Self-administered mindfulness interventions reduce stress in a large, randomized controlled multi-site study.

Mindfulness witnessed a substantial popularity surge in the past decade, especially as digitally self-administered interventions became available at relatively low costs. Yet, it is uncertain whether they effectively help reduce stress. In a preregistered (OSF https://doi.org/10.17605/OSF.IO/UF4JZ ; retrospective registration at ClinicalTrials.gov NCT06308744 ) multi-site study (nsites = 37, nparticipants = 2,239, 70.4% women, Mage = 22.4, s.d.age = 10.1, all fluent English speakers), we experimentally tested whether four single, standalone mindfulness exercises effectively reduced stress, using Bayesian mixed-effects models. All exercises proved to be more efficacious than the active control. We observed a mean difference of 0.27 (d = -0.56; 95% confidence interval, -0.43 to -0.69) between the control condition (M = 1.95, s.d. = 0.50) and the condition with the largest stress reduction (body scan: M = 1.68, s.d. = 0.46). Our findings suggest that mindfulness may be beneficial for reducing self-reported short-term stress for English speakers from higher-income countries.

Axillary Block-Induced Chemical Sympathectomy in the Setting of Digital Ischemia.

BACKGROUND: Digital ischemia is associated with several rheumatologic disorders and is often difficult to treat. Symptoms and sequelae can include pain, disability, need for amputation, and poor quality of life. METHODS: Patients diagnosed with digital ischemia were referred for an ultrasound-guided axillary nerve block using liposomal bupivacaine (Exparel, Pacira Pharmaceuticals). The primary outcome measure was radial and ulnar artery diameter preprocedure and postprocedure. Doppler waveform analyses were performed to measure arterial diameter and blood flow velocity. The QuickDASH questionnaire was administered to evaluate upper extremity function and perceived disability. RESULTS: Mean radial and ulnar artery diameters increased from 0.19 cm and 0.16 cm to 0.23 cm and 0.20 cm, respectively, 1 hour postprocedure. Concomitant increases in blood flow velocities and hand temperature and lower pain scores were also noted. Although pain generally returned to baseline after 1 week, QuickDASH symptom/disability scores improved at 30 days, and 2 patients' ischemic symptoms resolved spontaneously during the study period in the absence of other interventions. CONCLUSION: Data regarding chemical sympathectomy using regional anesthesia are limited at this time. Our experience suggests a potential role in the treatment and evaluation of digital ischemia. Patients with digital ischemia from rheumatologic conditions appeared to have a greater benefit from a chemical sympathectomy than patients whose conditions had an atherosclerotic or anatomic etiology. Even when the vasodilatory effects are transient, such an intervention may be useful when a more permanent option such as surgical sympathectomy is being considered. Liposomal bupivacaine is only approved for surgical infiltration at this time.

Intermediate-term follow-up of chronically ill patients with digital ischemia treated with peripheral digital sympathectomy.

Digital ischemia is commonly found in patients with scleroderma and has been shown to respond to peripheral digital sympathectomy. While favorable long- and intermediate-term results have been documented in the literature, minimal objective data are available and the mechanism of surgical sympathectomy has not been entirely elucidated. Patients with digital ischemia secondary to Raynaud's phenomenon that had undergone peripheral sympathectomy surgery between 2001 and 2009 were identified and contacted for participation. Radial artery Doppler ultrasound studies were performed and compared to those done at the time of their sympathectomy. Of 11 patients treated over a 9-year period, only two patients were available for detailed follow-up analysis. Four patients were deceased, and two were lost to follow-up. Four of the five remaining patients reported excellent use of the hand and no significant episodes of digital ischemia. Of the two patients studied, functional results were favorable and pain was markedly improved despite worsening of the digital flow resistance over time. We conclude that peripheral digital sympathectomy may provide favorable long-term results in patients with digital ischemia from autoimmune causes, although this intervention should be considered in the early stages once ischemic symptoms manifest. Interestingly, Doppler data did not appear to correlate with functional status and symptom severity in these two patients. Further research, particularly prospective studies, is warranted to guide clinical decisions in this patient population.

Judgments of Meaning in Life, Religious Beliefs, and the Experience of Cognitive (Dis)Fluency.

The primary aim of the current studies was to test whether religiousness interacted with self-reported levels of meaning in life (MIL) to predict the ease or difficulty in judging one's MIL, the search for meaning itself, and religious doubt. Undergraduate students in Study 1 (N = 111) and adult participants recruited online in Study 2 (N = 206) completed measures of religious beliefs, MIL, cognitive fluency related to MIL, and related variables. Study 3 merged these data sets. In Study 4 (N = 255), online participants completed measures of religious beliefs, cognitive fluency related to religious beliefs, and MIL. Studies 1 and 2 showed that highly religious people with lower MIL reported greater difficulty making their MIL judgments than other people. Study 3 showed that they were also more likely to search for MIL and that disfluency mediated this effect. Study 4 demonstrated that they also reported more difficult judgments of religious beliefs and more religious doubts than their religious peers with high MIL. The current studies demonstrate that the experience of ease or difficulty associated with MIL judgments represents an important yet largely unexamined aspect of MIL. Our findings have implications for understanding the cognitive mechanisms underlying responses to meaning threats.

Experiencing versus contemplating: Language use during descriptions of awe and wonder.

Awe and wonder are theorised to be distinct from other positive emotions, such as happiness. Yet little empirical or theoretical work has focused on these emotions. This investigation explored differences in language used to describe experiences of awe and wonder. Such analyses can provide insight into how people conceptualise these emotional experiences, and whether they conceptualise these emotions to be distinct from other positive emotions, and each other. Participants wrote narratives about experiences of awe, wonder and happiness. There were differences in the language used to describe these positive emotional states, consistent with the theorised functions of each emotion. Awe was related to observing the world, reflected in greater use of perception words. Wonder was related to trying to understand the world, reflected in greater use of cognitive complexity and tentative words. Language use for both emotions reflected an environmental focus, whereas language use for happiness reflected a social/relationship focus.

Novel PSTPIP1 gene mutation in a patient with pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome.

INTRODUCTION: Pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome is a rare autosomal dominant disease that usually presents in childhood with recurrent sterile arthritis. As the child ages into puberty, cutaneous features develop and arthritis subsides. We report the case of a now 25-year-old male patient with PAPA syndrome with the E250K mutation in PSTPIP1. We also present a systematic literature review of other PAPA cases. METHOD: We conducted a literature search of PubMed using the following search terms: E250K mutation, PSTPIP1, and PAPA. RESULTS: PAPA syndrome is caused by mutations on chromosome 15q affecting the proline-serine-threonine phosphatase-interacting protein 1 (PSTPIP1) gene, also known as CD2-binding protein 1 (CD2BP1). The reported cases of PAPA syndrome currently in the literature involve mutations in A230T and E250Q. One case of a novel E250K mutation has been reported, which presented with a different phenotype to previously described cases of PAPA syndrome. CONCLUSION: With variation present between disease presentations from case to case, it is possible that the spectrum of PAPA syndrome is wider than currently thought. Further research is needed which may uncover an as-yet undiscovered genetic abnormality linking these interrelated diseases together.

Heavy drinking, impulsivity and attentional narrowing following alcohol cue exposure.

RATIONALE: Research shows that alcohol-related stimuli have the propensity to capture attention among individuals motivated to consume alcohol. Research has further demonstrated that impulsive individuals are especially prone to this type of attentional bias. Recently, it is suggested that alcohol cue exposure can also produce a general narrowing of attention consistent with the activation of approach motivational states. OBJECTIVE: Based on previous models of addiction and recent research on the activation of approach motivational states, we predicted that impulsive individuals would demonstrate a constriction of attentional focus in response to alcohol cue exposure. METHODS: Participants (n = 392) completed a task assessing attentional breadth in response to alcohol and non-alcohol cues, followed by measures of alcohol use and impulsivity. RESULTS: The findings revealed that impulsivity scores predicted narrowing of attentional scope following the presentation of alcohol cues for heavier drinkers but not for light drinkers. CONCLUSION: These results suggest that impulsive individuals who drink more heavily demonstrate a narrowing of attention in the presence of alcohol-related incentive cues. Implications for how these findings might account for the link between impulsivity and alcohol use and misuse are discussed.

Maintaining hope at the 11th hour: authenticity buffers the effect of limited time perspective on hope.

Four studies tested the hypothesis that limited time perceptions are associated with lower levels of hope, and that this effect is buffered by high levels of authenticity. Study 1 (n = 256) utilized a cross-sectional design in which participants completed dispositional measures of time perspective, hope, and authenticity. Three subsequent studies tested our hypothesis experimentally. In a pilot study (n = 124), participants reported their perceived authenticity, future time perspective (FTP) was manipulated (limited vs. open-ended), and state hope was assessed. Study 2 (n = 156) introduced a new manipulation of FTP, and Study 3 (n = 242) replicated Study 2 with the addition of a neutral control condition. Across all studies, individuals who perceived time as limited reported lower levels of hope relative to those who perceived time as open-ended (or those in a neutral control condition), but, importantly, this effect was attenuated for highly authentic individuals.

The dynamic interplay between perceived true self-knowledge and decision satisfaction.

The present research used multiple methods to examine the hypothesis that perceived true self-knowledge and decision satisfaction are inextricably linked together by a widely held "true-self-as-guide" lay theory of decision making. Consistent with this proposition, Study 1 found that participants rated using the true self as a guide as more important for achieving personal satisfaction than a variety of other potential decision-making strategies. After establishing the prevalence of this lay theory, the remaining studies then focused on examining the proposed consequent relationship between perceived true self-knowledge and decision satisfaction. Consistent with hypotheses, 2 cross-sectional correlational studies (Studies 2 and 3) found a positive relationship between perceived true self-knowledge and decision satisfaction for different types of major decisions. Study 4 used daily diary methods to demonstrate that fluctuations in perceived true self-knowledge reliably covary with fluctuations in decision satisfaction. Finally, 2 studies directly examined the causal direction of this relationship through experimental manipulation and revealed that the relationship is truly bidirectional. More specifically, Study 5 showed that manipulating perceived knowledge of the true self (but not other self-concepts) directly affects decision satisfaction. Study 6 showed that this effect also works in reverse by manipulating feelings of decision satisfaction, which directly affected perceived knowledge of the true self (but not other self-concepts). Taken together, these studies suggest that people believe the true self should be used as a guide when making major life decisions and that this belief has observable consequences for the self and decision making.

Interactive effects of approach motivational intensity and alcohol cues on the scope of perceptual attention.

AIMS: Many theoretical perspectives suggest that alcohol-related stimuli bear on attentional processes. Building upon these ideas and recent advances regarding the attention-constricting impact of approach motivational states, we predicted that mere exposure to alcohol-related images would suffice to reduce the breadth of attention among individuals who possessed a strong motivation to consume alcohol. DESIGN: Two studies exposed participants to alcohol and neutral cues prior to assessing attention structure. In both studies, measures of alcohol use, negative alcohol expectancies, trait approach motivation and alcohol-related approach motivation were assessed. SETTING AND PARTICIPANTS: Study 1 comprised 102 undergraduates and study 2 comprised 161 undergraduates. Studies were conducted at Texas A&M University, College Station, Texas. MEASUREMENTS: In both studies, participants were briefly exposed to pictures of various stimuli (alcohol versus neutral pictures). After each picture was displayed, participants completed a trial assessing attentional focus. FINDINGS: After controlling for relevant covariates, both studies demonstrated that exposure to alcohol-related pictures led to a narrowing of attentional focus among individuals who possessed a strong motivation to use alcohol. Exposure to neutral pictures, however, did not interact with alcohol-related motivation to influence attentional focus. CONCLUSIONS: Alcohol cues narrow attentional breadth for individuals who are motivated to consume alcohol, suggesting a non-pharmacological means in which alcohol produces a narrow mindset. Alcohol cues may contribute to cognitive and behavioral deficits, as well as drinking behaviors, in part, because they lead to the inability to process a broad range of information in the environment.

Positive affect, meaning in life, and future time perspective: an application of socioemotional selectivity theory.

Four studies tested the prediction that positive affect (PA) would relate more strongly to meaning in life (MIL) as a function of perceived time limitations. In Study 1 (N = 360), adults completed measures of PA and MIL. As predicted, PA related more strongly to MIL for older, compared to younger, participants. In Studies 2 and 3, adults (N = 514) indicated their current position in their life span, and rated their MIL. PA, whether naturally occurring (Study 2) or induced (Study 3), was a stronger predictor of MIL for individuals who perceived themselves as having a limited amount of time left to live. Finally, in Study 4 (N = 98) students completed a measure of PA, MIL, and future time perspective (FTP). Results showed that PA was more strongly linked to MIL for those who believed they had fewer opportunities left to pursue their goals. Overall, these findings suggest that the experience of PA becomes increasingly associated with the experience of MIL as the perception of future time becomes limited. The contribution of age related processes to judgments of well-being are discussed.

Vitamin deficiency after gastric bypass surgery: a review.

More than 60% of the adult US population now meets the criteria for being overweight or obese. Gastric bypass surgery has become a popular and effective way to combat this medical problem. Despite the success of these procedures, they are associated with many complications, including malnutrition, neurological compromise, and vitamin deficiency. Research has determined that even with multivitamin supplementation for life, a large percentage of bypass patients develop vitamin deficiencies. We present a case of beriberi after Roux-en-Y bypass that illustrates the importance of close follow up. A thorough review of vitamin deficiencies in this unique patient population is explored. Vitamin supplementation and treatment recommendations are compiled from the most up-to-date sources. Even patients on regular supplements should be closely monitored for vitamin deficiencies. Patient education regarding vitamin supplementation is vital; it should begin prior to surgery and continue throughout the postoperative period and beyond.

Analysis of hydrazine in drinking water by isotope dilution gas chromatography/tandem mass spectrometry with derivatization and liquid-liquid extraction.

A new isotope dilution gas chromatography/chemical ionization/tandem mass spectrometric method was developed for the analysis of carcinogenic hydrazine in drinking water. The sample preparation was performed by using the optimized derivatization and multiple liquid-liquid extraction techniques. Using the direct aqueous-phase derivatization with acetone, hydrazine and isotopically labeled hydrazine-(15)N2 used as the surrogate standard formed acetone azine and acetone azine-(15)N2, respectively. These derivatives were then extracted with dichloromethane. Prior to analysis using methanol as the chemical ionization reagent gas, the extract was dried with anhydrous sodium sulfate, concentrated through evaporation, and then fortified with isotopically labeled N-nitrosodimethylamine-d6 used as the internal standard to quantify the extracted acetone azine-(15)N2. The extracted acetone azine was quantified against the extracted acetone azine-(15)N2. The isotope dilution standard calibration curve resulted in a linear regression correlation coefficient (R) of 0.999. The obtained method detection limit was 0.70 ng/L for hydrazine in reagent water samples, fortified at a concentration of 1.0 ng/L. For reagent water samples fortified at a concentration of 20.0 ng/L, the mean recoveries were 102% with a relative standard deviation of 13.7% for hydrazine and 106% with a relative standard deviation of 12.5% for hydrazine-(15)N2. Hydrazine at 0.5-2.6 ng/L was detected in 7 out of 13 chloraminated drinking water samples but was not detected in the rest of the chloraminated drinking water samples and the studied chlorinated drinking water sample.

Otolaryngology residency training: resurgence of the specialty.

Five decades ago, otolaryngology dealt primarily with infectious diseases of the head and neck. The quality of otolaryngology residency training programs was inconsistent and mostly determined by the institution and local faculty. The specialty flourished by developing new expertise in all facets of head and neck medicine and surgery through the leadership of outstanding clinicians and scientists in private practice and universities. Otolaryngology programs subsequently grew from weak divisions within a department of surgery with few faculty members to departments of otolaryngology with full-time, mostly fellowship-trained faculty. Teaching shifted from resident-to-resident to faculty teaching. Organized medicine encouraged systematic quality improvement and periodic review of programs for accreditation. Residencies were also bolstered through Medicare, Medicaid, and Veterans Administration hospitals, which provided funds for growth but limited flexibility of the faculty schedules. The American Academy of Otolaryngology/Head and Neck Surgery shouldered an enormous load of teaching and maintaining unity of the specialty from its birth to the present.

Inverse correlation of each functional status scale of the SF-36 with degree of disease activity in systemic lupus erythematosus (m-SLAM).

OBJECTIVES: To compare systemic lupus erythematosus (SLE) disease activity measured by a modified Systemic Lupus Activity Measure (m-SLAM) with functional/health status measured by the SF-36 questionnaire. PATIENTS AND METHODS: m-SLAM and SF-36 scores were obtained on 71 SLE patients during 242 clinic visits over 15 months. Patients were stratified into disease activity groups (m-SLAM <2 = remission; 2-4 = mild; 4-6 = moderate; >6 = severe). Mean SF-36 group scores were compared by analysis of variance (ANOVA). RESULTS: Two hundred and nineteen m-SLAM and SF-36 scores were completed. The disease activity groups correlated inversely with the SF-36 scores in all eight subscales, i.e. the patients' perceived health, as assessed by the SF-36, correlated with their disease activity level as measured by the m-SLAM. Inverse correlation of SLAM activity groups with all eight SF-36 subscales was highly statistically significant. CONCLUSION: The significant inverse correlation of the m-SLAM with all domains of the SF-36 in this study provides potentially useful information for evaluating patients with SLE.