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Mindfulness meditation has become a common method for reducing stress, stress-related psychopathology and some physical symptoms. As mindfulness programs become ubiquitous, concerns have been raised about their unknown potential for harm. We estimate multiple indices of harm following Mindfulness-Based Stress Reduction (MBSR) on two primary outcomes: global psychological and physical symptoms. In secondary analyses, we estimate multiple indices of harm on anxiety and depressive symptoms, discomfort in interpersonal relations, paranoid ideation and psychoticism.
Methods
Intent-to-treat analyses with multiple imputations for missing data were used on pre- and post-test data from a large, observational dataset (n = 2155) of community health clinic MBSR classes and from MBSR (n = 156) and waitlist control (n = 118) participants from three randomized controlled trials conducted contemporaneous to community classes in the same city by the same health clinic MBSR teachers. We estimate the change in symptoms, proportion of participants with increased symptoms, proportion of participants reporting greater than a 35% increase in symptoms, and for global psychological symptoms, clinically significant harm.
Results
We find no evidence that MBSR leads to higher rates of harm relative to waitlist control on any primary or secondary outcome. On many indices of harm across multiple outcomes, community MBSR was significantly preventative of harm.
Conclusions
Engagement in MBSR is not predictive of increased rates of harm relative to no treatment. Rather, MBSR may be protective against multiple indices of harm. Research characterizing the relatively small proportion of MBSR participants that experience harm remains important.
Given the prevalence of adolescent depression and the modest effects of current treatments, research ought to inform development of effective intervention strategies. Self-compassion is inversely associated with depression, and self-compassion interventions have demonstrated promising effects on reducing depression. However, little is known about the neural mechanisms underlying that relationship. Maladaptive self-processing is a characteristic of depression that contributes to the onset and chronicity of depression. Because our own face is an automatic and direct cue for self-processing, this study investigated whether self-compassion was associated with neural responses during sad v. neutral self-face recognition and explore their relationship with depression severity in depressed adolescents and healthy controls (HCs).
Methods
During functional magnetic resonance imaging, 81 depressed youth and 37 HCs were instructed to identify whether morphed self or other faces with sad, happy, or neutral expressions resembled their own.
Results
Self-compassion correlated negatively with activity during sad v. neutral self-face recognition in the dorsal anterior cingulate cortex in the total sample, and in the right posterior cingulate cortex/precuneus in HCs, respectively. In depressed adolescents, higher self-compassion correlated with lower activity during sad v. neutral self-face recognition in the right dorsolateral prefrontal cortex (DLPFC), implying that less cognitive effort might be needed to avoid dwelling on sad self-faces and/or regulate negative affect induced by them. Moreover, higher self-compassion mediated the relationship between lower DLPFC activity and reduced depression severity.
Conclusions
Our findings imply that DLPFC activity might be a biological marker of a successful self-compassion intervention as potential treatment for adolescent depression.
Laser–solid interactions are highly suited as a potential source of high energy X-rays for nondestructive imaging. A bright, energetic X-ray pulse can be driven from a small source, making it ideal for high resolution X-ray radiography. By limiting the lateral dimensions of the target we are able to confine the region over which X-rays are produced, enabling imaging with enhanced resolution and contrast. Using constrained targets we demonstrate experimentally a $(20\pm 3)~\unicode[STIX]{x03BC}\text{m}$ X-ray source, improving the image quality compared to unconstrained foil targets. Modelling demonstrates that a larger sheath field envelope around the perimeter of the constrained targets increases the proportion of electron current that recirculates through the target, driving a brighter source of X-rays.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
Monitoring species’ response in marine protected areas is important for informing both the management of those areas and the establishment of additional protected areas. Populations of spiny lobsters Jasus edwardsii were monitored in eight New Zealand marine reserves for up to 34 years. The populations displayed highly variable responses to protection. While a few showed rapid (within 1–2 years of protection) increases in abundance, others showed little response even after a decade of protection. Some reserves displayed little initial recovery, then a sudden increase following several years of protection, while others displayed significant declines in abundance following initial recovery. Marine reserves located in areas with initially high densities of juveniles tended to have rapid recovery, but aspects of reserve design had no significant influence on the recovery rate. Variability among recovery trajectories also suggests that supply-side dynamics may be a key driver of lobster recovery. Densities of legal-sized lobsters were positively correlated with reserve age, but the abundance of juvenile lobsters increased in all but one reserve, indicating enhanced recruitment, survival and/or movement of juvenile lobsters into reserves. It is important to consider the placement of reserves, with respect to potential levels of larval supply, when establishing marine reserves for either conservation or fisheries management purposes and for evaluating their effectiveness.
This book defines management mistakes and offers a variety of models to classify and interpret them. It describes the evolution of management mistakes, techniques for identifying and disclosing mistakes, the relationship between management and medical mistakes, and steps to prevent and correct mistakes. Six case studies, drawn from a real set of events in healthcare organizations, describe management mistakes and are followed by commentaries by experts in the field of healthcare management. They indicate steps that might have produced more positive outcomes. Ultimately, managers will not be completely successful in making healthcare better and more cost-effective without viewing mistakes as learning opportunities. This book is written for healthcare managers throughout the world and for the benefit of their patients, staff and communities.
A model of asymmetric contributions to the control of different subcomponents of approach- and withdrawal-related emotion and psychopathology is presented. Two major forms of positive affect are distinguished. An approach-related form arises prior to goal attainment, and another form follows goal attainment. The former is hypothesized to be associated with activation of the left prefrontal cortex. Individual differences in patterns of prefrontal activation are stable over time. Hypoactivation in this region is proposed to result in approach-related deficits and increase an individual's vulnerability to depression. Data in support of these proposals are presented. The issue of plasticity is then considered from several perspectives. Contextual factors are superimposed upon tonic individual differences and modulate the magnitude of asymmetry. Pharmacological challenges also alter patterns of frontal asymmetry. A diverse array of evidence was then reviewed that lends support to the notion that these patterns of asymmetry may be importantly influenced by early environmental factors that result in enduring changes in brain function and structure.
This chapter discusses three classes of theories: information-processing theories that build on modular elements, network theories that focus on the distributed access of conscious processing, and globalist theories that combine aspects of these two. It also discusses cognitive or functional models of consciousness with less reference to the burgeoning neuroscientific evidence that increasingly supports the globalist position. Beginning in the 1980s, a number of experimental methods gained currency as means of studying comparable conscious and non-conscious processes. The metaphor of cognitive architectures dates to the 1970s when cognitive psychologists created information-processing models of mental processes. The general position is that consciousness operates as a distributed and flexible system offering nonconscious expert systems global accessibility to information that has a high concurrent value to the organism. Future work should focus on obtaining neuroscientific evidence and corresponding behavioral observations that can address global access as the distinguishing feature of consciousness.
An emotion-modulated acoustic startle paradigm for inducing
positive and negative affect was used to address pregoal and
postgoal affect. Participants played a computerized lottery
task in which they chose digits that could match a subsequently
displayed, random set of numbers. In the positive conditions,
matches led to monetary rewards. In the negative condition,
matches led to an aversive noise blast. In three experiments,
we found eyeblink startle magnitude was potentiated just prior
to feedback concerning reward outcome, suppressed following
the feedback that a monetary reward was won, and potentiated
when threatened with an aversive noise. When presented with
a 0%, 45%, 90%, or 100% chance of winning, higher probabilities
suppressed startle response after feedback whereas the 45% trials
did not. These data indicate that postgoal positive affect (winning
reward) reliably suppressed the startle response whereas pregoal
positive affect did not.