Physiological Distress Research Articles

Physical activity regulates the intestinal microbiota composition

Gut microbiota is the name given today to the bacterial population living in our intestine. It provides nutrients, metabolites and affects the immune system. Recent animals and human studies suggest that regular physical activity increases the presence of beneficial microbial species of gut microbiota and improves the health status of the host. When gut bacteria diversity reduces, there are systemic consequences leading to gastrointestinal, physiological and psychological distress. This review describes the communication pathway of the microbiota-gut-brain axes and other possible mechanisms by which physical activity causes changes in microbiota composition. Furthermore, it provides the latest evidence of the beneficial role of exercise, which in turn can affect health and various disease processes. The results of research studies in this area are increasingly becoming a focus of scientific attention.

Bathing Method for Preterm Infants: A Systematic Review

Background: Current research suggests that routine daily bathing for preterm infants can render many adverse effects on physiological responses and comfort distress of the infant. Repeated stress on premature babies can have destructive longterm effects on brain development. Objectives: To identify the best current evidence regarding bathing method for preterm infants in enhancing neuro developmental care by using atraumaticcareapproach. Methods:Acomprehensiveliteraturesearchwasperformed in PubMed, ScienceDirect, Wiley Online Library, EbscoHost, Proquest from year of 2008 – May 2019 with the search strategy keywords: bathing, behavioral responses, physiological parameters, premature babies, preterm infants. Inclusion criteria for this study were an original research or systematic review about preterm/premature infants with gestational age is 30 – 37 weeks. PRISMA guideline was applied as a search strategy tool, compared to the used of another conceptualizing tool.
 Results: A total of 883 of records were identified. After removal of duplicates and initial screening, nine articles met the inclusion criteria of bathing methods for preterm infants. There are several bathing methods were identified: sponge bath, conventional/immersion tub bath, and swaddle bath which is related to physiological responses and behavioral distress during and after bathing intervention. This systematic review showed that swaddle bath had a positive effect on physiological measurement and behavioral responses to preterm infants compared to conventional tub bath and sponge bath which can increase physiological and behavioral discomfort to the preterm infants.
 Conclusion: This study showed that some of the processes actually reduce negative effects of bathing on the health of the preterm infants. Swaddle bath has proven to be the best and safest type of bathing method for preterm infants during hospitalization that produces fewer changes regarding physiological and behavioral distress to the preterm infants. It is recommended that swaddle bath should be used for preterm infants during they are hospitalized and to be considered as a standard operating procedure in the perinatology unit and neonatal intensive care unit or pediatric intensive care unit.

Awareness assessment of biophilic design principles application

The green architecture has developed in the last few years, since the sustainable system have evolved specially in buildings construction. The aim is to keep sources of non-renewable energy. With this evolution, a new concept related to the green architecture has been emerged called biophilia, or the living nature which is related to the human inheritance of loving nature. Many studies have proved that the existence of humans in the external environment reduces physiological and neurological distress and makes them feel better. This research deal with definition of architectural biophilic design with relation to the physical and physiological human health; as well as the merging of building interior with nature and their effects on the employee in terms of health and productivity. Moreover, it investigated the applications of the biophilic design inside work place to make it more comfortable and effective for the employee to enhance their productivity. The aim of this paper is to assess awareness about the biophilic design and its impact on employees and their wellbeing in Egypt because it’s too important to apply biophilic design especially at workspaces here in Egypt which had big percentage of unsuitable places to work full of stress and anxiety.

Acute Brain Injury Is Associated With Prolonged Suppression of Cerebral Blood Flow Oscillations

Abstract INTRODUCTION Low-frequency oscillations (LFOs, < 0.1 Hz) in cerebral blood flow (CBF) reflect changes in the coordinated activity of neuronal assemblies. Synchronized LFOs across multiple brain regions can be identified using magnetic resonance imaging to reveal functionally connected networks; however, how LFOs are altered by brain injury is largely unknown. METHODS We quantified changes in LFO magnitude over time in brain-injured patients where CBF was recorded continuously using invasive thermal diffusion flowmetry. Intracranial pressure (ICP), brain tissue oxygen (PbO2), and arterial blood pressure (ABP) were recorded concurrently in all patients. For each epoch of uninterrupted CBF data, the power spectral density within the 0.05 to 0.1 Hz frequency band was calculated. Periods of LFO suppression were defined as occurring when equal to 10% of the total power across all frequencies occurred in the 0.05 to 1 Hz frequency band. Average values of CBF, ICP, PbO2, and ABP were compared between suppressed and nonsuppressed epochs across all patients. RESULTS Twenty-five patients were included in this retrospective observational study. LFO suppression was associated with a lower average CBF (11.3 mL/100 g/min suppressed vs 31.6 mL/100 g/min unsuppressed, P < .0001) and lower average PbO2 (21.6 mm Hg suppressed vs 31.0 mm Hg unsuppressed, P < .0001). In a subset of patients, LFO suppression was associated with intracranial hypertension (ICP 25-60 mm Hg). Patients that regained consciousness and were discharged to acute rehab had a lower median fraction of time spent in the suppressed state (0.03 rehab vs 0.67 death/nursing home, P = .053). CONCLUSION Brain injury is associated with the suppression of low-frequency CBF fluctuations. LFO suppression is associated with periods of physiological distress and may provide a sensitive marker of disrupted brain function. The degree of LFO suppression may have a prognostic significance, and the re-emergence of LFOs after a period of suppression may provide a marker of return of consciousness after coma.

Differential impact of endocrine therapy (ET) and chemotherapy (CT) on quality of life (QoL) of 4,262 breast cancer (BC) survivors: A prospective patient-reported outcomes (PRO) analysis.

512 Background: We recently witnessed a trend to de-escalate CT and escalate ET in adjuvant BC treatment (tx). However, there has been limited prior research investigating the differential impact on QoL of tx classes. We aimed to test the impact of CT and ET on QoL PROs 2 yrs after diagnosis (dx). Methods: CANTO (NCT01993498) is a multicenter prospective longitudinal study of stage I-III BC pts that characterizes long-term toxicities of BC tx. For this analysis we included 4262 pts recruited from 2012-14. QoL was extensively evaluated using the EORTC QLQ C30 and BR23. Linear regression modeling was performed, adjusting for demographic and clinical factors, with use of CT and/or ET as independent variables. Analyses were stratified by menopausal status due to different tx patterns and sequelae of CT. Results: Median age at dx was 56 yrs, 63% of pts were post (PostM) and 37% premenopausal (PreM), 80% had Charlson score 0, 91% stage I-II. 26% received mastectomy, 52% CT (preM 68%, postM 44%; 86% anthracycline+taxane) and 82% ET (preM 89% tamoxifen; postM 88% aromatase inhibitor). 32% preM pts had menses 1 year after ET initiation. Overall, QoL deteriorates 2 yrs after dx. ET negatively impacts more QoL domains than CT at 2 yrs. Also, young age, smoking, income, aggressive local tx and physiological distress are often associated with low QoL. In the stratified analyses, in postM pts, mostly ET (not CT) is associated with deteriorated QoL. In contrast, in preM pts, mostly CT (not ET) is associated with deteriorated QoL. Table shows eg of associations. Conclusions: In a large prospective cohort of BC survivors, detrimental QoL 2 yrs after dx is mostly associated with ET; however, negative effects of CT persist on preM. This differential effect on QOL should be considered when choosing optimal adjuvant therapy and appropriate selection of pts for ET escalation should be a research priority. [Table: see text]

A framework to evaluate animal welfare implications of policies on rhino horn trade

There is currently fierce debate among rhino conservation stakeholders, scientists, and policy-makers over the legalisation of trade in rhino horn. Despite the prominent voice of animal welfare organisations in this debate and conservation more broadly, the welfare implications of a legal trade versus a trade ban have not been addressed. To explore this gap, we developed a framework to assess the welfare implications for white rhino (Ceratotherium simum) under different rhino horn trade policies. We surveyed rhino stakeholders in order to rank eleven welfare issues under a hypothetical legal trade versus a trade ban, and then calculated the resulting rhino welfare compromise under each policy. Results from expert input suggest that welfare compromise of legally-dehorned rhinos is substantially lower than welfare compromise of a poached animal. This is largely due to the differences in a rhino's physiological and psychological distress in response to being shot versus being immobilised with anaesthetics. Through a sensitivity analysis, we show how rhino welfare compromise changes with respect to the degree poaching levels could respond to legal trade (or a continued ban), from the scenario of low poaching pressure to the alternative scenario of increased poaching pressure. This analysis suggests that the policy that leads to the least poaching is likely best for improving rhino welfare because welfare compromise to poached individuals is much higher than the compromise from legally-dehorning a rhino. Our paper provides a framework to estimate and assess the welfare impacts of a hypothetical trade in rhino horn to inform policy debates.

Assessing hematologic ratios as biomarkers for psychosocial distress.

699 Background: Psychosocial distress is common among cancer patients and has been shown to have deleterious effects on a patient’s quality of life, treatment, and outcomes. Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-monocyte ratio (PMR) have been associated with poor outcomes in some cancers. Therefore we hypothesized that these ratios may be correlated to distress. This study looked at request for social work follow up as a surrogate marker for distress and investigated relationships between these ratios and markers of patient distress. Methods: A validated 48 item electronic distress screen was administered to patients in the medical and surgical oncology clinics of a large cancer center from 2009-2015. Patient requests for social work follow up were noted and patient charts reviewed for relevant labs and history. Patient demographics, NLR, LMR, PMR were reviewed. Chi-squared tests and univariate and multivariate regressions were performed to compare groups and relationships of variables and outcomes. Results: 43% of patients surveyed requested social work follow up. Of those, 75% received follow up, at a mean of 8 days. Non-Caucasian patients were more likely to request social work follow up (p = 0.03). Non-English speaking patients (p = 0.06) and those who saw medical oncologists trended towards significant desire for social work follow up. There was no significant correlation between NLR, PMR, LMR and desire to see a social worker. On multivariate analysis, patients with metastatic disease were less likely to want social work follow up (OR 0.43, 95% CI: 0.21-0.9, P = 0.02). Conclusions: In this study, non-white, non-English speaking patients, and those seeing medical oncologists were more likely to request social work follow up. We found no significant correlations between NLR, PMR, LMR and request for social work follow up. This suggests that desire for social work follow up is not a good correlate for physiologic distress in cancer patients. Further work is ongoing to provide better insight into determinants of psychosocial and physiologic stress in this patient population along with relevance of hematologic ratios.

The Mindfulness Pilot Project: The Effects of a Body Scan Activity on Bone Marrow Transplant Patients

Topic Significance & Study Purpose/Background/Rationale Patients with hematological malignancies, particularly those with acute diagnoses requiring immediate treatment and hospitalization, often experience high levels of distress. Mindfulness has been shown to alleviate symptoms of distress in cancer patients, but there is limited research on the effects of mindfulness on distress in this inpatient population. The purpose of this pilot study is to determine the effects of a mindfulness intervention on symptoms of distress during inpatient hospitalizations for patients with hematological malignancies (HM). Methods, Intervention, & Analysis A convenience sample of 30 patients with HM admitted to an oncology floor in a large, Midwestern hospital participated in this study. Participants completed the Rotterdam Symptom Checklist (RSCL): 30 physiological and psychological symptoms of distress, rating how much the symptoms bothered them during the past week on a Likert-type scale. Patients completed a 20-minute mindfulness activity including breathwork and the Body Scan in their rooms. Participants were given a summary sheet and practice log. The RSCL was again completed at two weeks. Patients were asked open-ended questions regarding their experience. Findings & Interpretation A Wilcoxon Signed Rank Test revealed a statistically significant reduction in physiological and psychological distress at the two-week follow-up, z=4.12, p Discussion & Implications Patients expressed the desire for their care to include mindfulness interventions. This intervention is low-risk and low-cost and might be extended to include recorded mindfulness exercises or informal classes. Future studies might explore the use of different media such as audio recordings or phone apps for inpatient self-practice. After initial education of the Body Scan, nurses might encourage patients to utilize it while waiting for as-needed medications to be administered, before or during inpatient procedures, or in conjunction with medication to alleviate side effects of treatment. Doing so could empower patients during the course of their hospitalization, improving the patient experience.

Colorful Screams of Silent Emotions: A Study with Oncological Patients.

Background:Art, as a product of human behavior, is the expression of emotions from inner states and may provide catharsis, purification, and release. Several branches of art, most notably music, dance, and painting, can be used for treatment purposes, especially in the case of psychological disorders. Cancer, which is defined as uncontrolled cell growth, has been an important health issue throughout history, but the recent increase in its frequency has made it one of the most significant public health problems. Both the physiological distress the disease subjects the body to and the accompanying emotional distress are important factors to be considered in cancer treatment.Aims:In this study, the role of art in expressing emotions of oncological patients was investigated.Materials and Methods:During the treatment period, patients were interviewed about their experiences, feelings, expectations and perceptions. The picture was used as an expression of emotions.Results:Communication between the patient and doctor is one of the most important elements in the treatment process, and it has come to the fore in branches of medicine, such as oncology, because of its positive contribution to treatment compliance. In general, the study showed a pronounced positivity and expectations on the part of patients from the hope-life-healing process rather than oncological treatment.Conclusion:In this study, we aim to demonstrate how the artistic expression of emotions, in particular, through painting, has a positive effect on healing, hope, and the interactions between cancer patients under oncological treatment and medical professionals.

Whole-Body Electromyostimulation Combined With Individualized Nutritional Support Improves Body Composition in Patients With Hematological Malignancies - A Pilot Study.

Patients undergoing the complex treatment for hematological malignancies are exposed to a high physiological and psychological distress inducing fatigue and physical inactivity. In line with cancer-related metabolic changes patients are predisposed for skeletal muscle mass loss that leads to a functional decline, affects therapeutic success, and quality of life. Benefits of physical exercise and nutritional interventions on muscle maintenance are observed in solid cancer patients, but marginally investigated in patients with hematological cancer. We here studied the effects of a combined supportive exercise and nutrition intervention using whole-body electromyostimulation (WB-EMS) training and individualized nutritional support in patients actively treated for hematological malignancy. In a controlled pilot trial, 31 patients (67.7% male; 58.0 ± 16.7 years) with various hematological cancers were allocated to a control group (n = 9) receiving nutritional support of usual care regarding a high protein intake (>1.0 g/kg/d) or to a physical exercise group (n = 22) additionally performing WB-EMS training twice weekly for 12 weeks. Bodyweight and body composition assessed by bioelectrical impedance analysis were measured every 4 weeks. Physical function, blood parameters, quality of life and fatigue were assessed at baseline and after 12 weeks. No WB-EMS-related adverse effects occurred. Patients attending the exercise program presented a higher skeletal muscle mass than controls after 12-weeks (1.51 kg [0.41, 2.60]; p = 0.008). In contrast, patients of the control group showed a higher fat mass percentage than patients of the WB-EMS group (-4.46% [-7.15, -1.77]; p = 0.001) that was accompanied by an increase in serum triglycerides in contrast to a decrease in the WB-EMS group (change ± SD, control 36.3 ± 50.6 mg/dl; WB-EMS -31.8 ± 68.7 mg/dl; p = 0.064). No significant group differences for lower limb strength, quality of life, and fatigue were detected. However, compared to controls the WB-EMS group significantly improved in physical functioning indicated by a higher increase in the 6-min-walking distance (p = 0.046). A combined therapeutic intervention of WB-EMS and protein-rich nutritional support seems to be safe and effective in improving skeletal muscle mass and body composition in hematological cancer patients during active oncological treatment.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02293239.

Effect of heat stress on crossbred dairy cattle in tropical Nepal: Impact on blood parameters

Chitwan district of Nepal has been known as the dairy kingdom of the country considering its strategic location andpotential to easily provision inputs and produce as well as market quality milk across the country. However, theclimate especially during summer has been a challenge to farmers that potentially compromise the daily milk yieldof cows. Therefore, sixteen crossbred dairy cattle were placed in a RCBD fashion to assess the impacts of cold waterbathing in ameliorating effect of heat stress on their performance and body physiology. Routine assessment of themicroclimate within the experimental shed and blood parameters was made. The results from the experimentinferred that frequency of bathing (none, once, twice or thrice a day) did not have any significant impact onHaemoglobin, Haematocrit, Sodium, Potassium, Chloride and Bicarbonate levels in the blood plasma(p>0.05). Inaddition, the animals did not exhibit any signs of physiological distress clinically either. A detailed study scopingtemperature humidity index and over a number of other milk and blood parameters are to be tested across a numberof other available breeds too in order for the researchers to come to a meaningful strategy to beat the heat stress.

Residual symptoms and disease burden among patients with psoriatic arthritis: is a new disease activity index required?

The aim of this study was to investigate residual symptoms or disease burden among patients with psoriatic arthritis (PsA) in remission or low disease activity (LDA) according to different outcome measures. A total of 126 patients with PsA were included and the following variables were assessed: Tender joint count (TJC), swollen joint count (SJC), patient's global assessment, physician's global assessment, pain, extra-articular manifestations, Psoriasis Area and Severity Index, Health Assessment Questionnaire, fatigue, Short Form-36, psoriatic quality of life, Hospital Anxiety and Depression Scale and C-reactive protein (CRP). Disease activity was measured using three different outcome measures including minimal disease activity (MDA), disease activity score for 28 joints (DAS28-CRP) and disease activity in psoriatic arthritis (DAPSA). The number (%) of patients who achieved remission or LDA was 9(14.1), 34(27.0) and 67(53.2) according to MDA, DAPSA and DAS28-CRP criteria, respectively, under usual care. SJC > 1 was seen in 3(8.8%) and 13(19.4%) of patients in remission or LDA as defined by the DAPSA and DAS28-CRP respectively. TJC > 1 was found at least 32.4% of patients with PsA in remission or LDA by any definition. 22.2-49.3% of patients with PsA in remission or LDA still suffered from clinically important fatigue. No patients in MDA had a substantial functional impairment while 2.9-19.4% of patients fulfilling remission or LDA according to the DAPSA and DAS28-CRP experienced functional disability. At least 22.2% of patients with PsA in remission or LDA by any description had higher risk for depression, and at least 11.1% for anxiety. Despite patients with PsA in remission or LDA by various definition, they may continue to experience pain, tender or swollen joints, fatigue, physiologic distress as well as functional impairment suggesting that there is a significant unmet need with regard to definition of remission or LDA in PsA.

Effect of spraying of fine water particles on facial skin moisture and viscoelasticity in adult women.

Background/purposeIt is known that the elderly and adult women with reduction in sebum secretion have reduced skin barrier function, drying of the skin in a low humidity environment is accompanied by physiological distress. As our hypothesis, when fine water particles are sprayed on the skin, the water content of the corneal layer is significantly increased. In the present study, we examined the ability of fine water particles to improve facial skin moisture levels in adult women.MethodsWe examined skin conductance, transepidermal water loss (TEWL), and skin elasticity as an index of skin barrier function at the cheek in 17 healthy adult women in the spraying of fine water particles, in the environment temperature at 24°C and 34.5% relative humidity.ResultsThe skin conductance of stratum corneum after 120 minute of spraying, A condition (peak particle size below 0.5 μm) was 119.7 ± 25.1%, B condition (peak particle size 1.8 μm) was 100.4 ± 31.7%, C condition (peak particle size 5.4 μm) was 110.1 ± 25.0%, and the A condition was significantly higher than the B condition. Also, skin elasticity in the A condition tended to be higher value than in the other conditions. Transepidermal water loss (TEWL) after 120 minute of spraying showed a lower value in the A condition than in the other conditions. In the A condition, the skin conductance steadily maintained their initial levels up to 360 minute after spraying.ConclusionEspecially, by spraying smallest fine water particles, skin barrier function at the cheek was improved. These data indicated that non‐charged fine water particles played an important role on moisten skin in a low humidity environment.

Social Networks and Health Outcomes: Importance for racial and socioeconomic disparities in cardiovascular outcomes.

A large body of research has indicated social network characteristics are associated with health and mortality. Additional literature suggests the structure and function of social networks differ by race and socioeconomic status. The current paper seeks to synthesize and further contextualize these two separate bodies of work, as well as illustrate potential mechanisms by which social networks may contribute to current disparities in cardiovascular disease outcomes. An increasing number of studies have examined the link between social networks and cardiovascular outcomes. Social isolation and loneliness are two network-based sources of risk for coronary heart disease and stroke. Social resource theory provides a framework for how network structure and function may differ among distinct population groups, and argues for more research regarding differential access to social drivers of health. While previous studies have often focused on lack of support or resources within networks, more recent studies have examined negative impacts of social networks on health, including network-based stress, which provide additional mechanisms for associations between present, yet, burdensome relationships. Other mechanisms linking social networks with cardiovascular disease risk, including social influence for behaviors associated with ideal cardiovascular health, are discussed. Examination of social network structure and function among diverse populations, including Black Americans and low socioeconomic status individuals, may elucidate potential sources of physiological and psychological distress, as well as sources of support, that are associated with cardiovascular disease outcomes. A richer understanding of these associations may offer solutions for alleviating systemic causes of cardiovascular disease disparities among high risk populations.

Effect of a Delayed Start to Oral Feeding on Feeding Performance and Physiological Responses in Preterm Infants: A Randomized Clinical Trial.

The efficient and safe oral feeding of preterm infants, an essential criterion for hospital discharge, is affected by neurodevelopmental maturation. However, the timing of initiating oral feeding and its relation to maturation, feeding performance, and physiological responses are unclear. The aim of this study was to determine the effect of a 1-week delay in the initiation of oral feeding on feeding performance, transition time, weight gain, and cardiorespiratory responses in preterm infants. In this randomized controlled trial, 40 infants with a gestational age at birth of less than 32 weeks were recruited. The control group (n = 18) began oral feeding when the infants were physiologically stable, whereas the experimental group (n = 22) began oral feeding 1 week later. Infant feeding performance, heart rate, and oxygen saturation were measured before, during, and after feeding on the first day of oral feeding and 3 days later. Daily weight gain was calculated by measuring body weight every morning, and transition time was calculated by counting the number of days from the initiation of oral feeding to the termination of tube feeding. There were no significant differences between the two groups in terms of feeding performance, weight gain, or postmenstrual age at the completion of full oral feeding. The transition time was significantly shorter in the experimental group than in the control group. More infants in the control group experienced episodes of oxygen desaturation during feeding than in the experimental group. For infants with a postmenstrual age of greater than 32 weeks who are ready to initiate oral feeding, postponing oral bottle feeding for 1 week may be considered as an intervention to reduce physiological distress.

Development and validation of the Mothers of Preterm Babies Postpartum Depression Scale

Postpartum depression, a common complication in childbearing women, is of great public health concern. Previous screening tools have focused on depressed mood, with less attention paid to postpartum anxiety and suicidal ideation. This study developed and validated a tool to measure postpartum depression among mothers of preterm babies. From the clinical interviews and a pilot survey (n=121) the Mothers of Preterm Babies Postpartum Depression Scale was developed. The Mothers of Preterm Babies Postpartum Depression Scale and the Edinburgh Postnatal Depression Scale questionnaires were completed by 152 mothers who delivered preterm babies at Massey Street Children’s Hospital, Lagos. Data were analyzed with use of confirmatory factor analysis, principal component analysis, and Cronbach’s alpha at the P≤0.05 level of significance. The new scale demonstrated a reliability (α) of 0.91. Construct validity with exploratory factor analysis (Kaiser-Meyer-Olkin measure 0.70) yielded three dimensions of cognitive and emotional difficulty (α=0.92), hopelessness and suicidal ideation (α=0.93), and physiological distress (α=0.71). Confirmatory factor analysis demonstrated a good fit: 18 degrees of freedom; goodness of fit index 0.97; adjusted goodness of fit index 0.93; and root mean square error of approximation 0.04. Convergent validity was established with the Edinburgh Postnatal Depression Scale (r=0.66, P=0.00). The new screening tool was demonstrated to have meritorious validity, faster and easier to administer to the obstetric population. Significance statement Having a baby is often marked by disturbance in mood, and the birth of a premature baby can put mothers at greater risk of psychological distress than the birth of a full-term baby. Available screening tools assess postpartum depression symptoms without consideration of mitigating sources of postpartum stress. Edinburgh Post-natal Depression scale is the commonest measure for differential diagnosis in Nigeria but limited in screening women for suicidal ideation and anxiety. This study developed a new tool that improves the efficiency of, and reduces the time spent diagnosing postpartum depression among mothers of preterm babies. Efficiency in diagnosing the pathological reaction of mothers of preterm babies to the child’s condition and the corresponding depression symptoms is highly important for implementation of cost-effective intervention by mental health practitioners.

Modelling perception-action coupling in the phenomenological experience of \u201chitting the wall\u201d during long-distance running with exercise-induced muscle damage in highly trained runners

Background“Hitting the wall” (HTW) can be understood as a psychophysiological stress process characterised by (A) discrete and poignant onset, (B) dynamic interplay between physiological, affective, motivational, cognitive, and behavioural systems, and (C) unintended alteration of pace and performance. A preceding companion article investigated the psychophysiological responses to 20-km self-paced treadmill time trials after producing exercise-induced muscle damage (EIMD) via a standardised muscle-lengthening contraction protocol.MethodsA 5-step procedure was applied determining the extent to which the observed data fit the hypothesised cause-effect relationships. Running with EIMD negatively impacts performance fatigability via (A) amplified physiological responses and a non-adaptive distress response and (B) deterioration in perceived fatigability: increase in perceived physical strain precedes decrease in valence, which in turn precedes increase in action crisis, eventually dissolving the initially aspired performance goal.ResultsFirst, haematological indicators of EIMD predicted increased blood cortisol concentration, which in turn predicted increased performance fatigability. Second, perceived physical strain explained 44% of the relationship between haematological indicators of EIMD and valence, which in turn predicted increased action crisis, which in turn predicted increased performance fatigability. The observed data fitted the hypothesised dual-pathway model well with good model-fit indices throughout.ConclusionsThe hypothesised interrelationships between physiological strain, perception, and heuristic and deliberative decision-making processes in self-regulated and goal-directed exercise behaviour were applied, tested, and confirmed: amplified physiological strain and non-adaptive distress response as well as strain-perception-thinking-action coupling impact performance fatigability. The findings provide novel insights into the psychophysiological processes that underpin the phenomenological experience of HTW and alteration in pacing behaviour and performance.

Cognitive-Behavioral Therapy for an Adolescent Female Presenting With Misophonia: A Case Example

The case illustrates the effective assessment and treatment of misophonia in a 14-year-old adolescent female in which short-term cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) principles were utilized. Misophonia-related symptomology declined significantly during treatment, and partial gains were consolidated over time with the use of ongoing sporadic booster sessions to maintain reported improvements and to address the variable nature of the patient’s symptom expression. Significant tolerance of noise triggers occurred, both within and in between sessions, and the patient achieved concurrent behavioral changes and tolerated a marked reduction in relevant avoidance behaviors. Self-reported and observed psychological and physiological distress diminished when confronted with identified trigger noises, both during conducted in vivo exposures and, more broadly, in the patient’s home and school environments. The case serves as a contribution to the growing body of psychiatric literature recognizing misophonia as a distinct phenomenon, and offers anecdotal evidence regarding assessment treatment implications.

Resilience, hope and flourishing are inversely associated with burnout among members of the Society for Gynecologic Oncology

PurposeIn this study we sought to: 1) determine rates of burnout and other associated indices of psychosocial distress such as alcohol and substance abuse, 2) establish the baseline performance of gynecologic oncologists on several positive psychology metrics, 3) determine if increased hope, resilience, and flourishing are associated with decreased burnout. MethodsA survey of members of the Society of Gynecologic Oncology (SGO) was conducted in spring of 2017. Participants were sent an electronic questionnaire consisting of 82 items measuring burnout, depression, substance abuse, flourishing, resilience, hope, and psychological wellbeing. ResultsA total of 1745 members were invited and 374 (21.4%) responded. Overall, 23.0% of respondents scores above clinical cutoffs indicating burnout. Almost 50.0% of participants screened positive for depression, 17.0% screened positive for alcohol abuse and 12.0% screened positive for substance abuse. Respondents meeting criteria for burnout were more likely to screen positive for depression (p < .001) and substance abuse (p < .001). Participants not meeting criteria for burnout had higher resilience, flourishing, hope, and wellbeing scores (p < .001). Male respondents had higher levels of hope, resilience, and wellbeing while married participants had higher flourishing and wellbeing scores than their unmarried counterparts. Parents had higher levels of resilience and wellbeing compared to non-parents. Conclusion(s)Burnout and associated indices of physiological distress continue to affect a large segment of SGO membership. Participants not meeting the criteria for burnout had higher scores on resilience, flourishing, hope, and wellbeing metrics. This suggests new targets for evidence-based interventions to mitigate burnout among members of SGO.

2280 Subjective, physiological activation and habituation, and response to written trauma narrative exposure

OBJECTIVES/SPECIFIC AIMS: Emotional processing theory and some observations suggest that activation of subjective and physiological distress during therapeutic exposure and habituation across exposure sessions are key to improvement. This study sought to determine whether initial subjective and physiological activation and between-session habituation would predict PTSD symptom reduction after a series of written trauma narrative exposure sessions. METHODS/STUDY POPULATION: In total, 29 urban-residing African-American participants with PTSD participated in four 30-minute writing sessions. Writing sessions 1 and 2 were 12 hours apart and session 3 and 4 were performed 1 week later, also 12 hours apart. PTSD symptoms were measured at baseline, after session 2, and 1 week after all 4 writing sessions with the Clinician Administered PTSD Scale. During each session, Subjective Units of Distress Scores (SUDS) were assessed 4 times and heart rate was measured continuously. RESULTS/ANTICIPATED RESULTS: Participants exhibited PTSD symptom improvement and habituation of subjective distress, but not physiological arousal, across writing sessions. First session baseline-corrected SUDS maximum and SUDS decrease from the initial to the final writing session were both positively associated with symptom improvement. DISCUSSION/SIGNIFICANCE OF IMPACT: Increased subjective, but not physiological, distress in the first exposure session and diminished subjective distress across sessions may be a helpful marker of emotional processing for clinicians and predictor of symptom improvement after written trauma narrative exposure.