The psychological burden of NMOSD - a mixed method study of patients and caregivers.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system with common symptoms of rapid onset of eye pain, loss of vision, neck/back pain, paralysis, bowel and bladder dysfunction and heat sensitivity. The rare, unpredictable, and debilitating nature of NMOSD constitutes a unique psychological burden for patients and their caregivers, the specific nature and extent of which is not yet known. This mixed methods study, informed by both quantitative and qualitative data collected via self-report measures, focus groups, and in-depth interviews, aims to investigate and understand the psychological burden of patients with NMOSD and their caregiver/loved ones, so as to inform a specialized intervention. 31 adults living with NMOSD and 22 caregivers of people with NMOSD in the United States and Canada, recruited from NMOSD patient advocacy groups, social media groups, and through word of mouth from other participants, completed a battery of standardized self-report measures of anxiety, depression, trauma, cognitive fusion, valued living, and coping styles. Semi-structured focus group sessions were conducted via HIPAA-compliant Zoom with 31 patients, and separate focus groups were conducted with 22 caregivers. A subset of these samples, comprised of 16 patients and 11 caregivers, participated in individual semi-structured interviews, prioritizing inclusion of diverse perspectives. Descriptive statistics and bivariate correlations were run on quantitative self-report data using SPSS [Version 28.0.1]; data were stored in REDCap. Reflexive thematic analysis was employed regarding qualitative individual interview data. The majority of patients reported experiencing anxiety, depression, cognitive fusion, over-controlled coping, and lack of values-based living. Caregivers also reported heightened anxiety, cognitive fusion, and over-controlled coping, although they did not endorse clinically significant depression. Patient and caregiver degree of anxiety and of overcontrolled coping were both strongly positively correlated, likely affecting how both parties manage NMOSD-related stressors, both individually and as a dyad. Patients reported more anxiety, depression, psychological inflexibility, and lack of values-based living, compared with caregivers. Patient and caregiver narrative themes included mistrust of medical professionals, lack of support immediately following diagnosis, changes in relationships, deviation from values-based living, internalization of feelings, and avoidant coping strategies to manage the psychological burden of NMOSD. A novel mental health intervention targeting the specific psychological burden of life with NMOSD is proposed.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW).

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

Unusually high SO2 emissions and plume height from Piton de la Fournaise volcano during the April 2020 eruption.

Piton de la Fournaise volcano, La Réunion, France, erupted between the 2 and 6 April 2020, one of a series of eruptive phases which occur typically two or three times per year. Here, we use back trajectory analysis of satellite data from the TROPOMI instrument to determine that gas emissions during the June 2020 eruption were of unusually high intensity and altitude, producing 34.9 ± 17.4 kt of SO2 and plume heights up to 5 km a.s.l. The early stages of the eruption (2-4 April 2020) were characterised by relatively low SO2 emission rates despite strong low frequency tremor (LFT); the latter phase followed an increase in intensity and explosivity in the early hours of 5 April 2020. This period included lava fountaining, significantly increased SO2 emission rates, increased high frequency tremor (HFT) and decreased LFT. Using the PlumeTraj back trajectory analysis toolkit, we found the peak SO2 emission rate was 284 ± 130 kg/s on the 6 April. The plume altitude peaked at ~ 5 km a.s.l. on 5 April, in the hours following a sudden increase in explosivity, producing one of the tallest eruption columns recorded at Piton de la Fournaise. PlumeTraj allowed us to discriminate each day's SO2, which otherwise would have led to a mass overestimate due to the plumes remaining visible for more than 24 h. The eruption exhibited a remarkable decoupling and anti-correlation between the intensity of the LFT signal and that of the magma and gas emission rates. LFT intensity peaked during the first phase with low magma and SO2 emissions, but quickly decreased during the second phase, replaced by unusually strong HFT. We conclude that the observation of strong HFT is associated with higher intensity of eruption, degassing, and greater height of neutral buoyancy of the plume, which may provide an alert to the presence of greater hazards produced by higher intensity eruptive activity. This might be particularly useful when direct visual observation is prevented by meteorological conditions. This eruption shows the importance of combining multiple data sets when monitoring volcanoes. Combining gas and seismic data sets allowed for a much more accurate assessment of the eruption than either could have done alone. Supplementary Information: The online version contains supplementary material available at 10.1007/s00445-023-01628-1.

Living Through the Pandemic: The Voices of Persons With Dementia and Their Caregivers.

Social-distancing guidelines from the COVID-19 pandemic have potential to compound morbidity in persons with dementia (PwD) and increase caregiver burden. This qualitative study utilized semi-structured interviews between August-November 2020 to explore the impact of COVID-19 on PwD and caregivers. Conventional qualitative content analysis was used. Inter-coder reliability was confirmed using the kappa coefficient. Twenty-five interviews were completed with four themes emerging: disruption of socialization, fear and risk mitigation, coping strategies, and caregiver burden. Participants described how lack of socialization and confinement led to feelings of loneliness, depression, and worsening memory problems. Caregivers reported increased burden and heightened feelings of responsibility for their loved one. Increased isolation imposed by the pandemic has a detrimental impact on PwD. Further work is needed to develop interventions to support PwD and other cognitive impairments and caregivers during the pandemic and when in-person socialization is not possible.

Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19.

Our team at the Jefferson Center City Clinic for Behavioral Medicine has recently been challenged to find a synthesis between the need to adapt to circumstances associated with the COVID-19 pandemic, while at the same time retaining the spirit and essential components of comprehensive DBT. This fine balance between unwavering centeredness and compassionate flexibility is central to DBT (Linehan, 1993), and has proven essential during these times of uncertainty. This short article highlights challenges and innovations faced by our DBT Team, Skills Group, individual DBT sessions, phone coaching, and also our community at large, as we strive to help our patients and team members build a life worth living during and following a pandemic.

Provider experiences of virtual reality in clinical treatment.

BACKGROUND: Virtual reality (VR) has proven effective in the treatment of specific phobias and trauma particularly when in-vivo exposure therapy might be costly (e.g. fear of flying, combat scenes). Similarly, VR has been associated with improvement of chronic pain and of acute pain during medical procedures. Despite its effectiveness as a healthcare tool, VR technology is not well-integrated into common practice. This qualitative study aims to explore the provider perception of the value of VR and identify barriers to VR implementation among healthcare providers. METHODS: A 66-item self-report survey was created to examine application of VR to clinical practice, perceived value of this treatment, ease of learning the technology, billing considerations, and other obstacles. 128 providers (MDs and PhDs) who were located in the United States and had used VR as a therapeutic tool in the past year were identified through research papers, as well as user lists and news articles from VR application websites. Of the 128 providers contacted, 17% (22) completed our online self-report measure. Of these, 13% of respondents (N = 17) completed greater than 75% of the questionnaire and were considered completers. Provider responses were collected over a one-month period and qualitatively analyzed. RESULTS: The majority of providers were from an academic institution (n = 12, 70.6%), and all providers practiced in the outpatient setting. Providers most commonly reported using VR for the treatment of acute pain and/or anxiety related to medical procedures (n = 11, 64.7%), followed by specific phobia (n = 6, 35.3%) and social phobia (n = 6, 35.3%). All providers agreed VR is a valuable tool they would recommend to colleagues. The majority (n = 15, 93.8%) believed VR helped their patients progress in treatment, compared with other methods. Providers cited the ability to individualize treatment (n = 14, 87.5%) and increase patient engagement (n = 15, 93.8%) as main benefits of VR. A minority reported negative feedback from patients about content (n = 4, 25%) or about the technology in general (n = 6, 37.5%), whereas all reported some form of positive feedback. The slight majority (n = 10, 58.8%) of providers did not find transitioning to VR difficult. Of those who did, cost was the most commonly cited barrier (n = 6). Regarding reimbursement, only 17.6% (n = 3) of providers reported the ability to bill for VR sessions. Most providers (n = 15, 88.2%) received training on their VR platform which they found beneficial. Comparing the trained and untrained groups found no significant difference in VR comfort level (p = 0.5058), the value of VR in practice (p = 0.551) or whether providers would recommend VR to others (p = 0.551), though sample sizes were small. CONCLUSIONS: In corroboration with previous research, this study demonstrates that VR is well-received by patients and providers, allowing increased patient engagement and treatment individualization. However, associated costs, including an inability to bill for this service, can present a barrier to further implementation. These findings will guide further development of virtual reality as a standardized tool in psychiatry and pain management.

The role of self-compassion and shame in persons living with HIV/AIDS.

Despite the connection between self-compassion, shame, and HIV/AIDS health outcomes in the literature, little is known about the relationship among these variables. Shame and self-compassion work independently of each other and experiences of shame can impede one's ability to engage in self-compassionate responses, which could prevent future health declines. Although shame has been found to mediate the relationship between self-compassion and a variety of mental health outcomes, it has not been examined in the context of HIV/AIDS. The purpose of the current study was to examine how shame mediates the relationship of self-compassion and adherence to HIV/AIDS medications, as well as how shame mediates the relationship of self-compassion and health-related quality of life (HRQL) in people living with HIV (PLWH). This is the first study to look at trait-based shame in PLWH in a sample of 34 patients at an urban outpatient integrated care facility for PLWH. Self-compassion was not correlated with HIV adherence behaviors or HRQL, and shame did not mediate the relationship between self-compassion and adherence or HRQL. However as expected, less shame was related to and predicted better HRQL in PLWH. Self-compassion' relationship to shame, adherence, and HRQL may be context dependent.

ACT with CF: A telehealth and in-person feasibility study to address anxiety and depressive symptoms among people with cystic fibrosis.

BACKGROUND: Anxiety and depressive symptoms are common among individuals with cystic fibrosis (CF) and are associated with decreased lung function [3], quality of life [4], and treatment adherence [2]. However, CF-specific targeted psychotherapeutic interventions are lacking. This study examined whether Acceptance and Commitment Therapy (ACT) [7], delivered via telehealth, would address this need and improve clinical symptoms. Telehealth is ideal for CF patients, given exposure precautions and frequent hospitalization. ACT emphasizes acceptance, thereby reducing avoidance of anxiety and depressive symptoms associated with CF. It was hypothesized that our ACT with CF protocol [11] would also improve lung function among people with CF. METHODS: Participants were 28 adults with CF and elevated clinical symptoms who completed 6 ACT with CF sessions. They completed measures of depression, anxiety, and cognitive fusion at baseline, post-intervention, and at a 3-month follow-up. Lung function was calculated 3 months pre- and 3 months post-treatment. RESULTS: The majority of participants selected treatment via telehealth (n = 22; 79%). 96% of participants (n=27) completed all 6 sessions, with 93% (n=26) voicing a strong desire to continue treatment with ACT. 79% of the sample (n=22) indicated, after just 1 session of ACT with CF, that treatment seemed logical and feeling confident that it would reduce symptoms of anxiety and depression. ACT with CF was associated with a statistically significant reduction in a composite score of psychological distress from pre to post treatment, corresponding to a large standardized effect size, that was not sustained at 3 months. Telehealth-delivered ACT with CF was as effective as in-person. Reductions in cognitive fusion were strongly related to improvements in psychosocial functioning. This is particularly promising as it reflects the proposed mechanism of action of ACT. ACT with CF was also associated with increased FEV1/FVC ratio at post-treatment follow-up. CONCLUSIONS: ACT with CF delivered via telehealth or in-person is a feasible and potentially effective treatment for improving anxiety and depressive symptoms, and increasing psychological flexibility via reductions in cognitive fusion. Due to the effect size associated with reduction in psychosocial distress, we are cautiously optimistic that ACT with CF will prove an effective treatment. Larger randomized controlled trials are needed to confirm the observed findings and further delineate the potential effects of ACT with CF on clinical outcomes among individuals with CF.

Aerial strategies advance volcanic gas measurements at inaccessible, strongly degassing volcanoes.

Volcanic emissions are a critical pathway in Earth's carbon cycle. Here, we show that aerial measurements of volcanic gases using unoccupied aerial systems (UAS) transform our ability to measure and monitor plumes remotely and to constrain global volatile fluxes from volcanoes. Combining multi-scale measurements from ground-based remote sensing, long-range aerial sampling, and satellites, we present comprehensive gas fluxes-3760 ± [600, 310] tons day-1 CO2 and 5150 ± [730, 340] tons day-1 SO2-for a strong yet previously uncharacterized volcanic emitter: Manam, Papua New Guinea. The CO2/ST ratio of 1.07 ± 0.06 suggests a modest slab sediment contribution to the sub-arc mantle. We find that aerial strategies reduce uncertainties associated with ground-based remote sensing of SO2 flux and enable near-real-time measurements of plume chemistry and carbon isotope composition. Our data emphasize the need to account for time averaging of temporal variability in volcanic gas emissions in global flux estimates.

Shame among people living with HIV: a literature review.

Shame is consistently associated with poor adjustment (e.g., depressive symptoms) among community samples but, surprisingly, has rarely been directly examined among people living with HIV/AIDS (PLWH). This limited research on shame is likely due, in part, to shame's having been subsumed within measures of internalized stigma, an imprecise construct with varied definitions in the HIV literature. The current review summarizes research directly examining the correlates of shame among PLWH. Findings indicate that shame is associated with greater depressive symptoms, less healthcare utilization, and poorer physical health among PLWH. Directions for future research examining shame among PLWH are highlighted, including the need for more prospective research examining shame as a predictor of future adjustment.

Development and psychometric properties of the Pulmonary-specific Quality-of-Life Scale in lung transplant patients.

BACKGROUND: The Pulmonary-specific Quality-of-Life Scale (PQLS) was developed to measure quality of life (QoL) among patients awaiting lung transplant. The objective of this study was to determine the psychometric properties of the PQLS, identify empirically derived sub-scales, and examine ability to detect changes in pulmonary-specific QoL scores after lung transplantation. METHODS: Data were derived from the INSPIRE trial, a dual-site randomized controlled trial of coping skills training in 389 lung transplant candidates (obstructive [48.3%], restrictive [24.2%], cystic fibrosis [13.6%], and other [13.9%]). Cronbach alpha was calculated to assess the internal reliability of the PQLS (n = 388). Test-retest reliability was assessed with correlation coefficients between baseline and 12-week post-baseline scores for the usual care control condition (n = 140). Convergent validity was assessed with correlation coefficients between the PQLS and established measures of QoL and emotional distress, 6-minute walk test distance, forced expiratory volume in 1 second, and use of supplemental oxygen at rest (n = 388). Change from baseline to 6 months post-transplantation was assessed with repeated measures analysis of variance (n = 133). RESULTS: The PQLS was internally reliable and stable across 12 weeks. The PQLS correlated strongly with QoL measures (e.g., Shortness of Breath Questionnaire, r = 0.78, p < 0.0001), moderately with mood and anxiety (e.g., Beck Depression Inventory-II, r = 0.59, p < 0.0001), and modestly with lung disease severity (e.g., 6-minute walk test, r = -0.41, p < 0.0001). PQLS scores improved by nearly 2 SDs after transplant. CONCLUSIONS: These results demonstrated the reliability, validity, and sensitivity to change of the PQLS for measuring pulmonary QoL among patients with advanced lung disease and the responsiveness of the PQLS to changes in QoL after lung transplantation.

Neurobehavioral functioning and survival following lung transplantation.

BACKGROUND: Neurobehavioral functioning is widely recognized as being an important consideration in lung transplant candidates, but little is known about whether these factors are related to clinical outcomes. The present study examined the relationship of neurobehavioral functioning, including measures of executive function and memory, depression, and anxiety, to long-term survival among lung transplant recipients. METHODS: The sample was drawn from 201 patients who underwent transplantation at Duke University and Washington University who participated in a dual-site clinical trial investigating medical and psychosocial outcomes in transplant candidates with end-stage lung disease. All patients completed the Beck Depression Inventory-II (BDI-II) and Spielberger State-Trait Anxiety Inventory at baseline and again after 12 weeks, while a subset of 86 patients from Duke University also completed neurocognitive testing. Patients were followed for survival up to 12 years after completing baseline assessments. RESULTS: One hundred eleven patients died over a mean follow-up of 10.8 years (SD=0.8). Baseline depression, anxiety, and neurocognitive function were examined as predictors of posttransplant survival, controlling for age, 6-min walk distance, FEV, and native disease; education and cardiovascular risk factors were also included in the model for neurocognition. Lower executive function (hazard ratio [HR]=1.09, P=.012) and memory performance (HR=1.11, P=.030) were independently associated with greater mortality following lung transplant. Although pretransplant depression and anxiety were not predictive of mortality, patients who scored>13 on the BDI-II at baseline and after 3 months pretransplant had greater mortality (HR=1.85 [95% CI, 1.04, 3.28], P=.036). CONCLUSIONS: Neurobehavioral functioning, including persistently elevated depressive symptoms and lower neurocognitive performance, was associated with reduced survival after lung transplantation. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00113139; URL: www.clinicaltrials.gov.

Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study.

OBJECTIVES: The aim of this study was to assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease. BACKGROUND: Although there is good evidence that clinical depression is associated with poor prognosis, optimal therapeutic strategies are currently not well defined. METHODS: One hundred one outpatients with coronary heart disease and elevated depressive symptoms underwent assessment of depression, including a psychiatric interview and the Hamilton Rating Scale for Depression. Participants were randomized to 4 months of aerobic exercise (3 times/week), sertraline (50-200 mg/day), or placebo. Additional assessments of cardiovascular biomarkers included measures of heart rate variability, endothelial function, baroreflex sensitivity, inflammation, and platelet function. RESULTS: After 16 weeks, all groups showed improvement on Hamilton Rating Scale for Depression scores. Participants in both the aerobic exercise (mean -7.5; 95% confidence interval: -9.8 to -5.0) and sertraline (mean -6.1; 95% confidence interval: -8.4 to -3.9) groups achieved larger reductions in depressive symptoms compared with those receiving placebo (mean -4.5; 95% confidence interval: -7.6 to -1.5; p = 0.034); exercise and sertraline were equally effective at reducing depressive symptoms (p = 0.607). Exercise and medication tended to result in greater improvements in heart rate variability compared with placebo (p = 0.052); exercise tended to result in greater improvements in heart rate variability compared with sertraline (p = 0.093). CONCLUSIONS: Both exercise and sertraline resulted in greater reductions in depressive symptoms compared to placebo in patients with coronary heart disease. Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as on quality of life. (Exercise to Treat Depression in Individuals With Coronary Heart Disease; NCT00302068).

Changes in neurocognitive functioning following lung transplantation.

Although neurocognitive impairment is relatively common among patients with advanced lung disease, little is known regarding changes in neurocognition following lung transplantation. We therefore administered 10 tests of neurocognitive functioning before and 6 months following lung transplantation and sought to identify predictors of change. Among the 49 study participants, native diseases included chronic obstructive pulmonary disease (n = 22), cystic fibrosis (n = 12), nonfibrotic diseases (n = 11) and other (n = 4). Although composite measures of executive function and verbal memory scores were generally within normal limits both before and after lung transplantation, verbal memory performance was slightly better posttransplant compared to baseline (p < 0.0001). Executive function scores improved in younger patients but worsened in older patients (p = 0.03). A minority subset of patients (29%) exhibited significant cognitive decline (i.e. >1 standard deviations on at least 20% of tests) from baseline to posttransplant. Patients who declined were older (p < 0.004) and tended to be less educated (p = 0.07). Lung transplantation, like cardiac revascularization procedures, appears to be associated with cognitive decline in a subset of older patients, which could impact daily functioning posttransplant.

Stress and coping in caregivers of patients awaiting solid organ transplantation.

Caregivers for patients undergoing solid organ transplantation play an essential role in the process of transplantation. However, little is known about stress and coping among these caregivers. Six hundred and twenty-one primary caregivers of potential candidates for lung (n = 317), liver (n = 147), heart (n = 115), and/or kidney (n = 42) transplantation completed a psychometric test battery at the time of the candidate's initial pre-transplant psychosocial evaluation. Caregivers were generally well adjusted, with only 17% exhibiting clinical symptoms of depression (Beck Depression Inventory-II score >13) and 13% reporting clinical levels of anxiety (State Trait Anxiety Inventory score >48). Greater caregiver burden and negative coping styles were associated with higher levels of depression. Greater objective burden and avoidant coping were associated with higher levels of anxiety. Caregivers evidenced a high degree of socially desirable (i.e., defensive) responding, which may reflect a deliberate effort to minimize fears or worries so as to not jeopardize patients' listing status.

Effects of intravenous secretin on language and behavior of children with autism and gastrointestinal symptoms: a single-blinded, open-label pilot study.

BACKGROUND: Autism is a severe developmental disorder with poorly understood etiology. A recently published case series describes 3 autistic children with gastrointestinal symptoms who underwent endoscopy and intravenous administration of secretin and were subsequently noted by their parents to demonstrate improved language skills over a 5-week period. This report sparked tremendous public interest, and investigators at several sites moved quickly to design controlled trials to test the efficacy of secretin as a therapy for autistic children. However, this is the first effort specifically designed to replicate the initial reported findings in terms of patient age, presenting symptoms, and drug administration. OBJECTIVE: To rigorously apply the scientific method by assessing the reproducibility of the reported effects of intravenous secretin on the language of young children with autism and gastrointestinal symptoms. METHODS: We performed a single-blinded, prospective, open-label trial by conducting formal language testing and blinded behavioral rating both before and repeatedly after a standardized infusion of secretin. We selected autistic children who were similar in age and profile to those described in the published retrospective case review. Inclusion criteria for study participation included age (3-6 years), confirmed diagnosis of autism, and reported gastrointestinal symptoms (16 had chronic diarrhea, 2 had gastroesophageal reflux, and 2 had chronic constipation). Twenty children (18 male) were admitted to the Pediatric Clinical Research Center at the University of California, San Francisco after administration of the Preschool Language Scale-3 (PLS-3). A 3 CU/kg dose of secretin (Secretin-Ferring) was administered intravenously (upper endoscopy was not performed). Behavioral ratings were derived using the Autism Observation Scale applied to a 30-minute time sample of the child's behavior consisting of a videotape of the PLS-3 (structured setting) and a second free play session with a standard set of developmentally appropriate toys. Participants then returned for follow-up evaluations, with readministrations of the PLS-3 at 1, 2, 3, and 5 weeks' postinfusion, and videotaping of each session for later blinded review by 2 independent observers using the Autism Observation Scale, uninformed about week of posttreatment. We also surveyed parents of our study children about their impressions of the effects of secretin using a 5-point Likert scale for parents to rate changes seen in their child. RESULTS: With a total study completion rate across all participants of 96%, repeated measures analyses of variance revealed no significant increases in children's language skills from baseline across all 5 study time periods after a single infusion of secretin. Similarly, neither significant decreases in atypical behaviors nor increases in prosocial behaviors and developmentally appropriate play skills emerged. Furthermore, no relationship was found between parental reports of change and observable improvement in the sample. Despite the objective lack of drug effect, 70% of parents in our study reported moderate to high change in their child's language and behavior. Furthermore, 85% of parents reported that they felt that their child would obtain at least some additional benefits from another infusion of secretin. CONCLUSIONS: The results of our pilot study indicate that intravenous secretin had no effects in a 5-week period on the language and behavior of 20 children with autism and gastrointestinal symptoms. The open-label, prospective design of our study with blinded reviews of patients both before and after secretin administration follows the scientific method by seeking to reproduce an observed phenomenon using validating and reliable outcome measures. Pilot studies remain a mandatory step for the design of future randomized, clinical trials investigating potential treatments for children with autism.

Type A-B scores and insomnia among college students: a replication and extension of earlier studies.

In an attempt to rationalize conflicting sets of data from earlier studies, groups of Type A- and Type B-classified university students were asked to respond to a sleep habits questionnaire that included the items of the Coren Insomnia Scale. As was the case in two earlier studies, we found significant but weak evidence from the Coren scale only that Type A-scoring students experience more sleep problems than Type B scorers. We also found, as in a recent study, a sharp increase in sleep problems among all the students sampled from the frequencies reported by similar groups in 1982.