Abstract Background and objectives In recent years, biochemical markers have been employed to predict the outcome of patients with traumatic brain injury (TBI). In mild TBI, S100B has shown the most ...promise as a marker of outcome. The objective of this study in patients with severe TBI was to: show the range of serum S100B levels during the acute phase after trauma: determine if S100B has potential to discriminate favourable from unfavourable outcome in patients with similar brain injury severity scores and to establish an S100B ‘cut-off’ predictive for death. Methods All patients with severe TBI, admitted to this neurointensive care unit within 24 h of injury were eligible for inclusion in the study. One serum blood sample was obtained from each patient at the 24 h post-injury time-point. S100B levels were measured using enzyme-linked immunosorbent assay. Injuries were coded using an internationally recognised injury severity scoring system (ISS). Three-month follow-up was undertaken with outcome assessed using the Glasgow outcome score (GOS). Results One hundred patients were recruited. Serum S100B levels ranged from 0.08 to 12.62 μg L−1 S100B levels were significantly higher in patients with a GOS of 1 (death) 2 and 3 (unfavourable outcome) compared with those with GOS 4 and 5 (good recovery). In this study a cut-off point of 0.53 μg L−1 has sensitivity of >80% and specificity of 60% to predict unfavourable outcome and 49% to predict death. Conclusion In 100 patients studied with similar brain injury severity scores, serum S100B measured at the 24-h time-point after injury is significantly associated with outcome but a cut-off 0.53 μg L−1 does not have good prognostic performance.
Background
Although chronic pain and obesity are global health crises with substantial healthcare costs, little is known about the relationship between pain perception and eating behaviours. Food ...consumption has been reported to provide an analgesic effect by the release of neurotransmitters modulating the pain network. However, whether short-term (acute) fasting affects pain perception remains unclear.
Purpose
This study aimed to investigate the effect of acute fasting on pain perception and whether attention and mood changes drove the observed changes.
Patients and methods
The cold pressor test (CPT) was used to investigate the pain tolerance of 25 healthy participants in both non-fasting and 12-h fasting sessions. They were randomised to either session with a crossover to the other after at least 24 h, with the experimenter blinded to the sessions. The pain tolerance was measured using a Stroop task in both attentive and distracted states. The Profile of Mood States (POMS) questionnaire was used to capture the mood, and a 10-point hunger scale was used to measure hunger. Mixed-effects models were used to investigate the influence of fasting and distraction on pain perception, accounting for the repeated measures.
Results
Fasting reduced CPT pain tolerance, with fasting participants twice as likely to withdraw their hands early (hazard ratio = 2.4, 95% CI: 1.3–4.5). Though men tolerated CPT pain longer than women, there was no evidence that men responded to fasting differently than women (
p
= 0.9). In addition, no evidence supporting that fasting affected attention or mood was found. Nonetheless, it increased hunger scores by 2.7 points on a 10-point scale (95% CI: 1.2–4.2) and decreased blood glucose concentration levels by 0.51 mmol/L (95% CI: 0.19–0.84).
Conclusion
Acute fasting reduces pain tolerance in the healthy participants, and this effect is independent of gender and attention or mood changes.
This collection of essays by leading scholars and practitioners addresses a timely and essential question: How can we design, plan, and sustain built environments that will foster health and healing? ...With a salutogenic (health-promoting) focus,Healthy Environments, Healing Spacesaddresses a range of contemporary issues, including health equity, biophilic cities, healthcare facility design, environmental health, aging in place, and food systems planning.
Contributors: Ellen Bassett ● Timothy Beatley ● Emily Chmielewski ● Jason Corburn ● Tanya Denckla Cobb ● Tye Farrow ● Ann Forsyth ● Howard Frumkin ● Judith H. Heerwagen ● J. David Hoglund ● Carla Jones ● Andrew Mondschein ● Christina Mullen ● Reuben Rainey ● Samina Raja ● Jennifer Whittaker
It is unclear whether a diagnosis of chronic pain is associated with an increase or decrease in the placebo response. The aim of this study was to use an experimental placebo conditioning paradigm to ...test whether expectancy for pain relief impacts on acute pain perception in individuals with a chronic pain diagnosis of osteoarthritis (OA) or fibromyalgia (FM), compared to healthy individuals (HIs). An inert cream was applied to the dominant forearm of participants (60 OA, 79 FM, and 98 HI), randomly assigned to either a placebo or control group. In both groups, an inactive cream was applied to the dominant forearm. The placebo group was told this may or may not be a local anaesthetic cream, whereas the control group was told the cream was inactive. Laser pain was delivered, and numerical pain intensity ratings collected before, during, and after cream application, along with expectation of pain relief and anxiety. The procedure was repeated 2 weeks later to assess reproducibility. There was a significant reduction in pain in the placebo group, independent of clinical diagnosis. Diagnostic groups (OA, FM, and HI) did not differ in their magnitude of placebo analgesia or expectancy of pain relief. The results were similar in the repeat session. The results demonstrate that individuals with chronic pain respond to experimental placebo analgesia in a similar and reproducible manner as HIs, despite higher levels of psychological comorbidity. This has implications for using placebo analgesia in the treatment of chronic pain.
HCISPP Study Guide Timothy Virtue, Justin Rainey
2014, 2014-12-11T00:00:00
eBook
The HCISPP certification is a globally-recognized, vendor-neutral exam for healthcare information security and privacy professionals, created and administered by ISC². The new HCISPP certification, ...focused on health care information security and privacy, is similar to the CISSP, but has only six domains and is narrowly targeted to the special demands of health care information security. Tim Virtue and Justin Rainey have created the HCISPP Study Guide to walk you through all the material covered in the exam's Common Body of Knowledge. The six domains are covered completely and as concisely as possible with an eye to acing the exam. Each of the six domains has its own chapter that includes material to aid the test-taker in passing the exam, as well as a chapter devoted entirely to test-taking skills, sample exam questions, and everything you need to schedule a test and get certified. Put yourself on the forefront of health care information privacy and security with the HCISPP Study Guide and this valuable certification. * Provides the most complete and effective study guide to prepare you for passing the HCISPP exam - contains only what you need to pass the test, and no fluff! * Completely aligned with the six Common Body of Knowledge domains on the exam, walking you step by step through understanding each domain and successfully answering the exam questions. * Optimize your study guide with this straightforward approach - understand the key objectives and the way test questions are structured.
Background
Hypothalamic‐Pituitary‐Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis ...changes in individuals with CWP and those at high risk of symptom development.
Methods
We sought to determine differences in morning and evening salivary cortisol levels in FM (n = 19), those at‐risk (n = 20) and pain‐free controls (n = 17). Risk factors included non‐CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research.
Results
Repeated measures ANOVA revealed significant main effects of group (p = 0.003), and time of day (p = 0.002), with no significant interaction. Cortisol levels were higher in FM (p = 0.027) and at‐risk (p = 0.003) groups, compared to controls, but there was no significant difference between FM and at‐risk groups. The main effect of group remained significant with sleep problems (p = 0.021) and life events (p = 0.007), but was not significant with anxiety (p = 0.076) or depression (p = 0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at‐risk group (p = 0.017).
Conclusions
This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain.
Significance
This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.
The kidney is a critical regulator of blood pressure (BP) and a contributor to cardiovascular health. Recently, microRNAs (miRNAs) have emerged as potential mediators of genetic predisposition to ...cardiovascular and kidney disorders, yet their overall role in blood pressure control has not been fully characterised. We sought to identify and catalogue all renal miRNAs, investigate which of them are genetically regulated and assess whether their expression-modifying single nucleotide polymorphisms (SNPs) overlap with genetic variants associated with BP in previous genome-wide association studies (GWAS).
We first characterised the entire renal miRNA transcriptome through de novo small RNA-sequencing of 493 human kidney samples. We then integrated these expression profiles with genotype information to perform expression quantitative trait loci (eQTL) analysis - the largest of its kind - and identify genetically regulated miRNAs and their regulatory SNPs. We then examined the extent to which miRNA-regulating variants overlapped with the curated list of BP-associated GWAS SNPs.
We identified 1,459 mature miRNAs expressed in the human kidney, and the top 50 most highly expressed miRNAs accounted for 24.2% of the measured expression. We also discovered that 78% of miRNA genes expressed in the kidney were intragenic to other genes and 58% mapped to an intron of those genes. After correction for multiple testing, our eQTL analysis had identified 140 genetically regulated miRNAs in the kidney. They were controlled by 19,901 unique SNPs (eSNPs) with a total of 21,805 miRNA-eSNP pairs. Functional annotation of miRNA eSNPs demonstrated 2.54-fold enrichment for kidney enhancer regions and 1.69-fold enrichment for kidney promoters when compared to randomly selected SNPs. Through overlap with GWAS SNPs for systolic, diastolic and pulse pressures, we identified 8 kidney BP miRNA eSNPs responsible for the regulation of 9 mature miRNAs.
Collectively, we generated a catalogue of miRNAs expressed in the human kidney, annotated novel kidney relevant miRNAs and their regulatory variants and discovered 9 renal microRNAs that may act as mediators of genetic predisposition to high BP.
Objectives:
MicroRNAs (miRNAs) are short non-coding RNAs acting as post-transcriptional regulators of mRNAs. It is becoming increasingly clear that they play an important role as molecular ...drivers/mediators of complex human diseases including hypertension. Given the key role of the kidney in the pathogenesis and treatment of hypertension we sought (i) to comprehensively characterise the network of renal miRNA-mRNA interactions and (ii) evaluate their relevance to human hypertension.
Design and method:
Using poly-A RNA-sequencing and small RNA-sequencing we have identified 22,558 genes and 1,604 miRNAs in the discovery analysis of 328 human kidney samples (Human Kidney Tissue Resource). The outputs from these experiments have been normalised and adjusted by linear regression. We conducted a replication analysis of the identified miRNA-gene pairs in normal control kidney samples from two National Institutes of Health cohorts - CPTAC (n = 66) and TCGA (n = 83). We then examined the extent to which the expression of kidney genes known as targets of blood pressure lowering medications can be modulated by microRNAs. Finally, we investigated whether the effects of these interactions are observed at the protein level (CPTAC dataset).
Results:
We identified 186,192 unique statistically significant inverse miRNA-gene correlations in our discovery resource. Of these, 4,319 were replicated in both NIH kidney resources. 32.5% of kidney protein-coding genes and 12.2% of kidney long non-coding RNAs had at least one such high-confidence miRNA associated with their expression. SLC12A3 (Solute Carrier Family 12 Member 3) - kidney gene target for thiazides, SLC12A1 (Solute Carrier Family 12 Member 1) - gene target for loop diuretics and SLC5A2 (Solute Carrier Family 12 Member 2) - gene target for SGLT2 inhibitors showed consistent, negative correlations with four, five and five kidney miRNAs in each of three independent datasets, respectively. Some of the identified miRNAs showed negative correlations with more than one gene-drug targets. For example, miR-31-5p showed a strong, significant inverse association with SLC5A2 (R = -0.67, P = 9.41E-10) and SLC12A3 (R = -0.70, P = 5.80E-11) in the CPTAC resource. We confirmed that miRNA-31-5p also negatively correlates with the renal expressions of SLC12A3 and SLC5A2 at the protein level (R = -0.58, P = 3.5E-7 and R = -0.45, P = 1.51E-4, respectively).
Conclusion:
We characterised highly credible miRNA-gene interactions in the human kidney and mapped them onto genes and proteins of established relevance to blood pressure lowering treatment. These kidney miRNAs represent exciting targets for the development of novel antihypertensives.
The research project utilized an explorative, descriptive method that required the administration of a Pre-COVID Employee Wellness Questionnaire, a Present Employee Wellness Questionnaire to assess ...the health care workers feelings before and during the COVID-19 pandemic. At the same time, the Administration Questionnaire measured each facility's challenges from a financial, work environment, and staffing perspective. The use of the Patient Health Questionnaire Depression Scale (PHQ8), the Insomnia Severity Index (ISI), and the Generalize Anxiety Disorder Screener (GAD-7) assessed symptoms of depression, insomnia, and anxiety in health care workers that have treated COVID-19 patients in a nursing home settings.
Temperature measurement is important during routine neurocritical care especially as differences between brain and systemic temperatures have been observed. The purpose of the study was to determine ...if infra-red temporal artery thermometry provides a better estimate of brain temperature than tympanic membrane temperature for patients with severe traumatic brain injury.
Brain parenchyma, tympanic membrane and temporal artery temperatures were recorded every 15-30 min for five hours during the first seven days after admission.
Twenty patients aged 17-76 years were recruited. Brain and tympanic membrane temperature differences ranged from -0.8 degrees C to 2.5 degrees C (mean 0.9 degrees C). Brain and temporal artery temperature differences ranged from -0.7 degrees C to 1.5 degrees C (mean 0.3 degrees C). Tympanic membrane temperature differed from brain temperature by an average of 0.58 degrees C more than temporal artery temperature measurements (95% CI 0.31 degrees C to 0.85 degrees C, P < 0.0001).
At temperatures within the normal to febrile range, temporal artery temperature is closer to brain temperature than is tympanic membrane temperature.
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