Virtual Reality Exposure Simulation for Student Veteran Social Anxiety and PTSD: A Case Study.

Exposure based exercises are a common element of many gold standard treatments for anxiety disorders and post-traumatic stress disorder and virtual reality simulations have been evaluated as a platform for providing clients with opportunities for repeated exposure during treatment. Although research on virtual reality exposure therapy (VRET) indicates effectiveness and high levels of user satisfaction, VRETs require a participant to complete exposure exercises in-offices with specialized equipment. The current exploratory case method study evaluates the experience and outcomes of one student veteran with social anxiety disorder and PTSD completing twelve sessions of VRET exposure using a mobile phone simulation of a virtual grocery store. The participant reported decreases in psychological symptoms, improvements in neurological connectivity, and better sleep quality upon completing the trial. Results suggest that VRET using a mobile application is feasible and warrants further research to evaluate effectiveness more fully. Implications include the use of a mobile based virtual reality simulation for intervening in social anxiety for student veterans.

Development of a Pulmonary Workshop for Organ Recovery Coordinators' Continuing Medical Education.

Organ recovery coordinators (ORCs) have varied professional education backgrounds; however, based on their specialized education, their training may not have included in-depth mechanical ventilation and pulmonary management. An 8-hour pulmonary workshop was developed in collaboration between an organ procurement organization and a university-based respiratory care department. The workshop focused on pulmonary management and hands-on laboratory exercises using mechanical ventilators. A program assessment questionnaire was completed by participants following the workshop, which requested their self-reported comfort/familiarity with pulmonary management skills before and after the workshop on a 5-point Likert scale. Following the pulmonary workshop, the mean ORC comfort/familiarity for all pulmonary management skills increased significantly (P < .01). This program suggests ORCs can develop a greater awareness and comfort with pulmonary management by participating in a continuing education pulmonary workshop. Continuing education initiatives focused on pulmonary management of donor patients using hands-on competencies should be part of the ORCs practice improvement efforts.

High-frequency oscillatory ventilation: A narrative review.

High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV is often utilized as a rescue strategy when conventional mechanical ventilation (CV) has failed. HFOV uses low tidal volumes and constant mean airway pressures in conjunction with high respiratory rates to provide beneficial effects on oxygenation and ventilation, while eliminating the traumatic "inflate-deflate" cycle imposed by CV. Although statistical evidence supporting HFOV is particularly low, potential benefits for its application in many clinical manifestations still remain. High-frequency oscillation is a safe and effective rescue mode of ventilation for the treatment of acute respiratory distress syndrome (ARDS). All patients who have ventilator-induced lung injury (VILI) or are at risk of developing VILI or ARDS would be suitable candidates for HFOV, especially those who have failed conventional mechanical ventilation. This narrative aims to provide a review of HFOV vis-à-vis its indications, contraindications, hazards, parameters to monitoring, patient selection, clinical goals, mechanisms of action, controls for optimizing ventilation and oxygenation, clinical application in ARDS, and a comparison with other modes of mechanical ventilation.

Análise da patogênese da doença de Alzheimer: revisão narrativa da literatura / Analysis of Alzheimer's disease pathogenesis: narrative literature review

Introdução: A patogênese de doenças neurodegenerativas, como a doença de Alzheimer (DA), têm sido cada vez mais objeto de estudo em inúmeras pesquisas científicas. Objetivo: A presente revisão narrativa teve por objetivo descrever a contribuição de fatores como o estresse oxidativo e o processo de netose para a patogênese de doenças neurodegenerativas, como a DA. Material e Métodos: Realizou-se revisão de literatura de forma não sistemática nos bancos de dados das plataformas PubMed e Scielo com os seguintes descritores: Alzheimer + oxidative stress, Alzheimer + netosis e Alzheimer + inflammation, em periódicos nacionais e internacionais de 2000 a 2018. Ao final da seleção foram utilizados 26 artigos nesta revisão. Resultados: Diversos estudos demostraram importantes componentes ligados à neuroinflamação como peças-chave para o entendimento do acometimento neurológico causado pela DA, tais como, o estresse oxidativo, respostas inflamatórias por parte de neutrófilos e da micróglia, alterações vasculares e da barreira hematoencefálica. Conclusão: Em função de tais descobertas, faz-se necessário a continuidade e o avanço no entendimento da fisiopatologia da DA bem como da busca por eficazes abordagens terapêuticas para esta doença.

Introduction: The pathogenesis of neurodegenerative diseases, such as Alzheimer's disease (AD), has been increasingly studied in numerous scientific studies. Objective: The purpose of this review was to describe the contribution of factors such as oxidative stress and the netosis process for the pathogenesis of neurodegenerative diseases such as AD. Material and Methods: A non-systematic bibliographic review was carried out in the databases PubMed and Scielo with the following descriptors: Alzheimer + oxidative stress, Alzheimer + netosis and Alzheimer + inflammation, in national and international scientific journals from 2000 to 2018. At the end of the selection 26 articles were used in this review. Results: Several studies have demonstrated important components linked to neuroinflammation as key components for the understanding of neurological involvement caused by AD, such as oxidative stress, neutrophil and microglial inflammatory responses, vascular and blood-brain barrier changes. Conclusion: Due to these findings, it is necessary to continue and advance the understanding of the pathophysiology of AD as well as the search for effective therapeutic approaches for this disease.