The role of extended reality in optometry education: a narrative review.

The evolution of digitally based pedagogies, such as extended reality (XR) - a group of simulated learning environments that include virtual simulation, virtual reality, and augmented reality - has prompted optometry educators to seek evidence to guide the implementation of these teaching and learning activities within their curricula. Looking more broadly across the medical and allied health fields, there is a wealth of evidence to guide the incorporation of XR, as it is increasingly being integrated into the curricula of other select health professions disciplines. Educators from these disciplines continue to explore and embed XR in practice. This narrative review summarises the findings and appraises the literature on the use of XR in optometry education. It identifies the learning domains in which XR has been implemented in optometry education and proposes areas for further investigation. The review questions the technology-focused approach that has driven the literature within the review and calls for richer pedagogical foundations with suggestions for future research agendas. As such, this narrative review provides optometry educators with new ways of understanding XR and its relationship with the curriculum.

Cardiovascular and renal profiles in rat offspring that do not undergo catch-up growth after exposure to maternal protein restriction.

Maternal protein restriction is often associated with structural and functional sequelae in offspring, particularly affecting growth and renal-cardiovascular function. However, there is little understanding as to whether hypertension and kidney disease occur because of a primary nephron deficit or whether controlling postnatal growth can result in normal renal-cardiovascular phenotypes. To investigate this, female Sprague-Dawley rats were fed either a low-protein (LP, 8.4% protein) or normal-protein (NP, 19.4% protein) diet prior to mating and until offspring were weaned at postnatal day (PN) 21. Offspring were then fed a non 'growth' (4.6% fat) which ensured that catch-up growth did not occur. Offspring growth was determined by weight and dual energy X-ray absorptiometry. Nephron number was determined at PN21 using the disector-fractionator method. Kidney function was measured at PN180 and PN360 using clearance methods. Blood pressure was measured at PN360 using radio-telemetry. Body weight was similar at PN1, but by PN21 LP offspring were 39% smaller than controls (Pdiet < 0.001). This difference was due to proportional changes in lean muscle, fat, and bone content. LP offspring remained smaller than NP offspring until PN360. In LP offspring, nephron number was 26% less in males and 17% less in females, than NP controls (Pdiet < 0.0004). Kidney function was similar across dietary groups and sexes at PN180 and PN360. Blood pressure was similar in LP and NP offspring at PN360. These findings suggest that remaining on a slow growth trajectory after exposure to a suboptimal intrauterine environment does not lead to the development of kidney dysfunction and hypertension.

Supervisor experiences of extended clinical placements in optometry: a mixed methods study.

BACKGROUND: In Australia, optometry students have traditionally undertaken their clinical training in short-block rotations at University-led teaching clinics in metropolitan locations. Demand for clinical placements is growing as the number of optometry students steadily increases. As such, universities and clinical education providers must look for more diverse methods of student placement. Extended clinical placements in community-based settings are one alternative: a model similar to the longitudinal clerkships in medicine. This study aimed to explore the experience of extended clinical placements from the perspective of the optometrists who supervised students. It also sought to determine whether there were differences in views between metropolitan and rural practitioners. METHODS: This mixed methods study included a survey and interviews with optometrists who had previously supervised Deakin University optometry students on an extended 26-week (2 x 13-weeks) clinical placement. Lines of enquiry focused on; the benefits and challenges associated with extended placements; areas for improvement; duration of the placement; and willingness to supervise further students. Interviews were transcribed verbatim and analysed using Braun and Clarke's 6 step method of thematic analysis with a qualitative descriptive approach. RESULTS: Supervisors felt that hosting a student prompted greater reflective practice and critical appraisal of clinical decisions. The extended nature of the placement was thought to foster greater immersion in the clinical setting and community for the students and establish a stronger relationship between supervisor and student. Supervisors recognised the importance of role-modelling and mentoring the next generation of optometrists however noted that taking on a student was a sizeable commitment. Willingness to host a student was not dependent on the supervisor's location (rural vs metropolitan) p = 0.57. However, interviews uncovered motivations that were unique to supervisors residing in rural locations, such as succession planning. CONCLUSION: Overall, supervisors were positive about the value of student extended clinical placement in optometry and felt that it was a fulfilling and professionally beneficial experience. Lack of time and financial remuneration were the key downsides highlighted. Schools of optometry might carefully consider engaging in discussion about the duration of such placements, but 26 weeks was considered appropriate by supervisors.

The perceived value and impact of virtual simulation-based education on students' learning: a mixed methods study.

BACKGROUND: Virtual simulations are used throughout healthcare training programs to enable development of clinical skills, however the potential for virtual simulation to enhance cognitive and affective skills is less well understood. This study explored pre-clinical optometry students' perceptions of the impact of virtual simulation on the development of core competency skills including patient-centred care, communication, scientific literacy, and evidence-based practice. METHODS: A mixed methods study was conducted using pre-existing anonymized data from an electronic survey distributed to pre-clinical optometry students enrolled in the double degree Bachelor of Vision Science/Master of Optometry at Deakin University, Australia. The data were interpreted using descriptive statistics and qualitative analysis using constant comparison for thematic analysis. RESULTS: A total of 51 responses were analyzed. Students reported that virtual simulation motivated them to become an optometrist (93%) and to learn beyond the course material (77%). Students reported that after participating in the virtual simulation, their core competency skills improved: patient-centered care (100%) evidence-based practice (93%) and clinical reasoning (93%). The themes identified through qualitative analysis were: enablers to cognitive experience in virtual simulation in optometry education, realism of the virtual simulation design, dimensions of fidelity in virtual simulations design replicated the complexity of the optometric environment, virtual simulation as an enabler for learning and assessment in optometry education, a place to develop cognitive and affective skills and application of learning in the virtual simulation developed an appreciation of future roles and professional identity. CONCLUSION: Optometry students perceived virtual simulation in optometric education as a valuable training and assessment strategy enabled by qualities that generate contextual, cognitive, functional, task and psychological fidelity. The data provide insight to inform how optometry educators can incorporate simulation into the curriculum.

Student perspectives of extended clinical placements in optometry: a qualitative study.

BACKGROUND: The number of students enrolled in health courses at Australian universities is rising, increasing demand for clinical placements. Optometry students have historically undertaken clinical training in short-block rotations at university-led teaching clinics in metropolitan locations. This is changing, with some optometry programs adopting extended placements. These placements are conducted in community-based practices, with many incorporating a rural component to the training. This study explored factors which influence placement success and satisfaction from the perspective of optometry students. METHODS: Nine focus groups were undertaken with 42 final year optometry students upon completion of a 26-week placement (of which at least half was undertaken in a non-metropolitan area, or area where a shortage of optometrists has been identified). Focus groups were audio recorded and transcribed verbatim. Thematic analysis was conducted according to Braun and Clarke's 6 step method. RESULTS: Four key themes were identified during analysis. 'Changing identity', related to how the students grew both personally and professionally, with the extended placement being considered the vital component that allowed students to begin thinking of themselves as clinicians. The theme 'Dealing with complex dynamics and circumstances' predominantly described instances where the student-supervisor relationship was strained, resulting in high levels of anxiety made worse by a perceived lack of university support. 'Optometrist under instruction', related to students feeling that the placement was an ideal opportunity to trial the everyday reality of work without the obligation of an ongoing commitment or employment contract. Finally, the theme 'Rural practice is more rewarding', was about a chance to seek different experiences, meet new people and challenge themselves professionally. CONCLUSION: While the majority of students enjoyed their placement and felt that it was the key component of their training that equipped them for future practice, it is clear that universities and placement providers must provide both students and supervisors thorough and explicit guidance covering placement expectations. Furthermore, student support systems should be embedded into placement programs to ensure where issues arise, they are dealt with promptly and successfully. It is vital that ongoing professional development and pedagogical training for supervisors underpins continued accreditation.

Feasibility of Imported Self-Management Program for Elderly People with Chronic Pain: A Single-Arm Confirmatory Trial.

INTRODUCTION: Multidisciplinary pain management programs incorporating a cognitive-behavioral therapy (CBT) approach have been reported to be helpful for elderly people with chronic pain. However, it is unclear whether the same program for elderly people with chronic pain would translate to different cultures. This study investigated whether a multidisciplinary program based on that of Nicholas et al. (Pain 154(6):824-835, 2013) in Australia would be effective for elderly people with chronic pain in Japan. METHODS: Twenty-seven community-dwelling elderly people with chronic pain were enrolled to confirm changes (effect size d = 0.5) in pain disability, which were previously reported by Nicholas et al. The multidisciplinary program consisted of eight sessions (2 sessions a week for 4 weeks). Pain disability was assessed using the Pain Disability Assessment Scale (PDAS) as the primary outcome at the baseline, the beginning and the end of the program, and the 1- and 3-month (final) follow-up. We also assessed the pain severity, catastrophizing, pain self-efficacy, and physical function with the Timed Up and Go test (TUG) and the two-step test as secondary outcomes. RESULTS: PDAS, pain catastrophizing, and pain self-efficacy were significantly improved immediately after the program compared with baseline, and these effects were maintained at 3-month follow-up. The effect size (d) for the PDAS score was a medium size (0.54) from baseline to 3-month follow-up. Those who showed improvements in TUG immediately after the program tended to report improved psychometric measures at 3-month follow-up. CONCLUSION: These results suggest that the Japanese multidisciplinary program has a similar effect on pain disability as that reported by Nicholas et al. This finding has important implications for the development of pain services in community-dwelling elderly Japanese.

Analysis of structure and gene expression in developing kidneys of male and female rats exposed to low protein diets in utero.

A maternal low protein (LP) diet in rodents often results in low nephron endowment and renal pathophysiology in adult life, with outcomes often differing between male and female offspring. Precisely how a maternal LP diet results in low nephron endowment is unknown. We conducted morphological and molecular studies of branching morphogenesis and nephrogenesis to identify mechanisms and timepoints that might give rise to low nephron endowment. Sprague-Dawley rats were fed a normal protein (19.4% protein, NP) or LP (9% protein) diet for 3 weeks prior to mating and throughout gestation. Embryonic day 14.25 (E14.25) kidneys from males and females were either cultured for 2 days after which branching morphogenesis was quantified, or frozen for gene expression analysis. Real-time PCR was used to quantify expression of key nephrogenesis and branching morphogenesis genes at E14.25 and 17.25. At E17.25, nephron number was determined in fixed tissue. There was no effect of either maternal diet or sex on branching morphogenesis. Nephron number at E17.25 was 14% lower in male and female LP offspring than in NP controls. At E14.25 expression levels of genes involved in branching morphogenesis (Gfrα1, Bmp4, Gdnf) and nephrogenesis (Hnf4a, Pax2, Wnt4) were similar in the dietary groups, but significant differences between sexes were identified. At E17.25, expression of Gfrα1, Gdnf, Bmp4, Pax2 and Six2 was lower in LP offspring than NP offspring, in both male and female offspring. These findings provide new insights into how a LP diet leads to low nephron endowment and renal sexual dimorphism.

The Non-Avoidant Pacing Scale: Development and Preliminary Validation.

Despite widespread use as a chronic pain management strategy, pacing has been linked with higher levels of pain and disability. A recent meta-analysis found a positive correlation between existing measures of pacing and avoidance, which may partially account for these poorer outcomes. A measure was developed to differentiate pacing from avoidance by emphasizing non-pain-contingent pacing behaviors and nonavoidance of pain. A sample of 283 adults with chronic pain completed the Non-Avoidant Pacing Scale (NAPS) and existing measures of pacing, avoidance, pain, and physical and psychological functioning. Exploratory factor analysis of 10 items (subsample 1, n = 141) suggested two 4-item factors: planned pacing behaviors and pacing through flare ups. Confirmatory factor analysis of 8 items (subsample 2, n = 142) revealed satisfactory fit (goodness-of-fit index .947, comparative fit index .964). The pattern of correlations between each factor and avoidance and key outcomes suggests that the NAPS total scale (ɑ = .819) captures key pacing behaviors and differentiates pacing from avoidance. Unlike existing measures, the NAPS was not positively correlated with avoidance and was associated with better psychological functioning across affective and cognitive domains. The NAPS allows researchers and clinicians to assess the role of pacing in chronic pain management without artefactual overlap with avoidance. PERSPECTIVE: The NAPS assesses activity pacing in chronic pain without artefactual overlap with avoidance. Associations were found between more frequent pacing, as measured by the NAPS, and better psychological functioning. Clearly differentiating pacing from avoidance allows for accurate assessment of the role of pacing in chronic pain management.

3D MRI Modeling of Thin and Spatially Complex Soft Tissue Structures without Shrinkage: Lamprey Myosepta as an Example.

3D imaging techniques enable the nondestructive analysis and modeling of complex structures. Among these, MRI exhibits good soft tissue contrast, but is currently less commonly used for nonclinical research than X-ray CT, even though the latter requires contrast-staining that shrinks and distorts soft tissues. When the objective is the creation of a realistic and complete 3D model of soft tissue structures, MRI data are more demanding to acquire and visualize and require extensive post-processing because they comprise noncubic voxels with dimensions that represent a trade-off between tissue contrast and image resolution. Therefore, thin soft tissue structures with complex spatial configurations are not always visible in a single MRI dataset, so that standard segmentation techniques are not sufficient for their complete visualization. By using the example of the thin and spatially complex connective tissue myosepta in lampreys, we developed a workflow protocol for the selection of the appropriate parameters for the acquisition of MRI data and for the visualization and 3D modeling of soft tissue structures. This protocol includes a novel recursive segmentation technique for supplementing missing data in one dataset with data from another dataset to produce realistic and complete 3D models. Such 3D models are needed for the modeling of dynamic processes, such as the biomechanics of fish locomotion. However, our methodology is applicable to the visualization of any thin soft tissue structures with complex spatial configurations, such as fasciae, aponeuroses, and small blood vessels and nerves, for clinical research and the further exploration of tensegrity. Anat Rec, 301:1745-1763, 2018. © 2018 Wiley Periodicals, Inc.

Maternal high fat diet induces early cardiac hypertrophy and alters cardiac metabolism in Sprague Dawley rat offspring.

BACKGROUND AND AIM: Maternal high fat diets (mHFD) have been associated with an increased offspring cardiovascular risk. Recently we found that the class IIa HDAC-MEF2 pathway regulates gene programs controlling fatty acid oxidation in striated muscle. This same pathway controls hypertrophic responses in the heart. We hypothesized that mHFD is associated with activation of signal controlling class II a HDAC activity and activation of genes involved in fatty acid oxidation and cardiac hypertrophy in offspring. METHODS AND RESULTS: Female Sprague Dawley rats were fed either normal fat diet (12%) or high fat diet (43%) three weeks prior to mating, remaining on diets until study completion. Hearts of postnatal day 1 (PN1) and PN10 pups were collected. Bioenergetics and respiration analyses were performed in neonatal ventricular cardiomyocytes (NVCM). In offspring exposed to mHFD, body weight was increased at PN10 accompanied by increased body fat percentage and blood glucose. Heart weight and heart weight to body weight ratio were increased at PN1 and PN10, and were associated with elevated signalling through the AMPK-class IIa HDAC-MEF2 axis. The expression of the MEF2-regulated hypertrophic markers ANP and BNP were increased as were expression of genes involved in fatty acid oxidation. However this was only accompanied by an increased protein expression of fatty acid oxidation enzymes at PN10. NVCM isolated from these pups exhibited increased glycolysis and an impaired substrate flexibility. CONCLUSION: Combined, these results suggest that mHFD induces signalling and transcriptional events indicative of reprogrammed cardiac metabolism and of cardiac hypertrophy in Sprague Dawley rat offspring.

Mid-to-Late Gestational Changes in Inflammatory Gene Expression in the Rat Placenta.

BACKGROUND: The placenta plays an important role during pregnancy providing maternal blood supply from the uterus to the developing fetus. The structure and function of the placenta changes with gestation, as the fetus develops and its demands change. This study aims to elucidate changes in cytokine and chemokine gene expression throughout mid-to-late gestation in rat placenta. METHODS: Sprague Dawley rats were time-mated, and placentae were obtained from 6 pregnant dams at 4 different gestational periods: E14.25, E15.25, E17.25, and E20. Changes in placental gene expression were measured by microarray analysis. Differentially expressed inflammatory genes were functionally categorized by pathway analysis. To validate the microarray results, a subset of genes was analyzed by quantitative real-time polymerase chain reaction (qPCR) in a validation cohort of 22 rats. RESULTS: Changes in messenger RNA (mRNA) expression of various cytokines, chemokines, and genes of the tumor growth factor ß and tumor necrosis factor family were analyzed in rat placentae at E14.25, E15.25, E17.25, and E20. Forty-six genes were differentially expressed, and of these 21 genes had increased expression in late gestation (E20). The gestational age pattern of gene expression was confirmed by qPCR in the validation cohort. CONCLUSION: The observed acute, prelabor changes in the expression of these genes during gestation warrant further investigation to elucidate their role in pregnancy and parturition.

Impact of maternal high fat diet on hypothalamic transcriptome in neonatal Sprague Dawley rats.

Maternal consumption of a high fat diet during early development has been shown to impact the formation of hypothalamic neurocircuitry, thereby contributing to imbalances in appetite and energy homeostasis and increasing the risk of obesity in subsequent generations. Early in postnatal life, the neuronal projections responsible for energy homeostasis develop in response to appetite-related peptides such as leptin. To date, no study characterises the genome-wide transcriptional changes that occur in response to exposure to high fat diet during this critical window. We explored the effects of maternal high fat diet consumption on hypothalamic gene expression in Sprague Dawley rat offspring at postnatal day 10. RNA-sequencing enabled discovery of differentially expressed genes between offspring of dams fed a high fat diet and offspring of control diet fed dams. Female high fat diet offspring displayed altered expression of 86 genes (adjusted P-value<0.05), including genes coding for proteins of the extra cellular matrix, particularly Collagen 1a1 (Col1a1), Col1a2, Col3a1, and the imprinted Insulin-like growth factor 2 (Igf2) gene. Male high fat diet offspring showed significant changes in collagen genes (Col1a1 and Col3a1) and significant upregulation of two genes involved in regulation of dopamine availability in the brain, tyrosine hydroxylase (Th) and dopamine reuptake transporter Slc6a3 (also known as Dat1). Transcriptional changes were accompanied by increased body weight, body fat and body length in the high fat diet offspring, as well as altered blood glucose and plasma leptin. Transcriptional changes identified in the hypothalamus of offspring of high fat diet mothers could alter neuronal projection formation during early development leading to abnormalities in the neuronal circuitry controlling appetite in later life, hence priming offspring to the development of obesity.

The Relationship Between Pacing and Avoidance in Chronic Pain: A Systematic Review and Meta-Analysis.

Activity pacing is ubiquitous in chronic pain management and aims to reduce pain-contingent avoidance of activity to improve functioning. A meta-analysis, however, has linked pacing with higher levels of pain and disability. One potential explanation is an overlap between existing measures of pacing and avoidance, leading to links with poorer outcomes that are typically associated with avoidance. This study systematically reviews the evidence regarding the relationship between measures of pacing and avoidance. A search was conducted for studies measuring both constructs in adults with chronic pain. A meta-analysis of correlations between pacing and avoidance was conducted; 16 studies were included and a small positive correlation was found (r = .290, P < .001) overall. Single-item and multiple-item measures were also compared; a moderate positive correlation was found for multiple-item measures (r = .410, P < .001), which differed significantly from a small positive correlation found for single-item measures (r = .105, P < .001). Due to limited studies, independent analyses of individual subscales were not possible. Existing measures of pacing-particularly multiple-item measures-may partially confound pacing with avoidance. Further research is required to ensure that a reliable measure of pacing that distinguishes this construct from avoidance is available to adequately evaluate pacing instruction and the effect of pacing on key outcomes in chronic pain. PERSPECTIVE: This meta-analysis examines the correlation between pacing and avoidance in adults with chronic pain. Results indicate that existing measures may partially confound pacing with avoidance. Directions for future research are proposed to ensure that an adequate measure of pacing exists to evaluate its effect on key outcomes in chronic pain.

Clinical perineural invasion of the trigeminal and facial nerves in cutaneous head and neck squamous cell carcinoma: Outcomes and prognostic implications of multimodality and salvage treatment.

BACKGROUND: Clinical perineural invasion (PNI) of the trigeminal and facial nerves from cutaneous head and neck squamous cell carcinoma (cutaneous HNSCC) is a rare clinical entity that poses unique therapeutic challenges. METHODS: A retrospective chart review of a skull base oncology database was performed of patients with the diagnosis of clinical PNI from a cutaneous HNSCC. Patients who were previously untreated underwent multimodal treatment entailing surgical resection and postoperative radiotherapy (PORT) and patients who were previously treated with radiotherapy underwent salvage surgical resection between the years 2006 and 2012. Survival outcomes, such as disease-free survival (DFS) and overall survival (OS), were analyzed and correlated with surgical factors, such as margin status, previous treatment, zone involvement, and trigeminal involvement (branch-specific), as well as the pretreatment and posttreatment pain scores. RESULTS: Of 21 patients with clinical PNI from cutaneous HNSCC, 7 patients (33%) were previously treated for their disease with primary radiotherapy. Negative tumor margins were achieved in 18 patients (86%). Three of the 7 patients (43%) undergoing salvage surgery had positive margins. One-year and 3-year DFS for previously untreated patients was 91% and 67%, respectively, whereas 1-year and 3-year DFS was 72% and 28%, respectively, for the previously treated patients. Previous radiotherapy, ophthalmic nerve involvement, and positive margins portended poorer survival outcomes in this study. CONCLUSION: The retrospective study of this rare clinical entity demonstrates that multimodal treatment can achieve favorable survival outcomes. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1280-1286, 2017.

Long-term outcomes from training in self-management of chronic pain in an elderly population: a randomized controlled trial.

This study compares the outcomes, from pretreatment to 1-year follow-up, of an outpatient, CBT-based pain self-management program (PSM) that included exercises, pain education, and pain coping strategies, with a control condition (exercise-attention control, EAC) that included exercises and a control for the attention of the treatment team. We previously reported short-term results (to 1-month follow-up) from the same study. This new paper considers the important issue of maintenance of treatment-related gains. The participants (n = 141) were a heterogeneous sample of ambulant, community-dwelling older adult patients with chronic pain (mean age: 73.90 [6.5] years [range: 65-87 years]). The long-term results indicate the pain self-management program group achieved and maintained significantly better results than the exercise-attention control group on the primary outcome, pain-related disability, as well as on usual pain, pain distress, depression, and fear-avoidance beliefs. The mean effect size for these gains by the pain self-management program group over the exercise-attention control group was 0.37 (range: 0.29-0.45), which is in the small effect size range. While statistically and clinically meaningful, these findings do indicate some weakening in effects over time but not to a significant degree. The study has implications for the provision of pain management interventions for community-dwelling older adults with chronic pain.

Radiologic and Audiologic Findings in the Temporal Bone of Patients with CHARGE Syndrome.

BACKGROUND: CHARGE syndrome is a common congenital anomaly. Hearing loss affects 60%-90% of these children. As temporal bone computed tomography (CT) has become more sophisticated, more abnormalities of the middle and inner ear have been found. We present the detailed CT findings for children with CHARGE syndrome and the correlation of the CT findings with audiograms. METHODS: We performed a retrospective medical records review of 12 patients with CHARGE syndrome, identified between 1990-2011 at Princess Margaret Hospital for Children in Western Australia, who underwent temporal bone CT for evaluation of hearing loss. RESULTS: We present our findings for the 24 ears in terms of the cochlear, semicircular canal, middle ear, facial nerve, external auditory canal, venous, and jugular anomalies. The internal auditory canal was normal in 83.3% (n=20) of ears. Three (12.5%) ears had enlarged basal turns, and 4 (16.7%) each had hypoplastic and incompletely partitioned apical turns. The majority (n=13, 56.5%) of the vestibules were dysplastic. Up to 70.8% had abnormalities of the semicircular canal. The middle ear cavity was normal in 55% (n=11) of ears; however, up to 80% of the ears had some abnormality of the ossicles, and up to 70% had an abnormality of the facial nerve (7th cranial nerve) segments, especially in the labyrinthine segment. CT findings did not correlate with the audiograms. CONCLUSION: The management of children with CHARGE syndrome is complex, requiring early evaluation and close attention of the multidisciplinary team. Early identification of hearing deficits is vital for patients' linguistic development.

The mediating role of catastrophizing in the relationship between pain intensity and depressed mood in older adults with persistent pain: A longitudinal analysis.

BACKGROUND AND AIMS: Depression is common in older adults with persistent pain. Cognitive-behavioural models of pain propose that the relationship between pain and depression is influenced or mediated by interpretations of events (cognitions), rather than by the event itself. Almost exclusively, the evidence for this position has come from studies of people aged less than 65 years. The role of cognitions in the pain experience of older adults has been unclear due to the limited and conflicting evidence available. The aim of our study was to examine the role of catastrophizing in mediating the relationship between pain intensity and depressed mood in older adults with persistent pain using reliable and valid measures for this population. METHODS: In a two-wave longitudinal design, a sample of 141 patients (89 women, 52 men) 65 years and over with persistent pain participating in an evaluation of a pain self-management programme completed questionnaires measuring usual level of pain intensity (NRS), depressed mood (DASS-21) and the catastrophizing factors of magnification and helplessness (PRSS) at the beginning of the programme and 6 months later. Demographic data and pain history were collected by self-completion questionnaires, which were mailed to patients prior to participating in the programme and returned by post. RESULTS: Change scores for usual level of pain intensity (NRS), depressed mood (DASS-21) and the magnification and helplessness factors on the PRSS-Catastrophizing were calculated by subtracting the scores at 6 months after completion of the study (Time 2) from the scores at the beginning of the study (Time 1). In the longitudinal analyses of mediation, using a series of regression analyses, change scores for both factors (magnification, helplessness) of the measure of catastrophizing (PRSS) totally and significantly mediated the relationship between change scores for pain intensity and depressed mood. The significant relative magnitude of beta between pain intensity and depression reduced from 0.22 to 0.13 and became non-significant after introducing magnification as a mediating variable, whilst the significant relative magnitude of beta reduced from 0.22 to 0.12 and also became non-significant after introducing helplessness as a mediating variable. CONCLUSIONS: These results support a cognitive-behavioural model and highlight the importance of cognitive factors, in this case catastrophizing, in the relationship between pain intensity and depressed mood in older adults with persistent pain. IMPLICATIONS: These findings also have important clinical implications for the treatment of older adults with persistent pain. They highlight the importance of targeting interventions to reduce the influence of catastrophizing as a prerequisite for reducing depressive symptoms in this growing population.

The rat placental renin-angiotensin system - a gestational gene expression study.

BACKGROUND: The placenta is an essential organ that provides nutrients and oxygen to the developing fetus and removes toxic waste products from the fetal circulation. Maintaining placental blood osmotic pressure and blood flow is crucial for viable offspring. The renin-angiotensin system (RAS) in the placenta is a key player in the regulation of maternal-fetal blood flow during pregnancy. Therefore, the aim of this study was to determine if RAS genes are differentially expressed in mid to late gestation in rat placenta. METHODS: Whole placental tissue samples from pregnant Sprague Dawley rats at embryonic (E) days 14.25, 15.25, 17.25 and 20 (n = 6 for each gestational age) were used for genome-wide gene expression by microarray. RAS genes with expression differences of >2 fold were further analyzed. Quantitative Real-Time PCR (qPCR) was performed on independent samples to confirm and validate microarray data. Immunohistochemisty and Western blotting were performed on a differentially expressed novel RAS pathway gene (ANPEP). RESULTS: Six out of 17 genes of the RAS pathway were differentially expressed at different gestational ages. Gene expression of four genes (Angiotensin converting enzyme (Ace), angiotensin converting enzyme 2 (Ace2), membrane metalloendopeptidase (Mme) and angiotensin II receptor 1A (Agtr1a)) were significantly upregulated at E20 whereas two others (Thimet oligopeptidase 1 (Thop1) and Alanyl aminopeptidase (Anpep)) were downregulated at E20 prior to the onset of labour. These changes were confirmed by qPCR. Western blots revealed no overall differences in ANPEP protein expression in the placentae. Immunohistochemical studies, however, indicated that the localization of ANPEP differed at E17.25 and E20 as ANPEP localization in the giant trophoblast cell of the junctional zone was no longer detectable at E20. CONCLUSIONS: The current study investigated the expression of members of the RAS pathway in rat placentae and observed significantly altered expression of 6 RAS genes at 4 gestational ages. These findings present the need for further comprehensive investigation of RAS genes in normal and complicated pregnancies.

Understanding the role of maternal diet on kidney development; an opportunity to improve cardiovascular and renal health for future generations.

The leading causes of mortality and morbidity worldwide are cardiovascular disease (high blood pressure, high cholesterol and renal disease), cancer and diabetes. It is increasingly obvious that the development of these diseases encompasses complex interactions between adult lifestyle and genetic predisposition. Maternal malnutrition can influence the fetal and early life environment and pose a risk factor for the future development of adult diseases, most likely due to impaired organogenesis in the developing offspring. This then predisposes these offspring to cardiovascular disease and renal dysfunction in adulthood. Studies in experimental animals have further illustrated the significant impact maternal diet has on offspring health. Many studies report changes in kidney structure (a reduction in the number of nephrons in the kidney) in offspring of protein-deprived dams. Although the early studies suggested that increased blood pressure was also present in offspring of protein-restricted dams, this is not a universal finding and requires clarification. Importantly, to date, the literature offers little to no understanding of when in development these changes in kidney development occur, nor are the cellular and molecular mechanisms that drive these changes well characterised. Moreover, the mechanisms linking maternal nutrition and a suboptimal renal phenotype in offspring are yet to be discerned-one potential mechanism involves epigenetics. This review will focus on recent information on potential mechanisms by which maternal nutrition   (focusing on malnutrition due to protein restriction, micronutrient restriction and excessive fat intake) influences kidney development and thereby function in later life.

The effectiveness of psychological treatments for chronic pain in older adults: cautious optimism and an agenda for research.

PURPOSE OF REVIEW: To explores the potential role of psychological treatments for older people who are affected by chronic pain. RECENT FINDINGS: It is now widely recognized that chronic pain is a highly prevalent health problem among older people, and guidelines have evolved to assist with the assessment and management of chronic pain. However, despite the fact that psychological treatments have been shown to be effective for a range of other conditions such as depression and anxiety, there is a relative paucity of studies focused on pain management. Although more evidence is needed, the trend from existing studies indicates that older people find psychological treatments for chronic pain to be relevant, acceptable in content, and beneficial in reducing distress and disability. Particular challenges arise for the delivery of psychological interventions to people with pain and cognitive impairment associated with dementia. There is a growing interest in this population and a good deal of research has focused on the assessment of pain, but with a small number of exceptions, almost no research activity as yet in developing psychological treatments for people with pain and dementia. SUMMARY: We conclude that there is sufficient evidence that psychological interventions are efficacious for older people with chronic pain. We propose a number of areas for research focus over the next 10 years that will help to consolidate our knowledge and to explore new avenues for the psychological management of chronic pain in older people.