Publications by authors named "Laura Lewis"

53 Publications

A Suite of Neurophotonic Tools to Underpin the Contribution of Internal Brain States in fMRI.

Curr Opin Biomed Eng 2021 Jun 12;18. Epub 2021 Feb 12.

Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.

Recent developments in optical microscopy, applicable for large-scale and longitudinal imaging of cortical activity in behaving animals, open unprecedented opportunities to gain a deeper understanding of neurovascular and neurometabolic coupling during different brain states. Future studies will leverage these tools to deliver foundational knowledge about brain state-dependent regulation of cerebral blood flow and metabolism as well as regulation as a function of brain maturation and aging. This knowledge is of critical importance to interpret hemodynamic signals observed with functional magnetic resonance imaging (fMRI).
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http://dx.doi.org/10.1016/j.cobme.2021.100273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095678PMC
June 2021

Supplying the sleeping brain.

Elife 2020 12 23;9. Epub 2020 Dec 23.

Department of Biomedical Engineering, Boston University, Boston, United States.

During sleep, the brain experiences large fluctuations in blood volume and altered coupling between neural and vascular signals.
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http://dx.doi.org/10.7554/eLife.64597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758057PMC
December 2020

Supplying the sleeping brain.

Elife 2020 12 23;9. Epub 2020 Dec 23.

Department of Biomedical Engineering, Boston University, Boston, United States.

During sleep, the brain experiences large fluctuations in blood volume and altered coupling between neural and vascular signals.
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http://dx.doi.org/10.7554/eLife.64597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758057PMC
December 2020

The Development and Preliminary Psychometric Evaluation of the Theory of Mind Inventory: Self Report-Adult (ToMI:SR-Adult).

J Autism Dev Disord 2020 Aug 26. Epub 2020 Aug 26.

University of Vermont, Burlington, USA.

This study describes the development and psychometric evaluation of a new self-report measure of social cognition: the Theory of Mind Inventory:Self-report-Adult (ToMI:SR-Adult). Adults with autism (or a suspicion of autism; n = 111) and typically developing adults (n = 109) completed a demographic questionnaire and the ToMI:SR-Adult online. Both quantitative and qualitative self-reports of one's own theory of mind functioning were collected. The ToMI:SR-Adult performed well under all examinations of reliability and validity (internal consistency, accuracy of classification, contrasting-groups). The qualitative data confirmed impressions of validity and revealed that the adults in our sample had high levels of self-insight regarding their own theory of mind. The ToMI:SR-Adult is offered as a promising research and clinical tool for the assessment of social cognition in adults.
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http://dx.doi.org/10.1007/s10803-020-04654-6DOI Listing
August 2020

Resting-state "physiological networks".

Neuroimage 2020 06 5;213:116707. Epub 2020 Mar 5.

Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA; Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, MA, USA.

Slow changes in systemic brain physiology can elicit large fluctuations in fMRI time series, which manifest as structured spatial patterns of temporal correlations between distant brain regions. Here, we investigated whether such "physiological networks"-sets of segregated brain regions that exhibit similar responses following slow changes in systemic physiology-resemble patterns associated with large-scale networks typically attributed to remotely synchronized neuronal activity. By analyzing a large group of subjects from the 3T Human Connectome Project (HCP) database, we demonstrate brain-wide and noticeably heterogenous dynamics tightly coupled to either respiratory variation or heart rate changes. We show, using synthesized data generated from physiological recordings across subjects, that these physiologically-coupled fluctuations alone can produce networks that strongly resemble previously reported resting-state networks, suggesting that, in some cases, the "physiological networks" seem to mimic the neuronal networks. Further, we show that such physiologically-relevant connectivity estimates appear to dominate the overall connectivity observations in multiple HCP subjects, and that this apparent "physiological connectivity" cannot be removed by the use of a single nuisance regressor for the entire brain (such as global signal regression) due to the clear regional heterogeneity of the physiologically-coupled responses. Our results challenge previous notions that physiological confounds are either localized to large veins or globally coherent across the cortex, therefore emphasizing the necessity to consider potential physiological contributions in fMRI-based functional connectivity studies. The rich spatiotemporal patterns carried by such "physiological" dynamics also suggest great potential for clinical biomarkers that are complementary to large-scale neuronal networks.
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http://dx.doi.org/10.1016/j.neuroimage.2020.116707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165049PMC
June 2020

The impact of a gerontology nursing course with a service-learning component on student attitudes towards working with older adults: A mixed methods study.

Nurse Educ Pract 2020 Jan 4;42:102684. Epub 2019 Dec 4.

University of Vermont, Department of Nursing, 203 Rowell Building, 106 Carrigan Drive, Burlington, VT, 05405-0068, USA. Electronic address:

A growing older adult population requires educational programs which prepare nursing students to care for and increase their interest in working with this population. Faculty at a large public university developed a course specific to gerontology to address this need, including designing a service-learning intervention entitled Aging is Very Personal. The purpose of this study was to explore the impact of this course on student attitudes towards working with older adults. Using a convergent parallel mixed-methods design, 79 students completed pre-course and post-course quantitative surveys and open-ended questions using the Senses Framework survey. Quantitative data were analyzed using a paired-sample t-test. Qualitative data were analyzed using Krippendorff's method of qualitative content analysis. Participants showed statistically significant positive changes in attitudes towards working with older adults on 11 of 15 items. Qualitative findings included 5 themes: acknowledgement of preconceptions prior to course; positive shift in perceptions about older adults; growing interest in working with older adults; appreciation of gerontological nursing as a highly skilled profession; and service-learning as a valuable opportunity to form connections with older adults. A designated course in gerontology with a service-learning component can markedly improve student attitudes towards working with older adults.
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http://dx.doi.org/10.1016/j.nepr.2019.102684DOI Listing
January 2020

Coupled electrophysiological, hemodynamic, and cerebrospinal fluid oscillations in human sleep.

Science 2019 11;366(6465):628-631

Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.

Sleep is essential for both cognition and maintenance of healthy brain function. Slow waves in neural activity contribute to memory consolidation, whereas cerebrospinal fluid (CSF) clears metabolic waste products from the brain. Whether these two processes are related is not known. We used accelerated neuroimaging to measure physiological and neural dynamics in the human brain. We discovered a coherent pattern of oscillating electrophysiological, hemodynamic, and CSF dynamics that appears during non-rapid eye movement sleep. Neural slow waves are followed by hemodynamic oscillations, which in turn are coupled to CSF flow. These results demonstrate that the sleeping brain exhibits waves of CSF flow on a macroscopic scale, and these CSF dynamics are interlinked with neural and hemodynamic rhythms.
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http://dx.doi.org/10.1126/science.aax5440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309589PMC
November 2019

Model-based physiological noise removal in fast fMRI.

Neuroimage 2020 01 4;205:116231. Epub 2019 Oct 4.

Department of Biomedical Engineering, Boston University, Boston, MA, USA. Electronic address:

Recent improvements in the speed and sensitivity of fMRI acquisition techniques suggest that fast fMRI can be used to detect and precisely localize sub-second neural dynamics. This enhanced temporal resolution has enormous potential for neuroscientists. However, physiological noise poses a major challenge for the analysis of fast fMRI data. Physiological noise scales with sensitivity, and its autocorrelation structure is altered in rapidly sampled data, suggesting that new approaches are needed for physiological noise removal in fast fMRI. Existing strategies either rely on external physiological recordings, which can be noisy or difficult to collect, or employ data-driven approaches which make assumptions that may not hold true in fast fMRI. We created a statistical model of harmonic regression with autoregressive noise (HRAN) to estimate and remove cardiac and respiratory noise from the fMRI signal directly. This technique exploits the fact that cardiac and respiratory noise signals are fully sampled (rather than aliasing) when imaging at fast rates, allowing us to track and model physiology over time without requiring external physiological measurements. We then created a joint model of neural hemodynamics, and physiological and autocorrelated noise to more accurately remove noise. We first verified that HRAN accurately estimates cardiac and respiratory dynamics and that our model demonstrates goodness-of-fit in fast fMRI data. In task-driven data, we then demonstrated that HRAN is able to remove physiological noise while leaving the neural signal intact, thereby increasing detection of task-driven voxels. Finally, we established that in both simulations and fast fMRI data HRAN is able to improve statistical inferences as compared with gold-standard physiological noise removal techniques. In conclusion, we created a tool that harnesses the novel information in fast fMRI to remove physiological noise, enabling broader use of the technology to study human brain function.
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http://dx.doi.org/10.1016/j.neuroimage.2019.116231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911832PMC
January 2020

Infection surveillance and prevention strategies to detect and prevent postaccess breast tissue expander infections.

Infect Control Hosp Epidemiol 2019 11 13;40(11):1275-1277. Epub 2019 Aug 13.

Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

No standardized surveillance criteria exist for surgical site infection after breast tissue expander (BTE) access. This report provides a framework for defining postaccess BTE infections and identifies contributing factors to infection during the expansion period. Implementing infection prevention guidelines for BTE access may reduce postaccess BTE infections.
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http://dx.doi.org/10.1017/ice.2019.222DOI Listing
November 2019

Undergraduate nursing students' experiences and attitudes towards working with patients with opioid use disorder in the clinical setting: A qualitative content analysis.

Nurse Educ Today 2019 Feb 9;73:17-22. Epub 2018 Nov 9.

MedStar Georgetown University Hospital, USA.

Background: With the US facing an opioid epidemic, undergraduate nursing students are increasingly encountering patients with opioid use disorder in the clinical setting. Yet, nursing curriculums have not adapted to meet this need. Previous research indicates students are exposed to negative messages that might influence their views about patients with opioid use disorder.

Objectives: The purpose of this study was to examine nursing students' experiences encountering patients with opioid use disorder in the clinical setting, their attitudes about their encounters, and their perceptions of their educational preparedness to care for this population.

Method: Purposive sampling was used to identify participants. Semi-structured interviews were conducted until saturation. Krippendorff's method for qualitative content analysis was used to cluster units within the data to identify emergent themes.

Participants: Eleven senior nursing students from a public university in New England participated.

Results: Analysis revealed six themes, including: navigating ethical dilemmas, gaining comfort with time and experience, avoiding the "elephant in the room," learning from real-world scenarios, witnessing discriminatory care, and recognizing bias and stigma.

Conclusions: Students were most likely to experience bias and internal conflict in maternity clinical rotations. Education should include practical communication strategies to reduce avoidance behaviors among nursing students as well as techniques to manage difficult situations and reduce moral distress. Nurses must be mindful of their power to influence students and should model non-judgmental language and behavior. Students ultimately expressed a desire to provide informed and empathetic care.
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http://dx.doi.org/10.1016/j.nedt.2018.11.001DOI Listing
February 2019

Bioinformatic characterisation of the effector repertoire of the strawberry pathogen Phytophthora cactorum.

PLoS One 2018 2;13(10):e0202305. Epub 2018 Oct 2.

Norwegian Institute of Bioeconomy Research (NIBIO), Division of Biotechnology and Plant Health, Ås, Norway.

The oomycete pathogen Phytophthora cactorum causes crown rot, a major disease of cultivated strawberry. We report the draft genome of P. cactorum isolate 10300, isolated from symptomatic Fragaria x ananassa tissue. Our analysis revealed that there are a large number of genes encoding putative secreted effectors in the genome, including nearly 200 RxLR domain containing effectors, 77 Crinklers (CRN) grouped into 38 families, and numerous apoplastic effectors, such as phytotoxins (PcF proteins) and necrosis inducing proteins. As in other Phytophthora species, the genomic environment of many RxLR and CRN genes differed from core eukaryotic genes, a hallmark of the two-speed genome. We found genes homologous to known Phytophthora infestans avirulence genes including Avr1, Avr3b, Avr4, Avrblb1 and AvrSmira2 indicating effector sequence conservation between Phytophthora species of clade 1a and clade 1c. The reported P. cactorum genome sequence and associated annotations represent a comprehensive resource for avirulence gene discovery in other Phytophthora species from clade 1 and, will facilitate effector informed breeding strategies in other crops.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202305PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168125PMC
March 2019

Identifying autism spectrum disorder in undiagnosed adults.

Nurse Pract 2018 Sep;43(9):14-18

Laura Foran Lewis is an assistant professor at the University of Vermont, Department of Nursing, Burlington, Vt.

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http://dx.doi.org/10.1097/01.NPR.0000544285.02331.2cDOI Listing
September 2018

A transient cortical state with sleep-like sensory responses precedes emergence from general anesthesia in humans.

Elife 2018 08 10;7. Epub 2018 Aug 10.

Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, United States.

During awake consciousness, the brain intrinsically maintains a dynamical state in which it can coordinate complex responses to sensory input. How the brain reaches this state spontaneously is not known. General anesthesia provides a unique opportunity to examine how the human brain recovers its functional capabilities after profound unconsciousness. We used intracranial electrocorticography and scalp EEG in humans to track neural dynamics during emergence from propofol general anesthesia. We identify a distinct transient brain state that occurs immediately prior to recovery of behavioral responsiveness. This state is characterized by large, spatially distributed, slow sensory-evoked potentials that resemble the K-complexes that are hallmarks of stage two sleep. However, the ongoing spontaneous dynamics in this transitional state differ from sleep. These results identify an asymmetry in the neurophysiology of induction and emergence, as the emerging brain can enter a state with a sleep-like sensory blockade before regaining responsivity to arousing stimuli.
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http://dx.doi.org/10.7554/eLife.33250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086660PMC
August 2018

SAP102 regulates synaptic AMPAR function through a CNIH-2-dependent mechanism.

J Neurophysiol 2018 10 1;120(4):1578-1586. Epub 2018 Aug 1.

Picower Institute for Learning and Memory, Massachusetts Institute of Technology , Cambridge, Massachusetts.

The postsynaptic density (PSD)-95-like, disk-large (DLG) membrane-associated guanylate kinase (PSD/DLG-MAGUK) family of proteins scaffold α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) complexes to the postsynaptic compartment and are postulated to orchestrate activity-dependent modulation of synaptic AMPAR functions. SAP102 is a key member of this family, present from early development, before PSD-95 and PSD-93, and throughout life. Here we investigate the role of SAP102 in synaptic transmission using a cell-restricted molecular replacement strategy, where SAP102 is expressed against the background of acute knockdown of endogenous PSD-95. We show that SAP102 rescues the decrease of AMPAR-mediated evoked excitatory postsynaptic currents (AMPAR eEPSCs) and AMPAR miniature EPSC (AMPAR mEPSC) frequency caused by acute knockdown of PSD-95. Further analysis of the mini events revealed that PSD-95-to-SAP102 replacement but not direct manipulation of PSD-95 increases the AMPAR mEPSC decay time. SAP102-mediated rescue of AMPAR eEPSCs requires AMPAR auxiliary subunit cornichon-2, whereas cornichon-2 knockdown did not affect PSD-95-mediated regulation of AMPAR eEPSC. Combining these observations, our data elucidate that PSD-95 and SAP102 differentially influence basic synaptic properties and synaptic current kinetics potentially via different AMPAR auxiliary subunits. NEW & NOTEWORTHY Synaptic scaffold proteins postsynaptic density (PSD)-95-like, disk-large (DLG) membrane-associated guanylate kinase (PSD-MAGUKs) regulate synaptic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) function. However, the functional diversity among different PSD-MAGUKs remains to be categorized. We show that distinct from PSD-95, SAP102 increase the AMPAR synaptic current decay time, and the effect of SAP102 on synaptic AMPAR function requires the AMPAR auxiliary subunit cornichon-2. Our data suggest that PSD-MAGUKs target and modulate different AMPAR complexes to exert specific experience-dependent modification of the excitatory circuit.
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http://dx.doi.org/10.1152/jn.00731.2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230800PMC
October 2018

Stimulus-dependent hemodynamic response timing across the human subcortical-cortical visual pathway identified through high spatiotemporal resolution 7T fMRI.

Neuroimage 2018 11 20;181:279-291. Epub 2018 Jun 20.

Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA.

Recent developments in fMRI acquisition techniques now enable fast sampling with whole-brain coverage, suggesting fMRI can be used to track changes in neural activity at increasingly rapid timescales. When images are acquired at fast rates, the limiting factor for fMRI temporal resolution is the speed of the hemodynamic response. Given that HRFs may vary substantially in subcortical structures, characterizing the speed of subcortical hemodynamic responses, and how the hemodynamic response shape changes with stimulus duration (i.e. the hemodynamic nonlinearity), is needed for designing and interpreting fast fMRI studies of these regions. We studied the temporal properties and nonlinearities of the hemodynamic response function (HRF) across the human subcortical visual system, imaging superior colliculus (SC), lateral geniculate nucleus of the thalamus (LGN) and primary visual cortex (V1) with high spatiotemporal resolution 7 Tesla fMRI. By presenting stimuli of varying durations, we mapped the timing and nonlinearity of hemodynamic responses in these structures at high spatiotemporal resolution. We found that the hemodynamic response is consistently faster and narrower in subcortical structures than in cortex. However, the nonlinearity in LGN is similar to that in cortex, with shorter duration stimuli eliciting larger and faster responses than would have been predicted by a linear model. Using oscillatory visual stimuli, we tested the frequency response in LGN and found that its BOLD response tracked high-frequency (0.5 Hz) oscillations. The LGN response magnitudes were comparable to V1, allowing oscillatory BOLD signals to be detected in LGN despite the small size of this structure. These results suggest that the increase in the speed and amplitude of the hemodynamic response when neural activity is brief may be the key physiological driver of fast fMRI signals, enabling detection of high-frequency oscillations with fMRI. We conclude that subcortical visual structures exhibit fast and nonlinear hemodynamic responses, and that these dynamics enable detection of fast BOLD signals even within small deep brain structures when imaging is performed at ultra-high field.
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http://dx.doi.org/10.1016/j.neuroimage.2018.06.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245599PMC
November 2018

Military Lesbian, Gay, Bisexual, and Transgender (LGBT) Awareness Training for Health Care Providers Within the Military Health System [Formula: see text].

J Am Psychiatr Nurses Assoc 2017 Nov/Dec;23(6):385-392. Epub 2017 Jun 1.

6 Jess Calohan, DNP, PMHNP-BC, The George Washington School of Nursing, Washington, DC, USA.

Background And Significance: Lesbian, gay, bisexual, and transgender (LGBT) individuals serving within the U.S. military and their beneficiaries have unique health care requirements. Department of Defense Directive 1304.26 "Don't Ask, Don't Tell" created a barrier for service members to speak candidly with their health care providers, which left specific health care needs unaddressed. There are no standardized cultural education programs to assist Military Health System (MHS) health care providers in delivering care to LGBT patients and their beneficiaries.

Purpose: The purpose of this project was to develop, implement, and evaluate the effectiveness of an LGBT educational program for health care providers within the MHS to increase cultural awareness in caring for this special population.

Method: This multisite educational program was conducted at Travis Air Force Base and Joint Base Lewis-McChord from November 15, 2014, to January 30, 2015. A 15-question multiple-choice questionnaire was developed based on the education program and was administered before and after the education program. A total of 51 individuals completed the program.

Results: Overall posttest scores improved compared to pretest scores.

Conclusion: This program was designed to begin the process of educating health care providers about the unique health care issues of military LGBT Service Members and their beneficiaries. This program was the first to address the disparities in LGBT health care needs within the Department of Defense. It also provided a platform for facilitating open communication among providers regarding LGBT population health needs in the military.
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http://dx.doi.org/10.1177/1078390317711768DOI Listing
July 2018

A Mixed Methods Study of Barriers to Formal Diagnosis of Autism Spectrum Disorder in Adults.

J Autism Dev Disord 2017 08;47(8):2410-2424

Department of Nursing, University of Vermont, 205 Rowell Building, 106 Carrigan Drive, Burlington, VT, 05405-0068, USA.

Delayed diagnosis of autism spectrum disorder (ASD) into adulthood is common, and self-diagnosis is a growing phenomenon. This mixed methods study aimed to explore barriers to formal diagnosis of ASD in adults. In a qualitative strand, secondary analysis of data on the experiences of 114 individuals who were self-diagnosed or formally diagnosed with ASD in adulthood was used to identify barriers. In a quantitative strand, 665 individuals who were self-diagnosed or formally diagnosed in adulthood were surveyed online to examine incidence and severity of barriers. Fear of not being believed by professionals was identified as the most frequently occurring and most severe barrier. Professionals must strategize to build trust with individuals with ASD, particularly when examining the accuracy of self-diagnosis.
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http://dx.doi.org/10.1007/s10803-017-3168-3DOI Listing
August 2017

"We will never be normal": The Experience of Discovering a Partner Has Autism Spectrum Disorder.

Authors:
Laura F Lewis

J Marital Fam Ther 2017 Oct 10;43(4):631-643. Epub 2017 Apr 10.

University of Vermont.

Online forums and lay literature suggest that partners of individuals with Autism Spectrum Disorder (ASD) experience depression, distress, and trauma in their everyday lives, exacerbated during the time surrounding diagnosis. In this content analysis, 29 participants were provided with an online open-ended statement asking them to describe in writing their experiences of discovering that their partners had ASD during their relationships. Six themes emerged, including: facing unique challenges within relationships; insisting partners seek diagnosis; initial shock and relief; losing hope for normalcy; making accommodations within relationships; and wishing for professional support. Marriage and family therapists should help couples minimize blaming and promote self-awareness, appropriate relationship expectations, and mutual understanding. Future research should explore the overall experience of neuro-mixed relationships for both partners.
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http://dx.doi.org/10.1111/jmft.12231DOI Listing
October 2017

What makes a space invader? Passenger perceptions of personal space invasion in aircraft travel.

Ergonomics 2017 Nov 17;60(11):1461-1470. Epub 2017 Apr 17.

a Human Factors Research Group, Faculty of Engineering, Department of Mechanical, Materials and Manufacturing Engineering , University of Nottingham , Nottingham , UK.

The invasion of personal space is often a contributory factor to the experience of discomfort in aircraft passengers. This paper presents a questionnaire study which investigated how air travellers are affected by invasions of personal space and how they attempt to adapt to, or counter, these invasions. In support of recent findings on the factors influencing air passenger comfort, the results of this study indicate that the invasion of personal space is not only caused by physical factors (e.g. physical contact with humans or objects), but also other sensory factors such as noise, smells or unwanted eye contact. The findings of this study have implications for the design of shared spaces. Practitioner Summary: This paper presents a questionnaire study which investigated personal space in an aircraft environment. The results highlight the factors which affect the perception of personal space invasion in aircraft and can therefore inform the design of aircraft cabin environments to enhance the passenger experience.
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http://dx.doi.org/10.1080/00140139.2017.1313456DOI Listing
November 2017

Comparison of Magnetic Resonance Imaging and Stress Radiographs in the Evaluation of Chronic Lateral Ankle Instability.

Foot Ankle Int 2017 Apr 6;38(4):397-404. Epub 2017 Jan 6.

2 Tripler Army Medical Center, Honolulu, HI, USA.

Background: In patients who develop chronic ankle instability, clinicians often obtain magnetic resonance imaging (MRI) as part of the evaluation prior to operative referral. The purpose of this study was to analyze the diagnostic efficacy of MRI in the diagnosis of chronic lateral ankle instability. Our hypothesis was that magnetic resonance imaging would not be a specific diagnostic tool in the evaluation of chronic lateral ankle instability.

Materials And Methods: A retrospective chart review of 187 consecutive patients (190 ankles) was performed. Inclusion criteria for the study group required a primary complaint of instability that required operative repair or reconstruction, a documented clinical evaluation consistent with instability, stress radiographs, and MRI. Stress radiographs and clinical examinations for the study group and a control group were reviewed independently by both a musculoskeletal radiologist and a board-certified orthopaedic foot and ankle surgeon. Predictive values in terms of sensitivity, specificity, and prevalence were performed. In total, 112 patients (115 ankles) were identified who underwent an operative reconstruction of their lateral ligaments with a history, physical examination, and stress radiographs consistent with lateral ankle instability. A control group was selected consisting of 75 patients seen in the foot and ankle clinic with a diagnosis other than lateral ankle instability. Thirty-seven of the patients in the control group had stress radiographs performed in the clinic to rule out instability as part of their evaluation, and this allowed for an evaluation of the efficacy of stress radiographs in addition to MRI. Statistical analysis was performed using predictive values from sensitivity, specificity, and prevalence.

Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in regards to MRI in the evaluation of patients found to have clinical lateral ankle instability and those who did not had statistical significance. Sensitivity of MRI was 82.6%, specificity was 53.3%, NPV was 66.7%, and PPV was 73%. Since 37 patients in the control group also had stress radiographs, a subanalysis was performed to identify the same values with stress radiographs. Sensitivity, specificity, NPV, and PPV were 66%, 97%, 48%, and 98.7%, respectively. The overall accuracy within this study was 71% for MRI and 74% for stress radiographs.

Conclusion: This study demonstrated that MRI has high sensitivity but low specificity in the evaluation of clinical ankle instability. While MRI has value as a screening tool for concomitant ankle pathology, it should not be considered diagnostic in terms of lateral ankle instability.

Level Of Evidence: Level III, retrospective cohort, comparative series.
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http://dx.doi.org/10.1177/1071100716685526DOI Listing
April 2017

Meta-Ethnography of Qualitative Research on the Experience of Being a Partner to an Individual with Schizophrenia Spectrum Disorder.

Issues Ment Health Nurs 2017 Mar 20;38(3):219-232. Epub 2016 Dec 20.

a University of Vermont , College of Nursing and Health Sciences , Burlington , Vermont , USA.

Several qualitative studies explore the experience of being a partner to an individual with schizophrenia spectrum disorder, but these studies remain isolated "islands of knowledge." This meta-ethnography aimed to synthesize current qualitative studies using Noblit and Hare's method. Thirteen studies were identified for inclusion. Three overarching themes were revealed: unmet expectations of relationship, renegotiating relationship roles, and separation versus togetherness. Themes interacted as a cycle with separation versus togetherness as temporal endpoints. Partners also renegotiated relationships with mental health professionals to accommodate unmet expectations. Leverage points for intervention were identified.
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http://dx.doi.org/10.1080/01612840.2016.1259699DOI Listing
March 2017

Fast fMRI can detect oscillatory neural activity in humans.

Proc Natl Acad Sci U S A 2016 10 11;113(43):E6679-E6685. Epub 2016 Oct 11.

Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA 02129; Department of Radiology, Harvard Medical School, Boston, MA 02114.

Oscillatory neural dynamics play an important role in the coordination of large-scale brain networks. High-level cognitive processes depend on dynamics evolving over hundreds of milliseconds, so measuring neural activity in this frequency range is important for cognitive neuroscience. However, current noninvasive neuroimaging methods are not able to precisely localize oscillatory neural activity above 0.2 Hz. Electroencephalography and magnetoencephalography have limited spatial resolution, whereas fMRI has limited temporal resolution because it measures vascular responses rather than directly recording neural activity. We hypothesized that the recent development of fast fMRI techniques, combined with the extra sensitivity afforded by ultra-high-field systems, could enable precise localization of neural oscillations. We tested whether fMRI can detect neural oscillations using human visual cortex as a model system. We detected small oscillatory fMRI signals in response to stimuli oscillating at up to 0.75 Hz within single scan sessions, and these responses were an order of magnitude larger than predicted by canonical linear models. Simultaneous EEG-fMRI and simulations based on a biophysical model of the hemodynamic response to neuronal activity suggested that the blood oxygen level-dependent response becomes faster for rapidly varying stimuli, enabling the detection of higher frequencies than expected. Accounting for phase delays across voxels further improved detection, demonstrating that identifying vascular delays will be of increasing importance with higher-frequency activity. These results challenge the assumption that the hemodynamic response is slow, and demonstrate that fMRI has the potential to map neural oscillations directly throughout the brain.
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http://dx.doi.org/10.1073/pnas.1608117113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087037PMC
October 2016

Exploring the Experience of Self-Diagnosis of Autism Spectrum Disorder in Adults.

Arch Psychiatr Nurs 2016 10 1;30(5):575-80. Epub 2016 Apr 1.

University of VT, Vermont. Electronic address:

One in 68 Americans has autism spectrum disorder (ASD), and diagnosis is often delayed into adulthood in individuals without comorbid intellectual disability. Many undiagnosed adults resort to self-diagnosis. The purpose of this descriptive phenomenology was to explore the experience of realizing a self-diagnosis of ASD among 37 individuals who were not formally diagnosed. Results revealed five themes: feeling "othered," managing self doubt, sense of belonging, understanding myself, and questioning the need for formal diagnosis. Healthcare professionals must have an understanding of self-diagnosis to help individuals transition to formal diagnosis and to adequately educate, support, and screen this population for comorbidities.
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http://dx.doi.org/10.1016/j.apnu.2016.03.009DOI Listing
October 2016

Validation of a rapid, automated method for the measurement of ethylene glycol in human plasma.

Ann Clin Biochem 2017 Jul 17;54(4):481-489. Epub 2016 Aug 17.

Department of Clinical Chemistry, Immunology & Toxicology, Heart of England NHS Foundation Trust, Birmingham, UK.

Background Ethylene glycol is a highly toxic compound found in various household products. Cases of poisoning are rare but may be fatal unless diagnosed and treated promptly. Early recognition of poisoning is critical for the management and recovery of patients. Indirect testing is not specific for the presence of ethylene glycol. Therefore, urgent and accurate measurement should be sought if ingestion is suspected in order to determine the need for treatment with an antidote. Here, we present the validation of an automated assay for measurement of ethylene glycol on an Abbott Architect using a commercially available kit (Catachem). Methods Analytical parameters of imprecision, linearity, stability and bias were determined using spiked human plasma samples processed on both the Catachem assay and on an in-house gas chromatography-mass spectrometry method. Interference was assessed using samples collected into a variety of sample collection tubes and spiked with a number of alcohols. Results Excellent agreement was observed between the two methodologies with the enzymatic assay demonstrating linearity and precision across the relevant clinical range (50-3000 mg/L). In addition, the Catachem assay displayed no interference from a number of different sample tubes and alcohols. However, propylene glycol interference was observed at concentrations associated with excessive use (>1 g/L) and 2,3-butanediol interference observed at concentrations associated with butanone ingestion. Inspection of the enzymatic reaction profile was found to differentiate between alcohols. Conclusions This automated assay is suitable for the diagnosis of ethylene glycol poisoning and is now in routine use, enabling the laboratory to provide a rapid 24 h service with support by gas chromatography-mass spectrometry as necessary.
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http://dx.doi.org/10.1177/0004563216667752DOI Listing
July 2017

Distracting people from sources of discomfort in a simulated aircraft environment.

Work 2016 Jul;54(4):963-79

Light Fusion Lab, Fraunhofer IAO, Stuttgart, Germany.

Background: Comfort is an important factor in the acceptance of transport systems. In 2010 and 2011, the European Commission (EC) put forward its vision for air travel in the year 2050 which envisaged the use of in-flight virtual reality. This paper addressed the EC vision by investigating the effect of virtual environments on comfort. Research has shown that virtual environments can provide entertaining experiences and can be effective distracters from painful experiences.

Objective: To determine the extent to which a virtual environment could distract people from sources of discomfort.

Methods: Experiments which involved inducing discomfort commonly experienced in-flight (e.g. limited space, noise) in order to determine the extent to which viewing a virtual environment could distract people from discomfort.

Results: Virtual environments can fully or partially distract people from sources of discomfort, becoming more effective when they are interesting. They are also more effective at distracting people from discomfort caused by restricted space than noise disturbances.

Conclusions: Virtual environments have the potential to enhance passenger comfort by providing positive distractions from sources of discomfort. Further research is required to understand more fully the reasons why the effect was stronger for one source of discomfort than the other.
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http://dx.doi.org/10.3233/WOR-162356DOI Listing
July 2016

Realizing a diagnosis of autism spectrum disorder as an adult.

Int J Ment Health Nurs 2016 Aug 4;25(4):346-54. Epub 2016 Mar 4.

College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA.

Many individuals with autism spectrum disorder are not diagnosed until adulthood, yet little is known about their experiences. This descriptive phenomenological study aimed to explore the experience of realizing a diagnosis of autism spectrum disorder in adulthood. A purposive sample of 77 adults was asked to describe their experiences of realizing a diagnosis as adults via an open-ended online survey. Data were analysed using Colaizzi's method and six themes were derived: feeling different from others, riding an emotional rollercoaster, striving to accept themselves, strategizing to improve their lives, maintaining normalcy, and wandering into the future. Nurses must realize the importance of screening for depression following a new diagnosis. Barriers to reaching a formal diagnosis should also be evaluated.
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http://dx.doi.org/10.1111/inm.12200DOI Listing
August 2016

Balancing Competing Needs: A Meta-Ethnography of Being a Partner to an Individual With a Mood Disorder.

J Am Psychiatr Nurses Assoc 2015 Nov-Dec;21(6):417-27

Laura Foran Lewis, RN, PhD, University of Vermont, Burlington, VT, USA

Background: More than 20% of individuals experience a mood disorder in their lifetime. Qualitative studies have explored the experience of being a partner to an individual with a mood disorder, but these studies remain isolated pieces of a larger puzzle.

Aims: In this metasynthesis, I aimed to integrate current qualitative research to describe the experience of being a partner to an individual with a mood disorder.

Method: A systematic search was conducted to identify qualitative research. Noblit and Hare's meta-ethnography was used to translate key metaphors from individual studies into a single set of metaphors to describe the experience.

Results: Results indicated that these partners are disenfranchised caregivers balancing their own needs with partners' perceived and reported needs to strive for a stasis of guarded stability.

Conclusions: Future research must explore ways to support these partners and include them in the health care team.
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http://dx.doi.org/10.1177/1078390315620611DOI Listing
January 2017

Transcriptional Dynamics Driving MAMP-Triggered Immunity and Pathogen Effector-Mediated Immunosuppression in Arabidopsis Leaves Following Infection with Pseudomonas syringae pv tomato DC3000.

Plant Cell 2015 Nov 13;27(11):3038-64. Epub 2015 Nov 13.

Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QD, United Kingdom

Transcriptional reprogramming is integral to effective plant defense. Pathogen effectors act transcriptionally and posttranscriptionally to suppress defense responses. A major challenge to understanding disease and defense responses is discriminating between transcriptional reprogramming associated with microbial-associated molecular pattern (MAMP)-triggered immunity (MTI) and that orchestrated by effectors. A high-resolution time course of genome-wide expression changes following challenge with Pseudomonas syringae pv tomato DC3000 and the nonpathogenic mutant strain DC3000hrpA- allowed us to establish causal links between the activities of pathogen effectors and suppression of MTI and infer with high confidence a range of processes specifically targeted by effectors. Analysis of this information-rich data set with a range of computational tools provided insights into the earliest transcriptional events triggered by effector delivery, regulatory mechanisms recruited, and biological processes targeted. We show that the majority of genes contributing to disease or defense are induced within 6 h postinfection, significantly before pathogen multiplication. Suppression of chloroplast-associated genes is a rapid MAMP-triggered defense response, and suppression of genes involved in chromatin assembly and induction of ubiquitin-related genes coincide with pathogen-induced abscisic acid accumulation. Specific combinations of promoter motifs are engaged in fine-tuning the MTI response and active transcriptional suppression at specific promoter configurations by P. syringae.
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http://dx.doi.org/10.1105/tpc.15.00471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682296PMC
November 2015

Thalamic reticular nucleus induces fast and local modulation of arousal state.

Elife 2015 Oct 13;4:e08760. Epub 2015 Oct 13.

Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, United States.

During low arousal states such as drowsiness and sleep, cortical neurons exhibit rhythmic slow wave activity associated with periods of neuronal silence. Slow waves are locally regulated, and local slow wave dynamics are important for memory, cognition, and behaviour. While several brainstem structures for controlling global sleep states have now been well characterized, a mechanism underlying fast and local modulation of cortical slow waves has not been identified. Here, using optogenetics and whole cortex electrophysiology, we show that local tonic activation of thalamic reticular nucleus (TRN) rapidly induces slow wave activity in a spatially restricted region of cortex. These slow waves resemble those seen in sleep, as cortical units undergo periods of silence phase-locked to the slow wave. Furthermore, animals exhibit behavioural changes consistent with a decrease in arousal state during TRN stimulation. We conclude that TRN can induce rapid modulation of local cortical state.
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http://dx.doi.org/10.7554/eLife.08760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686423PMC
October 2015