Implications for a mindfulness-enhanced positive affect induction: A brief commentary toward acute pain management.

Over the past decade research has increased on dynamics between mindfulness, positive affect, and pain. While there have been studies examining the direct use of positive psychology for pain management, few have examined the use of a specific mindfulness-enhanced positive affect induction (i.e. a singular brief technique engendering mindfulness and strong positive affect) toward acute pain and pain flare management. This topical commentary discusses the need for such a technique toward bolstered gold-standard interventions, related studies, and possible future directions for acute and post-surgical pain management. Future research is encouraged to build from prior research on loving-kindness meditation and examine novel, brief mindfulness-enhanced positive affect inductions for acute pain management.

Changes in Proportions of Emergency Department Patients with Mental Illness Noted in the National Hospital Ambulatory Medical Care Survey, 2012-2015.

OBJECTIVES: The primary objective of this study was to determine whether there was a change in the rate and types of patients with psychiatric illnesses being seen in the emergency department (ED) from 2012 to 2015 using the National Ambulatory Care Survey. A secondary objective was to determine what if any changes occurred in the resources available to care for these patients. METHODS: Our study used 2012-2015 data from the National Hospital Ambulatory Medical Care Survey and the State Mental Health Agency Per Capita Mental Health Services Expenditures, and expenditures data from 2012-2015 to examine whether there was a significant change in the rate and type of mental illness ED visits. Additional data on the number of beds per region from the National Mental Health Services Survey, 2012-2015 were used. A t test was used to look for significant (P = 0.05) changes in the rate and types of patients, ED dispositions, ED reimbursement types, region and community level income, sex, age, state mental health funding, and psychiatric beds from 2012 to 2015. RESULTS: There was an 8% increase in the rate of patients who presented with a diagnosed mental health disorder (P = 0.03, 95% confidence interval [CI] 5.32-5.96) and substance use disorders (P = 0.03, 95% CI 0.564-0.122). The reimbursement for these visits did change (P = 0.01, 95% CI 0.245-0.685); however, there was no significant increase (P = 0.07, 95% CI-214 to 101) in state mental health budgets and the number of psychiatric and detox hospital beds from 2012 to 2015. CONCLUSIONS: The rate and types of mental health patients coming to the ED are still on the rise. This is coupled with a lack of mental health infrastructure to address the needs and diagnoses that continue to be seen in the ED. States may need increased, targeted funding for mental health outside the increase in coverage via the Patient Protection and Affordable Care Act to slow the rate of mental health patients seen in the ED.

Comparison of Self-Administered Post Traumatic Stress Disorder Tool vs. Researcher Administered Tool in the Emergency Department.

BACKGROUND: Recent studies have shown that there is a high rate of post traumatic stress disorder in the inner city. OBJECTIVE: The purpose of this study was to determine whether patients in the Emergency Department would use a post traumatic stress disorder (PTSD) assessment. Additionally, did the type of administration of the PTSD tool impact the usage of PTSD services? METHODS: The sample population was taken from patients, 12 years or older, who presented with a non psychiatric illness. This study was done at a level one inner city adult and pediatric Emergency Department. The PTSD validated survey, was randomized between being self or research fellow administered. Half of the patients completed the survey on their own and half were administered by a research fellow. Those who screen positive on the tool were contacted one week later. This was done to determine if they have scheduled an appointment or were seen for a follow-up appointment. This study was IRB approved. RESULTS: A total of 299 participants completed the survey. Half (149) of which used a PTSD tool that was self administered. The total amount of participants who tested positive for PTSD was 35% (105). There was a significant difference (0.01) between those who self administered the tool 26% (40) and those who had the tool administered 12% (18). This was seen in relationship to who was more likely to follow up with behavioral health referrals. CONCLUSIONS: These results reveal that 35% of the participants tested positive for PTSD. The majority of those that screened positive and used follow up services had self administered the tool. This indicates that they are more likely to seek out services based on their results.

N-glycosylation bidirectionally extends the boundaries of thymocyte positive selection by decoupling Lck from Ca²âº signaling.

Positive selection of diverse yet self-tolerant thymocytes is vital to immunity and requires a limited degree of T cell antigen receptor (TCR) signaling in response to self peptide-major histocompatibility complexes (self peptide-MHCs). Affinity of newly generated TCR for peptide-MHC primarily sets the boundaries for positive selection. We report that N-glycan branching of TCR and the CD4 and CD8 coreceptors separately altered the upper and lower affinity boundaries from which interactions between peptide-MHC and TCR positively select T cells. During thymocyte development, N-glycan branching varied approximately 15-fold. N-glycan branching was required for positive selection and decoupled Lck signaling from TCR-driven Ca(2+) flux to simultaneously promote low-affinity peptide-MHC responses while inhibiting high-affinity ones. Therefore, N-glycan branching imposes a sliding scale on interactions between peptide-MHC and TCR that bidirectionally expands the affinity range for positive selection.

Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants.

PURPOSE: In 2002, we reported our preliminary experience using the ketogenic diet (KD) for predominantly intractable infantile spasms (IS) in 23 infants. Since that time, we have increased our use of the KD for this condition including those with new-onset IS. METHODS: Infants were referred and prospectively started on the traditional KD from 1996 to 2009 at our institution. Included subjects had documented clinical IS, hypsarrhythmia on electroencephalography (EEG), and parental consent to start the KD. Efficacy was assessed through phone communication, clinic visits, and EEG every 3 months. RESULTS: One hundred four infants, mean age 1.2 years, were started on the KD for IS, of which 74 (71%) had a symptomatic etiology. Previous therapy for this patients included a mean of 3.6 anticonvulsants; 71% including corticosteroids or vigabatrin. Using an intent-to-treat analysis, > 50% spasm improvement occurred in 64% at 6 months and 77% after 1-2 years. Thirty-eight (37%) became spasm-free for at least a 6-month period within a median 2.4 months of starting the KD. In addition, 62% reported improvement in development, 35% had EEG improvement, and 29% were able to reduce concurrent anticonvulsants. Adverse effects were noted in 33%, of which 6% had diminished linear growth. Older age at onset of IS and fewer prior anticonvulsants were more likely to be associated with > 90% spasm improvement at 6 months. DISCUSSION: The KD is an efficacious therapy for IS in approximately two-thirds of patients treated, and it should be considered strongly after failure of corticosteroids and vigabatrin.

Human tumor p53 mutations are selected for in mouse embryonic fibroblasts harboring a humanized p53 gene.

To date, there has been no way to examine induced human p53 gene mutations in cell cultures exposed to mutagenic factors, other than by restriction site analysis. Here, we used embryonic cells from our Hupki (human p53 knock-in) mouse strain to generate human p53 DNA-binding domain (DBD) mutations experimentally. Twenty cultures of untreated primary mouse Hupki fibroblasts and 20 short-wavelength UV light (UVC)-treated cultures (20J/m(2)) were passaged >20 times. Established Hupki embryonic fibroblast cell lines (HUFs) were genotyped by dideoxy DNA sequencing of p53 exons 4-9. Seven of the HUFs harbored point mutations in the humanized p53 DBD. Of the 9 mutations (6 single- and 1 triple-site mutation), 2 were at the most frequently mutated codons in human cancers (c.248 and c.273). The Affymetrix p53 GeneChip assay also readily identified the 6 single-base substitutions. All mutations in HUFs from UV-treated cultures were at dipyrimidine sites, including 3 nontranscribed strand C -->T transitions. The mutant HUFs were deficient in p53 transactivation function, and missense mutants had high levels of nuclear p53 protein. In a second experiment, primary Hupki cells were exposed to the carcinogen aristolochic acid I (AAI). Five of 10 cultures that became established within 2 months harbored p53 DBD mutations. All were transversions, including 4 A --> T substitutions on the nontranscribed strand, a hallmark of DNA mutation by AAI. We conclude that establishment of Hupki mouse fibroblasts in culture readily selects for p53 DBD mutations found in human tumors, providing a basis for generating experimental mutation patterns in human p53.