“A Conscious Control Over Life and My Emotions:” Mindfulness Practice and Healthy Young People. A Qualitative Study

PurposeAlthough quantitative benefits of mindfulness training have been demonstrated in youth, little is known about the processes involved. The aim of this study was to gain a detailed understanding of how young people engage with the ideas and practices known as mindfulness using qualitative enquiry.MethodsFollowing completion of a six-week mindfulness training program with a nonclinical group of 11 young people (age 16–24), a focus group (N = 7) and open-ended interviews (n = 5) were held and audio-recorded. Qualitative data, collected at eight time points over three months from the commencement of training, were coded with the aid of computer software. Grounded theory methodology informed the data collection process and generation of themes and an explanatory model that captured participants' experiences.ResultsParticipants described their daily lives as beset by frequent experiences of distress sometimes worsened by their unhelpful or destructive reactions. With mindfulness practice, they initially reported greater calm, balance, and control. Subsequently they commented on a clearer understanding of themselves and others. Mindfulness was then described as a “mindset” associated with greater confidence and competence and a lessened risk of future distress.ConclusionsParticipants demonstrated a sophisticated understanding of and engagement with mindfulness principles and practice. Their reported experience aligned well with qualitative research findings in adults and theoretical literature on mindfulness. An encouraging finding was that, with ongoing mindfulness practice and within a relatively short time, participants were able to move beyond improved emotion regulation and gain greater confidence in their ability to manage life challenges.     

INVESTIGATING COMMUNITY PERSPECTIVES ON FALLS PREVENTION INFORMATION SEEKING AND DELIVERY: OLDER PERSON PERCEPTIONS REGARDING PREFERENCES FOR FALLS PREVENTION EDUCATION USING A WORLD CAFE APPROACH

Falls among older people are a significant global socioeconomic problem, and older adults have low levels of self‐perceived risk and a lack of willingness to take up existing falls prevention strategies. We believe that given the challenges of delivering falls prevention information, meaningful engagement of community members would create solutions based on an understanding of what would work best for that community. A World Cafe community forum sought the opinions of 70 community‐dwelling older people about their preferences on how they would best receive and seek falls prevention information that could prevent falls within their age group. Participants evaluated the café as a highly positive experience and felt that learning occurred by way of interaction and “sharing of ideas.” Local communities could develop this participatory approach to engage older people in leading the translation of falls prevention evidence into practice.     

MR Quantitative Susceptibility Imaging for the Evaluation of Iron Loading in the Brains of Patients with β-Thalassemia Major

BACKGROUND AND PURPOSE:Patients with β-thalassemia require blood transfusion to prolong their survival, which could cause iron overload in multiple organs, including the heart, liver, and brain. In this study, we aimed to quantify iron loading in the brains of patients with β-thalassemia major through the use of MR quantitative susceptibility imaging.MATERIALS AND METHODS:Thirty-one patients with thalassemia with a mean (± standard deviation) age of 25.3 (±5.9) years and 33 age-matched healthy volunteers were recruited and underwent MR imaging at 3T. Quantitative susceptibility images were reconstructed from a 3D gradient-echo sequence. Susceptibility values were measured in the caudate nucleus, putamen, globus pallidus, red nucleus, substantia nigra, dentate nucleus, and choroid plexus. General linear model analyses were performed to compare susceptibility values of different ROIs between the patients with thalassemia and healthy volunteers.RESULTS:Of the 31 patients, 27 (87.1%) had abnormal iron deposition in one of the ROIs examined. Significant positive age effect on susceptibility value was found in the putamen, dentate nucleus, substantia nigra, and red nucleus (P = .002, P = .017, P = .044, and P = .014, respectively) in the control subjects. Compared with healthy control subjects, patients with thalassemia showed significantly lower susceptibility value in the globus pallidus (P < .001) and substantia nigra (P = .003) and significantly higher susceptibility value in the red nucleus (P = .021) and choroid plexus (P < .001).CONCLUSIONS:A wide range of abnormal susceptibility values, indicating iron overloading or low iron content, was found in patients with thalassemia. MR susceptibility imaging is a sensitive method for quantifying iron concentration in the brain and can be used as a potentially valuable tool for brain iron assessment.

Beta-thalassemia major is a disease caused by genetic defects that lead to reduced production of hemoglobin. The patients require blood transfusion to prolong their survival, which could cause iron overload in multiple organs, including the heart, liver, and brain.¹ Iron chelation therapy is administrated to clear the excess iron. Whereas iron overload in the heart and liver may cause death, alterations of iron content in the brain may contribute to cognitive impairment, as observed in some patients with thalassemia,^2,3 which has not been found to correlate with age and blood ferritin levels. Accurate assessment of iron content in the brains of patients with thalassemia could provide valuable information for individualized patient treatment. Conventionally, MR relaxometry on the basis of methods that use T2 and T2* mapping has been used to quantify iron in the brain.⁴ Recently, the application of measuring brain iron by use of phase value of MR imaging with SWI^5,6 and quantitative susceptibility mapping (QSM)^7–12 has been evaluated for the quantification of iron content in patients with Parkinson disease.¹³ QSM is an MR imaging technique that measures the magnetic susceptibility of tissues, such as blood or iron content, through mathematically modeling their induced effects on the phase of signal. Although the derivation of a magnetic susceptibility image from the phase information obtained from MR imaging is an ill-posed problem, techniques have been established to overcome this by imposing smoothness or sparseness constraints on the susceptibility images.^9–11 QSM has been successfully applied in multiple sclerosis, Parkinson disease, and so forth. A recent study¹⁴ has also established positive correlation between magnetic susceptibility values measured by use of QSM and iron content measured by x-ray fluorescence imaging and inductively coupled plasma mass spectrometry. In the present study, we quantified the brain iron content in a cohort of patients with β-thalassemia major and compared this with healthy age-matched subjects. We hypothesize that there are significant differences in iron loading between patients with thalassemia and healthy control subjects as measured by QSM.     

Foetal and neonatal autopsy rates and use of tissue for research: the influence of 'organ retention' controversy and new consent process

AIM: To examine whether the 'organ retention' controversy and new autopsy consent process had any effect on foetal and neonatal autopsy rates and on permitting the use of tissue for scientific research and education. METHODS: An audit of perinatal autopsy rates in a tertiary hospital prior to (1999-2001) and subsequent to the 'organ retention' controversy (2001-2002), and the introduction of a new consenting process (2002-2004). Rates were compared also with those a decade earlier (1990-1993). RESULTS: Overall autopsy rates have been falling significantly between the three study periods (1999-2001 71.7%; 2001-2002 61.5%; 2003-2004 50.5%). Autopsy rates have fallen significantly between 1990-1993 and 1999-2001 (P<0.00005) and between 1990-1993 and 1999-2004 (P<0.0000001). The autopsy rates for stillbirths and neonatal deaths have fallen significantly further since the 'organ retention' controversy but not significantly so following the new consenting process. Significantly fewer autopsies are performed on foetuses less than 20 weeks gestation in recent years than a decade ago (P<0.0000001). There were more external or limited autopsies in later years (P=0.015). Permission for the use of tissue for education and research is less frequent following the 'organ retention' controversy and particularly following the introduction of the new consenting process. CONCLUSION: Perinatal autopsy rates have fallen over the past 10 years. Fewer autopsies are being performed following the 'organ retention' controversy and use of tissue for research and education is permitted even less frequently following the introduction of the new consenting process.     

Can the specificity of the FDT for glaucoma be improved by confirming abnormal results?

PURPOSE: To determine whether the specificity of the frequency-doubling technology (FDT) perimeter in the screening mode for glaucoma can be improved by repeating abnormal screening results. METHODS: The FDT perimeter was used in C-20-5 screening mode, and the right eye was tested first. After both eyes were tested, the screening was repeated in eyes with any abnormal visual field defects on FDT perimetry. The printouts were categorized as possible visual field abnormality (zero or one miss), probable visual field abnormality (two to four misses), and definite visual field abnormality (more than five misses). A clinical ophthalmologic examination was conducted on the day of the FDT perimetry screening. RESULTS: Complete data were available for 223 people. The participants ranged in age from 23 to 91 years (mean, 68.5 years; standard deviation. 13.7 years), and 119 (53%) were women. The sensitivity of the FDT perimetry screening was 100%; both cases of glaucoma showed an abnormality on FDT perimetry both times. The specificity improved moderately from the first screening to the second screening. The specificity the first time was 62% (95% confidence interval, 53.1-71.2). The specificity the second time was 68.5% (95% confidence interval, 59.8-77.1). Improvement on FDT perimetry rescreening varied by the language spoken at home. Seven of the 19 non-English speakers without glaucoma improved on rescreening, compared with none of the 23 English speakers (P = 0.002). Seven of the 25 right eyes with FDT perimetry abnormalities both times and no glaucoma had no other detectable diseases. Three of 24 left eyes with FDT perimetry abnormalities both times and no glaucoma had no other detectable diseases. Of the 85 patients who did not have glaucoma but had FDT perimetry abnormalities both times, only one did not have some other detectable disease. DISCUSSION: In summary, the sensitivity for glaucoma of the C-20-5 screening mode is excellent, but a paradigm for screening with the FDT perimeter to improve the overall specificity for glaucoma still must be developed.     

Expression of MHC class II antigens by placental villi: no relationship with villitis of unknown origin.

The aim of the study was to determine whether immunoreactivity to major histo-compatibility complex (MHC) class II antigens studied by immunohisto-chemistry could be used reliably to define villitis lesions in placenta. Eighteen placental sections with villitis and 32 without, as determined in a careful observer reproducibility study, were immunolabelled with a monoclonal antibody to monomorphic determinants of MHC class II antigens (CR3/43), using a standard avidin-biotin peroxidase technique. Placentas with villitis were found to express MHC class II antigens. However, some showed no immunoreactivity. Occasional villi unaffected by villitis, including those near placental infarcts, also expressed MHC class II antigens. The study therefore showed that immunohistochemistry cannot be used to define villitis of unknown aetiology. It provides further evidence of the difficulties that can arise when immunohistochemistry conflicts with previous light microscopy findings.     

An immunohistologic study of endothelialization of uteroplacental vessels in human pregnancy--evidence that endothelium is focally disrupted by trophoblast in preeclampsia.

OBJECTIVE: Our objective was to study the endothelial status of the luminal lining of uteroplacental vessels in the human placental bed in normal and abnormal pregnancy in the third trimester. STUDY DESIGN: Six placental basal plates from uncomplicated pregnancies and five from pregnancies complicated by preeclampsia (n = 3), preeclampsia and a small-for-gestational-age infant (n = 1), and diabetes mellitus (n = 1) were accessioned from the archives because of documentation of their containing uteroplacental vessels. Five placental bed biopsy specimens with intraluminal endovascular trophoblast in the third trimester were also studied. Sections were subjected to immunohistochemical analysis with monoclonal and polyclonal antibodies labeling endothelium and trophoblast. RESULTS: In third-trimester normal uncomplicated pregnancies the uteroplacental arteries and veins were completely endothelialized with no disruption of the endothelium. In third-trimester abnormal pregnancies the uteroplacental veins were also completely endothelialized. However, intraluminal endovascular trophoblast was seen within the uteroplacental arteries in eight of the 10 complicated pregnancies; this finding was associated with disruption of the endothelium. CONCLUSION: In preeclampsia there is an aberrant wave of endovascular trophoblast migration in the third trimester, resulting in focal disruption of the endothelium. This may be responsible for the endothelial cell dysfunction thought to be of pathogenetic importance in preeclampsia.