learning (EL) in pediatrics presents an opportunity for students to improve their self-efficacy in communication and patient handling. The purpose was to investigate changes in PT students' perceived self-efficacy in communication and patient handling following a structured and focused 8-week EL opportunity with a pediatric population. METHODS: Thirty-two PT students completed the Pediatric Communication and Handling Self-Efficacy Scale before and after an 8-week pediatric EL opportunity. A paired-samples t test was performed to assess changes in students' self-efficacy levels of communication and patient handling. RESULTS: Perceived self-efficacy levels significantly improved in regard to students' communication and patient handling skills following a pediatric EL opportunity. CONCLUSIONS: Our findings reinforce the benefits of incorporating pediatric EL opportunities into the DPT curriculum as an effective learning strategy in pediatric education.

Social feedback processing from early to late adolescence: influence of sex, age, and attachment style.

OBJECTIVE: The establishment of an accurate understanding of one's social context is a central developmental task during adolescence. A critical component of such development is to learn how to integrate the objective evaluation of one's behavior with the social response to the latter--here referred to as social feedback processing. CASE REPORT: We measured brain activity by means of fMRI in 33 healthy adolescents (12-19 years old, 14 females). Participants played a difficult perceptual game with integrated verbal and visual feedback. Verbal feedback provided the participants with objective performance evaluation (won vs. lost). Visual feedback consisted of either smiling or angry faces, representing positive or negative social evaluations. Together, the combination of verbal and visual feedback gave rise to congruent versus incongruent social feedback combinations. In addition to assessing sex differences, we further tested for the effects of age and attachment style on social feedback processing. Results revealed that brain activity during social feedback processing was significantly modulated by sex, age, and attachment style in prefrontal cortical areas, ventral anterior cingulate cortex, anterior insula, caudate, and amygdala/hippocampus. We found indication for heightened activity during incongruent social feedback processing in females, older participants, and individuals with an anxious attachment style. Conversely, we observed stronger activity during processing of congruent social feedback in males and participants with an avoidant attachment style. CONCLUSION: Our findings not only extend knowledge on the typical development of socio-emotional brain function during adolescence, but also provide first clues on how attachment insecurities, and particularly attachment avoidance, could interfere with the latter mechanisms.

Cellular characterization of the primosome and rep helicase in processing and restoration of replication following arrest by UV-induced DNA damage in Escherichia coli.

Following arrest by UV-induced DNA damage, replication is restored through a sequence of steps that involve partial resection of the nascent DNA by RecJ and RecQ, branch migration and processing of the fork DNA surrounding the lesion by RecA and RecF-O-R, and resumption of DNA synthesis once the blocking lesion has been repaired or bypassed. In vitro, the primosomal proteins (PriA, PriB, and PriC) and Rep are capable of initiating replication from synthetic DNA fork structures, and they have been proposed to catalyze these events when replication is disrupted by certain impediments in vivo. Here, we characterized the role that PriA, PriB, PriC, and Rep have in processing and restoring replication forks following arrest by UV-induced DNA damage. We show that the partial degradation and processing of the arrested replication fork occurs normally in both rep and primosome mutants. In each mutant, the nascent degradation ceases and DNA synthesis initially resumes in a timely manner, but the recovery then stalls in the absence of PriA, PriB, or Rep. The results demonstrate a role for the primosome and Rep helicase in overcoming replication forks arrested by UV-induced damage in vivo and suggest that these proteins are required for the stability and efficiency of the replisome when DNA synthesis resumes but not to initiate de novo replication downstream of the lesion.

The price of your soul: neural evidence for the non-utilitarian representation of sacred values.

Sacred values, such as those associated with religious or ethnic identity, underlie many important individual and group decisions in life, and individuals typically resist attempts to trade off their sacred values in exchange for material benefits. Deontological theory suggests that sacred values are processed based on rights and wrongs irrespective of outcomes, while utilitarian theory suggests that they are processed based on costs and benefits of potential outcomes, but which mode of processing an individual naturally uses is unknown. The study of decisions over sacred values is difficult because outcomes cannot typically be realized in a laboratory, and hence little is known about the neural representation and processing of sacred values. We used an experimental paradigm that used integrity as a proxy for sacredness and which paid real money to induce individuals to sell their personal values. Using functional magnetic resonance imaging (fMRI), we found that values that people refused to sell (sacred values) were associated with increased activity in the left temporoparietal junction and ventrolateral prefrontal cortex, regions previously associated with semantic rule retrieval. This suggests that sacred values affect behaviour through the retrieval and processing of deontic rules and not through a utilitarian evaluation of costs and benefits.

Non-cell-autonomous planar cell polarity propagation in the auditory sensory epithelium of vertebrates.

Sensory epithelia of the inner ear require a coordinated alignment of hair cell stereociliary bundles as an essential element of mechanoreceptive function. Hair cell bundle alignment is mediated by core planar cell polarity (PCP) proteins, such as Vangl2, that localize asymmetrically to the circumference of the cell near its apical surface. During early phases of cell orientation in the chicken basilar papilla (BP), Vangl2 is present at supporting cell junctions that lie orthogonal to the polarity axis. Several days later, there is a striking shift in the Vangl2 pattern associated with hair cells that reorient towards the distal (apical) end of the organ. How the localization of PCP proteins transmits planar polarity information across the developing sensory epithelium remains unclear. To address this question, the normal asymmetric localization of Vangl2 was disrupted by overexpressing Vangl2 in clusters of cells. The BP was infected with replication-competent retrovirus encoding Vangl2 prior to hair cell differentiation. Virus-infected cells showed normal development of individual stereociliary bundles, indicating that asymmetry was established at the cellular level. Yet, bundles were misoriented in ears infected with Vangl2 virus but not Wnt5a virus. Notably, Vangl2 misexpression did not randomize bundle orientations but rather generated larger variations around a normal mean angle. Cell clusters with excess Vangl2 could induce non-autonomous polarity disruptions in wild-type neighboring cells. Furthermore, there appears to be a directional bias in the propagation of bundle misorientation that is towards the abneural edge of the epithelium. Finally, regional bundle reorientation was inhibited by Vangl2 overexpression. In conclusion, ectopic Vangl2 protein causes inaccurate local propagation of polarity information, and Vangl2 acts in a non-cell-autonomous fashion in the sensory system of vertebrates.

Time and number of displays impact critical signal detection in fetal heart rate tracings.

Interest in centralized monitoring in labor and delivery units is growing because it affords the opportunity to monitor multiple patients simultaneously. However, a long history of research on sustained attention reveals these types of monitoring tasks can be problematic. The goal of the present experiment was to examine the ability of individuals to detect critical signals in fetal heart rate (FHR) tracings in one or more displays over an extended period of time. Seventy-two participants monitored one, two, or four computer-simulated FHR tracings on a computer display for the appearance of late decelerations over a 48-minute vigil. Measures of subjective stress and workload were also obtained before and after the vigil. The results showed that detection accuracy decreased over time and also declined as the number of displays increased. The subjective reports indicated that participants found the task to be stressful and mentally demanding, effortful, and frustrating. The results suggest that centralized monitoring that allows many patients to be monitored simultaneously may impose a detrimental attentional burden on the observer. Furthermore, this seemingly benign task may impose an additional source of stress and mental workload above what is commonly found in labor and delivery units.

Monitoring simulated maternal-fetal heart rate signals.

The present study represents the first in a series aimed at examining how individuals monitor maternal-fetal heart rate signals over an extended period of time. Seventy-two undergraduate students monitored simulated maternal-fetal heart rate signals for late decelerations of either high or low amplitude for 48 minutes. The results showed that the ability to detect late decelerations was quite good and did not decline over time. Although the findings regarding detections are encouraging, the participants also made a lot of false alarms. Collectively, these results suggest that the observers still struggled to distinguish critical patterns from the background fetal heart activity.