Physiological Domains Research Articles

TH50. GENOME-WIDE ASSOCIATION STUDY OF BORDERLINE PERSONALITY DISORDER – FIRST RESULTS FROM THE INTERNATIONAL BORDERLINE GENOMICS CONSORTIUM

Emotional expression (i.e., identifying and labeling emotion using specific words), is theorized to reduce negative emotion and facilitate emotion regulation. However, it remains unclear how individuals with borderline personality disorder express emotion, and whether this influences their emotion regulation. This study examined whether: 1) emotional expression in borderline personality disorder differed from healthy controls based on word valence, emotionality, and vocabulary; and 2) whether such characteristics predict emotion regulation effectiveness across self-reported and physiological emotion domains differentially across these groups.Individuals with borderline personality disorder (n = 29) and age and sex-matched healthy controls (n = 30) listened to an evocative story, expressed emotion, and regulated emotion by applying Mindfulness or Cognitive Reappraisal. Emotion regulation was measured by changes in self-report, parasympathetic, and sympathetic emotion, while implementing the emotion regulation strategies. The words used to express emotion were coded based on valence, emotionality, and depth of vocabulary.Generalized estimating equations revealed no differences between groups in valence, emotionality, and vocabulary. Additionally, using a larger emotional vocabulary predicted more effective sympathetic emotion regulation, and using more negatively valenced words predicted more effective parasympathetic emotion regulation across groups.Among other things, this study is limited by its predominantly female sample, and that it does not determine whether valence, emotionality, or vocabulary independently predict emotional expression effectiveness.Emotional expression may not be deficient in borderline personality disorder across the indices studied. Using more negative words and broadening vocabulary while expressing emotion may offer emotion regulation benefits.

Proof-of-Concept and Test-Retest Reliability Study of Psychological and Physiological Variables of the Mental Fatigue Paradigm.

This study provided a proof-of-concept and test–retest reliability of measures frequently used to assess a mental fatigue paradigm. After familiarization, 28 healthy men performed (40-min) the Rapid Visual Information Processing (RVP) test in a test–retest design, having mental fatigue sensation, motivation, emotional arousal, total mood disturbance, and electroencephalography (EEG) in the prefrontal cortex measured before and after the test. EEG was recorded during a 3-min rest so that the power spectral density of theta (3–7 Hz) and alpha (8–13 Hz) bands was calculated. Pre-to-post RVP test changes in psychological and physiological domains were compared (paired-T tests), and absolute (standard error of measurement (SEM) and minimal difference (MD)) and relative reliability (intraclass correlation coefficient (ICC)) were calculated. The RVP test induced an increase (p < 0.05) in mental fatigue sensation (120.9% (109.4; 132.4)) and total mood disturbance (3.5% (−6.3; 13.3)), and a decrease in motivation (−7.1% (−9.2; −5.1)) and emotional arousal (−16.2% (−19.1; −13.2)). Likewise, EEG theta (59.1% (33.2; 85.0); p < 0.05), but not alpha band, increased due to RVP test. All psychophysiological responses showed poor-to-moderate relative reliability. Changes in mental fatigue sensation and motivation were higher than SEM and MD, but changes in EEG theta band were higher only than SEM. Mental fatigue sensation, motivation, and EEG theta band were sensitive to distinguish a mental fatigue paradigm despite true mental fatigue effects on theta activity may be trivial.

Development and Validation of a Patient-Reported Outcome Scale for Tension-Type Headache.

Objective: To validate a patient-reported outcome (PRO) measure for patients with tension-type headache (TTH).Methods: Literature analysis, interview, and group discussion were performed to develop an initial TTH-PRO. Thereafter, the initial scale was pre-evaluation in a small range of patients with TTH, and the expert panel made necessary adjustments based on the content feedback. The clinical test was carried out by using the adjusted initial scale. Based on the test results, the items were screened by the method of classical test theory to form the final scale, and the performance evaluation indicators such as validity, reliability, and responsiveness of the final scale were tested.Results: The final formed TTH-PRO scale contained three domains, six dimensions, and 30 items. The split-half reliability, Cronbach's α coefficients, and construct validity of the scale were acceptable, as was feasibility. The responsiveness in the physiological domain was fair, but the overall responsiveness still needed further clinical validation.Conclusions:The TTH-PRO scale has been developed with extensive patient input and demonstrates evidence for reliability and validity. It is complementary to existing evaluation indicators of TTH, emphasizing the patient's experience. Further studies are needed to optimize its items and to verify its clinical applicability for population in more regions and countries.

Outcome measurement instrument selection for lung physiology in systemic sclerosis associated interstitial lung disease: A systematic review using the OMERACT filter 2.1 process

ObjectiveThe Outcome Measures in Rheumatology (OMERACT) is a research organization focused on improving health care outcomes for patients with autoimmune and musculoskeletal diseases. The Connective Tissue Disease-Interstitial Lung Disease (CTD-ILD) Working Group on Lung Physiology is a group within OMERACT charged with identifying outcome measures that should be implemented in studies of patients with CTD-ILD. The OMERACT Filter 2.1 is an evidence-based algorithm used to identify outcome measures that are truthful, feasible, and able to discriminate between groups of interest. Our objective was to summate evidence (published literature, key opinion leader input, patient perspectives) that would influence the CTD-ILD Working Group's vote to accept or reject the use of two measures of lung physiology, the forced vital capacity (FVC) and the diffusion capacity of carbon monoxide (DLco) for use in randomized controlled trials (RTCs) and longitudinal observational studies (LOSs) involving patients with systemic sclerosis associated ILD (SSc-ILD). MethodsPatient Research Partners (those afflicted with SSc-ILD) and the CTD-ILD Working Group on Lung Physiology were polled to assess their opinion on the FVC and DLco in terms of feasibility; the CTD-ILD Working Group was also queried on these instruments’ face and content validity. We then conducted a systematic literature review to identify articles in the SSc-ILD population that assessed the following measurement properties of FVC and DLco: (1) construct validity, (2) test-retest reliability, (3) longitudinal construct validity, (4) clinical trial discrimination/sensitivity to detect change in clinical trials, and (5) thresholds of meaning. Results were summarized in a Summary of Measurement Properties (SOMP) table for each instrument. OMERACT CTD-ILD Working Group members discussed and voted on the strength of evidence supporting these two instruments and voted to endorse, provisionally endorse, or not endorse either instrument. ResultsForty Patient Research Partners reported these two measures are feasible (are not an unnecessary burden or represent an infeasible longitudinal assessment of their disease). A majority of the 18 CTD-ILD Working Group members voted that both the FVC and DLco are feasible and have face and content validity. The systematic literature review returned 1,447 non-duplicated articles, of which 177 met eligibility for full text review. Forty-eight studies (13 RCTs, 35 LOSs) were included in the qualitative analysis. The FVC SOMP table revealed high quality, consistent data with evidence of good performance for all five measurement properties, suggesting requisite published evidence to proceed with endorsement. The DLco SOMP table showed a lack of data to support test-retest reliability and inadequate evidence to support clinical trial discrimination. There was unanimous agreement (15 [100%]) among voting CTD-ILD Working Group members to endorse the FVC as an instrument for lung physiology in RCTs and LOSs in SSc-ILD. Based on currently available evidence, DLco did not meet the OMERACT criteria and is not recommended for use in RCTs to represent lung physiology of SSc-ILD. The OMERACT Technical Advisory Group agreed with these decisions. ConclusionThe OMERACT Filter 2.1 was successfully applied to the domain of lung physiology in patients with SSc-ILD. The FVC was endorsed for use in RCTs and LOSs based on the Working Group's vote; DLco was not endorsed.

Development and validation of a patient-reported outcome measure for patients with chronic respiratory failure: The CRF-PROM scale.

BackgroundVarious health‐related quality‐of‐life (HRQOL) tools are used to evaluate patients with chronic respiratory failure (CRF), but there is a relative lack of tools available for the evaluation of social support and treatment in these patients. The present study focused on the development of a systematic patient‐reported outcome measure (PROM) tool for use in patients with CRF.MethodsThe CRF‐PROM scale conceptual framework and item bank were generated after reviewing the corresponding literature and HRQOL scales, interviewing CRF patients and focus groups. After creation of the initial scale, the items in the scale were selected through two item selection theories, and the final scale was created. The reliability, validity and feasibility of the final scale were assessed.ResultsThe CRF‐PROM scale includes four domains (i.e., physiological domain, psychological domain, social domain and therapeutic domain) and 10 dimensions. After the item selection process, the final scale included 50 items. Cronbach's α coefficients, which were all above 0.7, indicated the reliability of the scale. The results of structural validity met the relevant standards of confirmatory factor analysis. The response rates of the preinvestigation and the formal investigation were 93.3% and 97.6%, respectively.ConclusionsThe CRF‐PROM scale developed in the present study is effective and reliable. It could be used widely in the posthospital management of patients, in CRF studies and in clinical trials of new medical products and interventions.Patient or Public ContributionParticipants from eight different hospitals and communities participated in the development or validation phase of the CRF‐PROM scale.

Identify the patients perceived learning needs after myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease is the major trait to public health and the leading cause of death worldwide. There are over 1 million new and recurrent myocardial infarctions (MI) occur each year and 12,000 of these individuals are still living. Patients surviving from MI have to adapt to live with the heart disease and restore their quality of life. Hence health education for patients to combat the disease as secondary prevention has become very important. Health care professionals must understand the information needs of patients so that effective health education could be taken place consistently with patients’ needs, to optimize outcome of risk factor modification and lifestyle changes. Purpose This study aims to identify post MI patients" perceived learning needs and the demographic factors that influence the needs. Methods Cross-sectional design and convenience sampling method were used for this study. A questionnaire adapted from Cardiac Patient Learning Needs Inventory (CPLNI) was completed by 56 patients who were recruited from a tertiary hospital during inpatient hospitalization in Malaysia. Data from the questionnaires were analyzed using SPSS version 24. Results It was shown that patients’ perceived learning needs were highly important in all eight domains. All domains range from mean 3.52-3.66. Information in the domains of other pertinent information (sign and symptom of MI), medication as well as anatomy and physiology were highly needed by post MI patients, with mean 3.66, 3.65 and 3.64 respectively. Age was significantly related to the patients’ learning need in the domain of anatomy and physiology. Conclusion MI patients need abundant cardiac related information prior discharge, to regain and improve their life. This need should be met by delivering appropriate health education before discharge or during follow-up by health care professionals. There is a necessity to integrate this study finding into the cardiac rehabilitation content to benefit post MI patients.

The Role of Social and Physiological Variables on Older Adults’ Cognitive Improvement after a Group Singing Intervention: The Sing4Health Randomized Controlled Trial

Population aging prompts efforts to help older adults maintain a high quality of life and independence. Group singing (GS) has shown benefits on social, physical, and cognitive domains, being a cost-effective strategy to reach these goals. Nevertheless, randomized controlled trials (RCT) evaluating systematic GS interventions and the interplay between their effects on those domains are scarce. Thus, the present RCT assessed whether a 34-session GS intervention boosts older adults’ cognitive functions (executive functions and verbal memory) and whether it has an impact on systemic inflammation markers. Additionally, it intended to determine whether changes in social or physiological domains mediated the intervention effects on cognition. One hundred and forty-nine participants were allocated to a waiting-list group, which kept their usual activity levels, or an intervention group. Blinded outcome assessments were conducted at baseline, post-intervention, and follow-up. Results confirmed positive effects of GS on cognition, especially marked for verbal memory. Evidence of GS’s protective effect on systemic inflammation is also provided. Mediation analyses revealed a complex interaction of GS intervention engagement and respiratory function and social wellbeing changes with the magnitude of cognitive improvement. These results highlight socialization and respiratory functions as critical pieces of multidimensional GS interventions, maximizing their benefits on older adults’ cognition.

Scaling the effects of ocean acidification on coral growth and coral-coral competition on coral community recovery.

Ocean acidification (OA) is negatively affecting calcification in a wide variety of marine organisms. These effects are acute for many tropical scleractinian corals under short-term experimental conditions, but it is unclear how these effects interact with ecological processes, such as competition for space, to impact coral communities over multiple years. This study sought to test the use of individual-based models (IBMs) as a tool to scale up the effects of OA recorded in short-term studies to community-scale impacts, combining data from field surveys and mesocosm experiments to parameterize an IBM of coral community recovery on the fore reef of Moorea, French Polynesia. Focusing on the dominant coral genera from the fore reef, Pocillopora, Acropora, Montipora and Porites, model efficacy first was evaluated through the comparison of simulated and empirical dynamics from 2010–2016, when the reef was recovering from sequential acute disturbances (a crown-of-thorns seastar outbreak followed by a cyclone) that reduced coral cover to ~0% by 2010. The model then was used to evaluate how the effects of OA (1,100–1,200 µatm pCO2) on coral growth and competition among corals affected recovery rates (as assessed by changes in % cover y−1) of each coral population between 2010–2016. The model indicated that recovery rates for the fore reef community was halved by OA over 7 years, with cover increasing at 11% y−1 under ambient conditions and 4.8% y−1 under OA conditions. However, when OA was implemented to affect coral growth and not competition among corals, coral community recovery increased to 7.2% y−1, highlighting mechanisms other than growth suppression (i.e., competition), through which OA can impact recovery. Our study reveals the potential for IBMs to assess the impacts of OA on coral communities at temporal and spatial scales beyond the capabilities of experimental studies, but this potential will not be realized unless empirical analyses address a wider variety of response variables representing ecological, physiological and functional domains.

Inadequate emergence after anesthesia for elective cancer surgery: a single-center cohort study

BackgroundInadequate emergence after anesthesia (IEA) is a common phenomenon in adult patients undergoing anesthesia. The aim of this study was to evaluate the incidence and determinants of IEA for elective cancer surgery, and to study its influence on the quality of recovery. MethodsIn this observational, prospective study, 148 patients scheduled for elective cancer surgery were included. IEA was considered for patients having emergence delirium or hypoactive emergence applying The Richmond Agitation and Sedation Scale (RASS) 10 minutes after admission at PACU. Postoperative Quality of Recovery Scale (PQRS) was used at baseline and after surgery at minutes 15 (T15) and 40 (T40), and days 1 (D1) and 3 (D3). ResultsOf the 148 patients, 48 (32%) had IEA. Complete recovery at PQRS was less frequent in patients with IEA on physiological domain at T15 and D1, and activities of daily living domain at D3. Patients with IEA recovered more frequently in emotive domain at T15, T40, and D3. Determinants of IEA were age, risk of surgery, congestive heart disease, cerebrovascular disease, ASA physical status, RCRI score, and duration of anesthesia. IEA patients had more frequently postoperative delirium and stayed for longer at PACU and at the hospital. ConclusionIEA was a common phenomenon after anesthesia for elective curative surgery for cancer. Patients with IEA were older and had more comorbidities and a higher surgical risk. Patients with IEA had a less frequent complete recovery on the PD and in AD domains, and a more frequent complete recovery on the ED.

Diurnal and seasonal differences in cardiopulmonary response to exercise in morning and evening chronotypes

ABSTRACT Circadian clocks regulate multiple physiological domains from molecular to behavioral levels and adjust bodily physiology to seasonal changes in day length. Circadian regulation of cellular bioenergy and immunity in the cardiovascular and muscle systems may underpin the individual diurnal differences in performance capacity during exercise. Several studies have shown diurnal differences in cardiopulmonary parameters at maximal and submaximal workloads in morning and evening circadian human phenotypes. However, the effect of seasons on these changes was not elucidated. In this study, we recruited subjects with Morningness–Eveningness Questionnaire scores corresponding to morning and evening types. Subjects underwent morning (7:00–9:00) and evening (20:00–22:00) maximal workload spiroergometry in both winter and summer seasons. We analyzed their performance time, anaerobic threshold, heart rate, and respiratory parameters. Our results suggest that evening types manifest diurnal variations in physical performance, particularly in winter. They also have slower heart rate recovery than morning types, irrespective of the time of day or season. Compared to winter, the chronotype effect on the magnitude of morning–evening differences in performance time, maximal heart rate, and anaerobic threshold onset was more significant in summer. Our data are in concordance with previous observations and confirm the difference between morning and evening types in the timing of maximum performance capacity.

Multi-dimensional frailty and its risk factors among older residents in long-term care facilities in Shanghai, China

ObjectivesThe integrated model of frailty shifted the physiologically-dominated view to an integrated and multidisciplinary view of frailty and adopted an integrated and holistic approach to the complex challenges facing frail older adults and their caregivers. There is an urgent need for researchers to identify multi-faceted frailty among older adults and to explore contributors to it. We assessed the level of frailty among older residents in long-term care (LTC) facilities in Shanghai, China and explored risk factors of multiple dimensions of frailty among older residents. MethodsIt is a cross-sectional descriptive study. We interviewed 218 older residents from nine LTC facilities. We used Tilburg Frailty Indicator to assess older residents’ physiological, psychological, and social frailty. The Geriatric Depression Scale, Mini-Mental state examination, Athens Insomnia Scale, and Activity of Daily Living (ADL) Scale were used to assess their depressive symptoms, cognitive function, sleep quality and ADL abilities, respectively. ResultsOlder residents have a moderate level of frailty in physiological, psychological and social domains. There is a high correlation among dimensions of frailty. Older residents’ depressive symptoms have remained positively associated with their overall and each domain of frailty. Older residents’ actual activity participation and exercise in LTC facilities are negatively associated with older residents’ overall, physiological and social frailty. ConclusionsFrailty is a multi-dimensional concept and is prevalent among older residents in LTC facilities. It is important to take an integrated view on frailty and carry out appropriate and comprehensive interventions to prevent adverse outcomes and provide holistic care for frail older residents in LTC facilities. There is an urgent need to improve the quality and expand the number of activities offered within LTC facilities that would engage older residents in a person-centered way, despite their age, ADL abilities, frailty and functional limitations.

Recovery-Stress Response of Blood-Based Biomarkers.

The purpose of this study was to investigate blood-based biomarkers and their regulation with regard to different recovery-stress states. A total of 35 male elite athletes (13 badminton, 22 soccer players) were recruited, and two venous blood samples were taken: one in a ‘recovered’ state (REC) after a minimum of one-day rest from exercise and another one in a ‘non-recovered’ state (NOR) after a habitual loading microcycle. Overall, 23 blood-based biomarkers of different physiologic domains, which address inflammation, muscle damage, and tissue repair, were analyzed by Luminex assays. Across all athletes, only creatine kinase (CK), interleukin (IL-) 6, and IL-17A showed higher concentrations at NOR compared to REC time points. In badminton players, higher levels of CK and IL-17A at NOR were found. In contrast, a higher value for S100 calcium-binding protein A8 (S100A8) at REC was found in badminton players. Similar differences were found for BDNF in soccer players. Soccer players also showed increased levels of CK, and IL-6 at NOR compared to REC state. Several molecular markers were shown to be responsive to differing recovery-stress states, but their suitability as biomarkers in training must be further validated.

Accelerated aging in the brain, epigenetic aging in blood, and polygenic risk for schizophrenia

Schizophrenia patients show signs of accelerated aging in cognitive and physiological domains. Both schizophrenia and accelerated aging, as measured by MRI brain images and epigenetic clocks, are correlated with increased mortality. However, the association between these aging measures have not yet been studied in schizophrenia patients.In schizophrenia patients and healthy subjects, accelerated aging was assessed in brain tissue using a longitudinal MRI (N = 715 scans; mean scan interval 3.4 year) and in blood using two epigenetic age clocks (N = 172). Differences (‘gaps’) between estimated ages and chronological ages were calculated, as well as the acceleration rate of brain aging. The correlations between these aging measures as well as with polygenic risk scores for schizophrenia (PRS; N = 394) were investigated.Brain aging and epigenetic aging were not significantly correlated. Polygenic risk for schizophrenia was significantly correlated with brain age gap, brain age acceleration rate, and negatively correlated with DNAmAge gap, but not with PhenoAge gap. However, after controlling for disease status and multiple comparisons correction, these effects were no longer significant. Our results imply that the (accelerated) aging observed in the brain and blood reflect distinct biological processes. Our findings will require replication in a larger cohort.

The vicious circle between physical, psychological, and physiological characteristics of shift work in nurses: a multidimensional approach.

To compare physical, psychological, and physiological adaptations between rotating and morning shift health workers using objective and subjective approaches. Forty nurses [n = 20 morning shift (MS) group; n = 20 rotating shift (RS) group] were evaluated for anthropometry, body composition, and handgrip strength. Quality of life, depression, fatigue, daytime sleepiness, and sleep quality were assessed with SF-36, Zung Self-Rating Depression Scale (SDS), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale(ESS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and triaxial accelerometers. Sleep-related data were monitored with sleep actigraphy. Salivary melatonin levels were analyzed before/after sleep, and blood lipid profiles were measured the following morning. The RS group had higher mean BMI and total and abdominal fat and scored lower in the SF-36 (p < 0.01). All nurses showed reduced physical activity levels, which, in the RS group, were negatively correlated with FSS (p = 0.033) and SDS scores (p = 0.025). Poor sleep was revealed in 53% of nurses. The RS group had worse sleep quality by PSQI than the MS group (p = 0.045). PSQI scores were inversely related to SF-36 scores and positively correlated with FSS, BMI, waist circumference, and body fat (p < 0.05). RS nurses showed increased body mass and total and abdominal fat along with decreased quality of life and sleep quality compared to MS counterparts. A strong relationship was found between physical, psychological, and physiological domains. Further studies should consider workplace interventions to prevent obesity, promote physical activity, and manage poor sleeping patterns in nurses.

Analgesic effect of electroacupuncture on chronic pelvic pain in patients with sequelae of pelvic inflammatory disease

To observe the effect of electroacupuncture (EA) on chronic pelvic pain in patients with sequelae of pelvic inflammatory disease. A total of 144 patients with chronic pelvic pain were randomly divided into an observation group (72 cases, 10 cases dropped off) and a control group (72 cases, 9 cases dropped off). The patients in the control group were treated with ibuprofen sustained-release capsules 10 days before menstruation, 0.3 g each time, once a day. On the basis of the treatment of the control group, the patients in the observation group were treated with EA at Guanyuan (CV 4), Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32), disperse-dense wave, 2 Hz/15 Hz of frequency, once a day. The patients in both groups were treated for 10 days per menstrual cycle for 3 menstrual cycles. The visual analogue scale (VAS) scores of lower abdomen and lumbosacral area, local sign score, quality of life scale score and pain disappearance rate were compared between the two groups before and after treatment. The VAS scores of lower abdomen and lumbosacral area as well as each item score and total score of local signs in the observation group after treatment were significantly lower than those before treatment and those in the control group (P<0.05). Compared before treatment, the scores of physiological, psychological, social and environmental domains of the quality of life scale in the observation group were significantly increased after treatment (P<0.05); the score of physiological domain in the control group after treatment was significantly higher than that before treatment (P<0.05); the score of physiological domain in the observation group was higher than that in the control group (P<0.05). The pain disappearance rate was 87.1% (54/62) in the observation group, which was higher than 46.0% (29/63) in the control group (P<0.05). EA can relieve the pain symptoms in patients with chronic pelvic pain and improve their quality of life.

Expert Views on Therapeutic Climbing-A Multi-Perspective, Qualitative Study.

Therapeutic climbing (TC) is regularly used as an add-on treatment option for a variety of disorders. However, evidence on the assessment of professionals deciding on the treatment options or assessing the appropriateness of treatment options is lacking. Therefore, the aim of the present study was to assess the potential of TC as an exercise intervention from different expert perspectives. The study was designed as a qualitative, problem-centered interview experiment to assess the perspectives of pedagogues, physicians, and psychologists on exercise therapy in general and the potential of TC. The sample consisted of 30 experts (10 pedagogues, 10 physicians, and 10 psychologists) with different levels of experience in TC (ᴓage: 41.7 years, ♀ = 43%). Overall, the potential of TC as an add-on treatment option for various disorders was rated by the respondents as positive and useful. The interviewed experts believed that TC can have a decisive effect on the social, psychological, and physiological domain as a sensibly used add-on therapy. However, considering the reported potential adverse effects and the costs connected with TC, it should not be considered as a panacea. Although research in this area is still much in its infancy, the positive perspective of the professional representatives surveyed could facilitate access to TC for patients and may foster more research in this field.

A Conceptual Framework for Understanding Speaking Dyspnea.

Purpose A conceptual framework is proposed to better understand the experience of people who have dyspnea (breathing discomfort) when speaking: its nature, its physiological mechanisms, and its impacts on their lives. Method The components of the framework are presented in their natural order. They are a Speaking Domain (Speaking Activities and Speaking Variables), a Physiological Domain (Speech Breathing Variables and Physiological Mechanisms), a Perceptual Domain (Dyspnea), a Symptom Impact Domain (Emotional Responses, Immediate Behavioral Responses, and Long-Term Behavioral Response), and a Life Impact Domain (Short-Term Impacts and Long-Term Impacts). Results We discuss literature that most directly supports these components and includes findings from healthy people and those with disorders in whom speaking dyspnea was either evoked or measured. Caveats are noted where information is limited and further study is needed. A case example is provided to illustrate how to apply the framework. Conclusions This framework provides a broader view of the elements that contribute to the experience of speaking dyspnea. It is meant to guide researchers, clinicians, instructors, caregivers, and those for whom speaking dyspnea is a daily or even a life-long challenge.

Wearable Devices in Health Monitoring from the Environmental towards Multiple Domains: A Survey.

The World Health Organization (WHO) recognizes the environmental, behavioral, physiological, and psychological domains that impact adversely human health, well-being, and quality of life (QoL) in general. The environmental domain has significant interaction with the others. With respect to proactive and personalized medicine and the Internet of medical things (IoMT), wearables are most important for continuous health monitoring. In this work, we analyze wearables in healthcare from a perspective of innovation by categorizing them according to the four domains. Furthermore, we consider the mode of wearability, costs, and prolonged monitoring. We identify features and investigate the wearable devices in the terms of sampling rate, resolution, data usage (propagation), and data transmission. We also investigate applications of wearable devices. Web of Science, Scopus, PubMed, IEEE Xplore, and ACM Library delivered wearables that we require to monitor at least one environmental parameter, e.g., a pollutant. According to the number of domains, from which the wearables record data, we identify groups: G1, environmental parameters only; G2, environmental and behavioral parameters; G3, environmental, behavioral, and physiological parameters; and G4 parameters from all domains. In total, we included 53 devices of which 35, 9, 9, and 0 belong to G1, G2, G3, and G4, respectively. Furthermore, 32, 11, 7, and 5 wearables are applied in general health and well-being monitoring, specific diagnostics, disease management, and non-medical. We further propose customized and quantified output for future wearables from both, the perspectives of users, as well as physicians. Our study shows a shift of wearable devices towards disease management and particular applications. It also indicates the significant role of wearables in proactive healthcare, having capability of creating big data and linking to external healthcare systems for real-time monitoring and care delivery at the point of perception.

Yawn contagion promotes motor synchrony in wild lions, Panthera leo

Yawning, a fixed action pattern, is widespread in almost all vertebrate taxa. Several hypotheses have been proposed to explain the functions of yawning. These hypotheses, not mutually exclusive, can be conventionally arranged according to both physiological (e.g. drowsiness hypothesis: yawning when switching between sleep and being awake; arousal hypothesis: yawning in contexts of high social tension) and social communicative domains (e.g. contagion hypothesis, activity synchronization hypothesis). Owing to their high social cohesion and synchronized group activity, wild lions are a good model to investigate both spontaneous yawning from the physiological domain and, possibly, contagious yawning, from the social communicative domain. We videorecorded two groups of lions in the Makalali Reserve (Limpopo region, South Africa) and analysed their yawning behaviour. Spontaneous yawning was particularly frequent when the lions were relaxed and, in agreement with the 24 h activity cycle typical of the species, was similarly distributed over the night and day. These findings support the drowsiness hypothesis predicting that yawning is linked to the transition between sleeping and waking (and vice versa). Lions did not show high levels of yawning during competition over clumped food such as carcasses; hence, the arousal hypothesis was not supported. We found that yawn contagion was present, supporting the contagion hypothesis and the activity synchronization hypothesis. Our findings suggest that the convergence of motor behaviour triggered by yawn contagion (to our knowledge never explored in any other species) could represent an important tool to shed light on the adaptive and immediate benefits that underlie the evolution of the yawn contagion phenomenon in human and nonhuman animals. • Lions yawn when they are relaxed and engage in social affiliation. • The arousal state seems to inhibit yawning in wild lions. • Wild lions are infected by others' yawns. • Yawn contagion facilitates motor convergence thus favouring lion group synchrony.

An exploration of clinical, behavioral, and community factors associated with sleep duration and efficiency among middle-aged Black/African American smokers

We examined the most important correlates to sleep duration and efficiency from a comprehensive array of multilevel factors. Baseline data from a cohort of 216 Black/African American smokers aged 40-65 years were examined. The binary outcomes of healthy sleep duration (6-8 h/night) and efficiency (≥85%) were ascertained from 14 consecutive days of actigraphy. Seventy-three independent variables from socio-demographic, individual behavioral, individual physiological, interpersonal, and community domains were assessed. Random survival forest decision trees were generated for each outcome, and variable importance metrics used to rank the predictive abilities of exposure variables. The 5 most predictive exposure variables for each outcome were entered into a regression model of the respective outcome (with age and sex). Study participants (N=216) had a mean age of 54.57 years (SD=6.17) and 57% were male. Healthy sleep duration was achieved by 56.5% and healthy sleep efficiency by 13.6% of the sample. Regression models showed every additional minute of light physical activity was associated with 1% increased odds, while every unit decrease in the inflammation marker of interleukin-8 was associated with 12% increased odds, of achieving a healthy sleep duration. Every unit increase in total social support was associated with a 34% increased odds, while every unit increase in the hazardous drinking score corresponded with 30% decreased odds, of achieving healthy sleep efficiency. Light physical activity, social support, and alcohol consumption may be key modifiable intervention targets to improving sleep duration and sleep efficiency in this population.