Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis

Meta-analysis was used to investigate the potential benefits of stress management interventions (SMIs) on vagally-mediated heart rate variability (HRV) in adults with cardiovascular disease. Electronic bibliographic databases were searched through August 2022. Randomized controlled trials and quasi-experimental studies assessing effects of SMIs on HRV were included. Methodological quality was assessed with a standardized checklist. A pooled effect size was calculated for vagally-mediated HRV indices (standard deviation of normal-to-normal intervals, root mean square of the successive differences, and high frequency power) using random effects models. Fourteen studies (1202 participants, Mage: 59 ± 6.25 years; 25% ± 16% women; 61% ± 22% White) were included. Ten studies (11 effects) reported short-term HRV assessment; a small between-group difference emerged for vagally-mediated HRV (d+ = .27, 95% confidence interval [CI] 0.01-0.52, k = 11). Most interventions examined biofeedback; these studies yielded a small between-group difference on vagally-mediated HRV (d+ = 0.31, 95% CI 0.09-0.53, k = 7, Q [6] = 3.82, p = .70, I2 = 11%). This is the first systematic examination of the effect of SMIs on HRV in adults with CVD. Findings suggest a small effect of SMIs on vagally-mediated HRV, with biofeedback likely driving the effect. More research is required to fully understand whether this benefit on vagally-mediated HRV applies to other SMIs.

The protective roles of coping self-efficacy and social support for posttraumatic stress during the COVID-19 pandemic

OBJECTIVE

This study examined the roles of social support and coping self-efficacy (CSE) in attenuating posttraumatic stress (PTS) symptoms during the COVID-19 pandemic among a nonclinical university student sample.

METHOD

Participants (n = 610; 59% female) completed questionaries assessing psychological distress (Kessler Psychological Distress Scale) at baseline and 6-month follow-up, and social support (Interpersonal Support Evaluation List-12), CSE Scale, and PTS symptoms (Impact of Event Scale-Revised) at 6 months. A path analysis was conducted using SPSS Amos to examine the direct and indirect pathways from psychological distress to PTS symptoms that are accounted for by social support and CSE, controlling for gender.

RESULTS

All direct effects in the path analysis were significant except for the relationship between social support and PTS symptoms. Notably, CSE was directly related to PTS symptoms (CSE: β = -.30, p < .001). There was a significant indirect effect of early psychological distress on PTS symptoms 6 months into the pandemic through social support and CSE (β = .14, p < .001).

CONCLUSIONS

Individuals with higher levels of social support are more likely to have greater confidence in their coping capabilities, which helps to explain PTS symptom severity after controlling for initial levels of psychological distress and gender. These findings suggest that following a potentially traumatic event, CSE may be one factor to screen for to better identify individuals who are at higher risk for significant psychological difficulties and may benefit from interventions that bolster protective factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-Care Mental Health App Intervention for Post-Intensive Care Syndrome-Family: A Randomized Pilot Study

BACKGROUND

Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management.

OBJECTIVE

To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients.

METHODS

The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use.

RESULTS

The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app.

CONCLUSIONS

Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms.

Psychometric Properties and Factor Structure of the Multidimensional Behavioral Health Screen (MBHS) With a University Sample

The Multidimensional Behavioral Health Screen (MBHS) is a brief screening measure of behavioral health symptoms. Although the measure was first developed for primary care, it is likely to have clinical utility in other settings. This study examined the MBHS's factor structure and psychometric properties with a university undergraduate and graduate student sample (n = 602, 58.6% female, 75.9% White, primarily aged 20-24) during the COVID-19 pandemic. MBHS subscale scores demonstrated internal consistency reliability and both convergent and discriminant relations with external, criterion variables. Confirmatory factor analyses supported a 7-subscale factor structure of the MBHS and did not find evidence of higher order factors. Clinical and theoretical implications, as well as future research directions, are discussed.

Psychological distress of college students during the COVID-19 pandemic

Objectives To assess levels of psychological distress among a group of US undergraduate college students during the initial phases of the novel coronavirus (SARS-CoV-2) pandemic. Methods: All undergraduates at Kent State University were surveyed in three randomly selected cohorts on March 18, March 25, and April 1, yielding 3924 valid responses for the weighted dataset (73.8% female, 88.9% White). Distress was assessed using the Kessler Psychological Distress Scale (K6). Data were weighted using known population counts. Results: K6 scores averaged 8.19 ± 5.9, with 44.3% in the moderately elevated range and 23.8% above the cutoff for severe psychological distress.Conclusions: A high proportion of undergraduate university students reported elevated psychological distress as the COVID-19 pandemic unfolded. K6 scores appeared higher than averages from comparison samples. Targeted surveillance can inform public health in mitigating threats to mental health conferred by pandemics. Colleges and universities should anticipate sharply elevated psychological distress during and after the COVID-19 pandemic.

Sleep quality and mental health during COVID-19: the role of distress tolerance

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted psychological health for many. This study aimed to investigate if distress tolerance, an individual's perceived or actual 'capacity to withstand negative psychological states', helps to explain the relationship between sleep and mental health problems during the COVID-19 pandemic. College students (N = 187) completed questionnaires using an online survey platform between 6 April 2020, and 6 June 2020, during the COVID-19 pandemic. Hierarchical multiple regression analyses were used to examine the indirect effect of distress tolerance on the relationship between sleep quality and mental health. Distress tolerance partially accounted for the relationship between sleep quality and perceived stress but did not help to explain the association between sleep quality and depression or anxiety. Two components of distress tolerance, absorption and appraisal, helped to explain the relationship between sleep quality and all mental health outcomes. These findings help explain how distress tolerance relates to mental health when sleep is negatively impacted. Prospective designs replicating these findings are needed and future research may inform how psychological interventions could target distress tolerance in the context of poor sleep, especially during major stressors.

A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.

Deep Electric Field Predictions by Drift-Reduced Braginskii Theory with Plasma-Neutral Interactions Based on Experimental Images of Boundary Turbulence

We present two-dimensional turbulent electric field calculations via physics-informed deep learning consistent with (i) drift-reduced Braginskii theory under the framework of an axisymmetric fusion plasma with purely toroidal field and (ii) experimental estimates of the fluctuating electron density and temperature on open field lines obtained from analysis of gas puff imaging of a discharge on the Alcator C-Mod tokamak. The inclusion of effects from the locally puffed atomic helium on particle and energy sources within the reduced plasma turbulence model is found to strengthen correlations between the electric field and electron pressure. The neutrals are also directly associated with broadening the distribution of turbulent field amplitudes and increasing E×B shearing rates. This demonstrates a novel approach in plasma experiments by solving for nonlinear dynamics consistent with partial differential equations and data without encoding explicit boundary nor initial conditions.

Meta-Analysis of Antidepressant Pharmacotherapy in Patients Eligible for Cardiac Rehabilitation: ANTIDEPRESSANT AMBIVALENCE

PURPOSE

Many patients exhibit clinically significant depression upon enrollment in cardiac rehabilitation (CR). Antidepressants are a first-line treatment option for depression, but the effectiveness of antidepressants in patients with heart disease is mixed. The purpose of this meta-analysis was to evaluate the efficacy of antidepressants for depression in patients eligible for CR.

METHODS

A meta-analysis was conducted including randomized controlled trials of antidepressants from January 1990 to September 2021 that compared antidepressants with placebo. Random-effects models were used between group effect sizes (Hedges' g ).

RESULTS

A total of 13 trials with predominately White (68% ± 12; n =7) male (70% ± 11) samples averaging 61 ± 5 yr compared antidepressants (1128 participants) with placebo (1079 participants). Antidepressants reduced depressive symptoms ( g = 0.17: 95% CI, 0.08-0.27), but the effect was small. Heterogeneity among study effects was low ( I2 = 6.42) and nonsignificant ( Q = 10.75, P = .46), although patients with heart failure ( gHF = 0.05: 95% CI, -0.09 to 0.18) demonstrated smaller effects compared with patients with other cardiovascular disease conditions (g non-HF = 0.22: 95% CI, 0.11-0.32) ( QB [1] = 3.97; P < .05). No study reported safety concerns associated with antidepressants.

SUMMARY

The effect size of antidepressant pharmacotherapy in this population is small. No trials reported on the combined effects of exercise and pharmacotherapy. If the patient is not suicidal, CR staff may consider patient preference and refer patients for additional treatment as necessary.

Robust identification of multiple-input single-output system response for efficient pickup noise removal from tokamak diagnostics

Electromagnetic pickup noise in the tokamak environment imposes an imminent challenge for measuring weak diagnostic photocurrents in the nA range. The diagnostic signal can be contaminated by an unknown mixture of crosstalk signals from coils powered by currents in the kA range. To address this issue, an algorithm for robust identification of linear multi-input single-output (MISO) systems has been developed. The MISO model describes the dynamic relationship between measured signals from power sources and observed signals in the diagnostic and allows for a precise subtraction of the noise component. The proposed method was tested on experimental diagnostic data from the DIII-D tokamak, and it has reduced noise by up to 20 dB in the 1-20 kHz range.

Deep modeling of plasma and neutral fluctuations from gas puff turbulence imaging

The role of turbulence in setting boundary plasma conditions is presently a key uncertainty in projecting to fusion energy reactors. To robustly diagnose edge turbulence, we develop and demonstrate a technique to translate brightness measurements of HeI line radiation into local plasma fluctuations via a novel integrated deep learning framework that combines neutral transport physics and collisional radiative theory for the 3³D - 2³P transition in atomic helium with unbounded correlation constraints between the electron density and temperature. The tenets for experimental validity are reviewed, illustrating that this turbulence analysis for ionized gases is transferable to both magnetized and unmagnetized environments with arbitrary geometries. Based on fast camera data on the Alcator C-Mod tokamak, we present the first two-dimensional time-dependent experimental measurements of the turbulent electron density, electron temperature, and neutral density, revealing shadowing effects in a fusion plasma using a single spectral line.

Psychosocial management in cardiac rehabilitation: Current practices, recommendations, and opportunities

Psychosocial management is a core component of outpatient Phase-II cardiac rehabilitation (CR) and includes psychosocial assessment, providing interventions, measuring outcomes, and care coordination. Psychosocial management contributes to the effectiveness of comprehensive CR, but the implementation is not always consistent or clearly described in the literature, in part due to the availability of behavioral health specialists. Patients in CR have many psychosocial needs including anxiety, depression, substance use disorders, sleep problems, psychosocial stress, and cognitive impairment. Behavioral considerations are inherent in many other aspects of CR,such as participation in CR, health behaviors, adherence, and tobacco cessation. Evaluation, or psychosocial assessment, should identify significant issues, record related medications, and incorporate findings in the individual treatment plan. Some patients require further evaluation and treatment by a qualified behavioral health specialist. Psychosocial interventions provided to all patients include patient education, counseling, stress-management, a supportive environment, and exercise. Measuring outcomes entails repeating the psychosocial assessment when patients finish CR and documenting changes. Coordinating care requires understanding available local mental health infrastructure and procedures for making referrals, and may entail identifying additional resources. Interventions provided concurrently with CR to a subset of patients with more extensive needs are typically pharmacotherapy, psychotherapy, or addictions counseling, which are beyond the scope of practice for most CR professionals. The way psychosocial management is implemented suggests clinical and research opportunities. For example, the combined effects of antidepressants and CR on depression and anxiety are not known. A prominent clinical opportunity is to fully implement psychosocial assessment, as required by statute and the core components. This could involve referring patients for whom clinically significant psychosocial concerns are identified during the evaluation for a more thorough assessment by a behavioral health specialist using an appropriate billing model. A research priority is a contemporary description of behavioral health services available to CR programs, including how psychosocial management is implemented. As delivery of CR comes to include more alternative models (e.g., home-based), research is needed on how that affects the delivery of psychosocial management. Increased use of telehealth may broaden clinical opportunities for psychosocial management.

Health Literacy, Cognitive Function, and Mortality in Patients With Heart Failure

BACKGROUND

Health literacy has predicted mortality in heart failure. However, the role of cognitive functioning in this relationship has not been evaluated. We hypothesized that health literacy would predict all-cause mortality but that cognitive functioning would modify the relationship between health literacy and mortality in heart failure.

OBJECTIVE

The aim of this study was to examine the association between health literacy, cognitive functioning, and mortality in patients with heart failure.

METHODS

This secondary analysis of a larger study included 298 patients with heart failure with reduced ejection fraction (trial identifier: NCT01461629). Health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine (REALM) and Medical Term Recognition Test (METER), and cognitive functioning was evaluated using the Modified Mini-Mental Status Examination (3MS). Cox proportional hazards regression was used with time-until-death as the dependent variable.

RESULTS

After controlling for age, sex, and race, neither METER nor REALM scores predicted mortality in heart failure (Ps ≥ .37). However, 3MS predicted mortality in models using the METER (Δχ2 = 9.20, P < .01; B = -.07; hazard ratio, 0.94 [95% confidence interval, 0.89-0.98]; P < .01) and REALM (Δχ2 = 9.77, P < .01; B = -0.07; hazard ratio, 0.94 [95% confidence interval, 0.90-0.97]; P < .01). Furthermore, adding the 3MS improved model fit.

CONCLUSIONS

Cognitive functioning predicted mortality in heart failure better than health literacy. Results suggest the need to further evaluate the contribution of cognitive functioning to increased risk of mortality in those with heart failure.

Delivering Cognitive Behavioral Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App

BACKGROUND

Family members of intensive care unit (ICU) patients are at risk for post-intensive care syndrome- family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management.

OBJECTIVES

To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients.

METHODS

This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms.

RESULTS

The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app.

CONCLUSIONS

The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

Distress and Prevention Behaviors During the COVID-19 Pandemic Among College Students: the Moderating Role of Resilience

Background

Pandemics can generate considerable distress, which can affect prevention behaviors. Resilience may buffer the negative effects of distress on engagement in relevant prevention behaviors, which may also hold true for COVID-19 prevention behaviors. The objective of the current study was to evaluate whether resilience moderated the relationship between distress and COVID-19 prevention behaviors early in the pandemic.

Methods

Data were collected via surveys in which all students at a large midwestern university were emailed invitations beginning March 18, 2020. Surveys were completed by 5,530 individuals. In addition to demographic questions and items about COVID-19 prevention behaviors, distress was assessed using the K6 Distress Scale and resilience using the Brief Resilience Scale. Data were analyzed using moderator regression analysis.

Results

Resilience moderates the effects from distress to prevention behaviors, such that the relationship was stronger for individuals with higher resilience than for individuals with lower resilience. When resilience was one standard deviation below the mean, at the mean value of resilience, and when resilience was one standard deviation above the mean, there was a significant positive relationship between distress and COVID-19 prevention behaviors. However, the relationship was strongest for those with high resilience, and lowest for those with low resilience.

Conclusions

In the current sample, resilience appeared to influence the strength of the relationship between distress and COVID-19 prevention behaviors. Having higher resilience may promote positive adaptation to distress, leading individuals to engage in a greater number of disease-related prevention behaviors. Future research should examine this relationship longitudinally and in relation to differing constructs of resilience.

Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study

BACKGROUND

Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy.

OBJECTIVE

The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients.

METHODS

For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura's social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study.

RESULTS

Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022.

CONCLUSIONS

The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30813.

Uncovering turbulent plasma dynamics via deep learning from partial observations

One of the most intensely studied aspects of magnetic confinement fusion is edge plasma turbulence which is critical to reactor performance and operation. Drift-reduced Braginskii two-fluid theory has for decades been widely applied to model boundary plasmas with varying success. Towards better understanding edge turbulence in both theory and experiment, we demonstrate that a physics-informed deep learning framework constrained by partial differential equations can accurately learn turbulent fields consistent with the two-fluid theory from partial observations of electron pressure which is not otherwise possible using conventional equilibrium models. This technique presents a paradigm for the advanced design of plasma diagnostics and validation of magnetized plasma turbulence theories in challenging thermonuclear environments.

Feasibility study for a high-k temperature fluctuation diagnostic based on soft x-ray imaging

A new pseudolocal tomography algorithm is developed for soft X-ray(SXR) imaging measurements of the turbulent electron temperature fluctuations (δ T_e) in tokamaks and stellarators. The algorithm overcomes the constraints of limited viewing ports on the vessel wall (viewing angle) and limited number of lines of sight (LOS). This is accomplished by increasing the number of LOS locally in a region of interest. Numerical modeling demonstrates that the wavenumber spectrum of the turbulence can be reliably reconstructed, with an acceptable number of viewing angles and LOS and suitable low SNR detectors. We conclude that a SXR imaging diagnostic for measurements of turbulent δ T_e using a pseudolocal reconstruction algorithm is feasible.

A combined community health worker and text messagingbased intervention for smoking cessation in India: Project MUKTI - A mixed methods study

INTRODUCTION

We sought to evaluate the effectiveness of a community health worker (CHW) led smoking cessation intervention, supplemented by text messages, and tailored to an individual’s readiness to quit.

METHODS

We conducted a cluster randomized controlled trial (April 2018–August 2019) in adult smokers residing in a semi-urban region of India. Participants in the intervention arm received CHW-led home visits and had the option of choosing to receive regular text messages. The dose and content of CHW counseling and text messages were tailored to the participant’s readiness to quit. The control group received brief education only. Primary outcome was biochemically verified smoking cessation at the end of 12 months. Both intention-to-treat and as-treated analyses were performed.

RESULTS

A total of 238 (mean age 43±12.3 years, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12 months, 31 (20.5%) participants in the intervention arm and 9 (10.8%) in the control arm quit smoking (absolute risk difference=9.7%; RR=1.69; 95% CI: 0.04–71.33, p=0.74). In the as-treated analysis, 17 (36.9%) of the 46 participants who received optimal dose of the intervention quit smoking.

CONCLUSIONS

CHW-led home-based counseling, supplemented by regular text messages, led to an increase in quit rates for smoking, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging with larger populations, as a supplement to CHW-based counseling.

A 1D Lyman-alpha profile camera for plasma edge neutral studies on the DIII-D tokamak

A one dimensional, absolutely calibrated pinhole camera system was installed on the DIII-D tokamak to measure edge Lyman-alpha (Ly-α) emission from hydrogen isotopes, which can be used to infer neutral density and ionization rate profiles. The system is composed of two cameras, each providing a toroidal fan of 20 lines of sight, viewing the plasma edge on the inboard and outboard side of DIII-D. The cameras' views lie in a horizontal plane 77 cm below the midplane. At its tangency radius, each channel provides a radial resolution of ∼2 cm full width at half maximum (FWHM) with a total coverage of 22 cm. Each camera consists of a rectangular pinhole, Ly-α reflective mirror, narrow-band Ly-α transmission filter, and a 20 channel AXUV photodetector. The combined mirror and transmission filter have a FWHM of 5 nm, centered near the Ly-α wavelength of 121.6 nm and is capable of rejecting significant, parasitic carbon-III (C-III) emission from intrinsic plasma impurities. To provide a high spatial resolution measurement in a compact footprint, the camera utilizes advanced engineering and manufacturing techniques including 3D printing, high stability mirror mounts, and a novel alignment procedure. Absolutely calibrated, spatially resolved Ly-α brightness measurements utilize a bright, isolated line with low parasitic surface reflections and enable quantitative comparison to modeling to study divertor neutral leakage, main chamber fueling, and radial particle transport.

Absolute calibration of the Lyman-α measurement apparatus at DIII-D

The LLAMA (Lyman-Alpha Measurement Apparatus) diagnostic was recently installed on the DIII-D tokamak [Rosenthal et al., Rev. Sci. Instrum. (submitted) (2020)]. LLAMA is a pinhole camera system with a narrow band Bragg mirror, a bandpass interference filter, and an absolute extreme ultraviolet photodiode detector array, which measures the Ly-α brightness in the toroidal direction on the inboard, high field side (HFS) and outboard, low field side (LFS). This contribution presents a setup and a procedure for an absolute calibration near the Ly-α line at 121.6 nm. The LLAMA in-vacuum components are designed as a compact, transferable setup that can be mounted in an ex situ vacuum enclosure that is equipped with an absolutely calibrated Ly-α source. The spectral purity and stability of the Ly-α source are characterized using a vacuum ultraviolet spectrometer, while the Ly-α source brightness is measured by a NIST-calibrated photodiode. The non-uniform nature of the Ly-α source emission was overcome by performing a calibration procedure that scans the Ly-α source position and employs a numerical optimization to determine the emission pattern. Nominal and measured calibration factors are determined and compared, showing agreement within their uncertainties. A first conversion of the measured signal obtained from DIII-D indicates that the Ly-α brightness on the HFS and LFS is on the order of 10²⁰ Ph sr^-1 m^-2 s^-1. The established calibration setup and procedure will be regularly used to re-calibrate the LLAMA during DIII-D vents to monitor possible degradation of optical components and detectors.

The Contribution of Living Arrangements, Social Support, and Self-efficacy to Self-management Behaviors Among Individuals With Heart Failure: A Path Analysis

BACKGROUND

Living arrangements, social support, and self-efficacy have significant implications for self-management science. Despite the theoretical linkages among the 3 concepts, there is limited empirical evidence about their interplay and the subsequent influence on heart failure (HF) self-management.

OBJECTIVE

The aim of this study was to validate components of the Individual and Family Self-management Theory among individuals with HF.

METHODS

This is a secondary analysis of cross-sectional data generated from a sample of 370 individuals with HF. A path analysis was conducted to examine the indirect and direct associations among social environment (living arrangements), social facilitation (social support) and belief (self-efficacy) processes, and self-management behaviors (HF self-care maintenance) while accounting for individual and condition-specific factors (age, sex, race, and HF disease severity).

RESULTS

Three contextual factors (living arrangements, age, and HF disease severity) had direct associations with perceived social support and self-efficacy, which in turn were positively associated with HF self-management behaviors. Living alone (β = -.164, P = .001) was associated with lower perceived social support, whereas being an older person (β = .145, P = .004) was associated with better support. Moderate to severe HF status (β = -.145, P = .004) or higher levels of perceived social support (β = .153, P = .003) were associated with self-efficacy.

CONCLUSIONS

Our results support the Individual and Family Self-management Theory, highlighting the importance of social support and self-efficacy to foster self-management behaviors for individuals with HF. Future research is needed to further explore relationships among living arrangements, perceived and received social support, self-efficacy, and HF self-management.

Depressive Symptoms are Associated with Heart Rate Variability Independently of Fitness: A Cross-Sectional Study of Patients with Heart Failure

BACKGROUND

Depression is associated with reduced heart rate variability (HRV) in healthy and cardiac samples, which may be accounted for by physical fitness. In a small sample of cardiac patients, activity and fitness levels attenuated the relationship between HRV and depression. In the current study of heart failure (HF) patients, we hypothesized that depressive symptoms and HRV would be inversely related and physical fitness would attenuate this association.

PURPOSE

To determine if previous associations among depressive symptoms, physical fitness, and HRV would replicate in a sample of HF patients.

METHODS

The sample consisted of HF patients (N = 125) aged 68.55 ± 8.92 years, 68.8% male, and 83.2% Caucasian. The study was cross-sectional and a secondary analysis of a nonrandomized clinical trial (Trial Identifier: NCT00871897). Depressive symptoms were evaluated using the Beck Depression Inventory (BDI)-II, fitness with the 2 min step test (2MST), and HRV during a 10 min resting laboratory psychophysiology protocol. The dependent variable in hierarchical linear regressions was the root mean square of successive differences.

RESULTS

Controlling for sex, age, β-blocker use, hypertension, and diabetes, higher BDI-II scores significantly predicted lower HRV, β = -.29, t(92) = -2.79, p < .01. Adding 2MST did not attenuate the relationship in a follow-up regression.

CONCLUSION

Depressive symptoms were associated with lower HRV in HF patients, independent of physical fitness. Given the prevalence of depression and suppressed HRV common among HF patients, interventions addressing depressive symptoms and other predictors of poor outcomes may be warranted.

Mineral separation protocol for accurate and precise rhenium-osmium (Re-Os) geochronology and sulphur isotope composition of individual sulphide species

A temporal framework for mineral deposits is essential when addressing the history of their formation and conceptualizing genetic models of their origin. This knowledge is critical to understand how crust-forming processes are related to metal accumulations at specific time and conditions of Earth evolution. To this end, high-precision absolute geochronology utilising the rhenium-osmium (Re-Os) radiometric system in specific sulphide minerals is becoming a method of choice. Here, we present a procedure to obtain mineral separates of individual sulphide species that may coexist within specific mineralized horizons in ore deposits. This protocol is based on preliminary petrographic and paragenetic investigations of sulphide and gangue minerals using reflected and transmitted light microscopy. Our approach emphasizes the key role of a stepwise use of a Frantz isodynamic separator to produce mineral separates of individual sulphide species that are subsequently processed for Re-Os and sulphur isotope geochemistry.•Detailed method and its graphical illustration modified from an original procedure introduced by [1], [2].•Quality control and validation of monophasic mineral separates made by microscopic investigations and qualitative analysis of aliquots embedded in epoxy mounts.•The present method, which contributed to the successful results presented in the co-publication by Saintilan et al. (2020), demonstrates why other studies reporting Re-Os isotope data for mixtures of sulphide minerals should be considered with caution.

Abstract 366: A Combined Community Health Worker and Text Messaging-based Intervention for Smoking Cessation in India

Background: Home-based Community Health Worker (CHW) led care is a mode of health promotion. We sought to evaluate the effectiveness of a CHW-led smoking cessation intervention, supplemented by text messages in a semi-urban region of India.

Methods: We conducted a cluster randomized controlled trial (4/2018- 8/2019) in adult smokers residing in the eastern part of India. Participants in the intervention arm were offered CHW-led home visits that were focused on counseling. In addition, participants could choose to receive text messages. Both CHW counseling and test messages were adapted to the participant’s stage of change. The control group received brief education only. Our primary outcome was self-reported smoking cessation at the end of 12 months, verified by exhaled carbon monoxide levels. CHWs were interviewed at the end of the study.

Results: A total of 234 (mean age 43±12.3, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12-months, 30 (19.8%) participants in the intervention arm and 12 (14.4%) in the control arm quit smoking (absolute risk difference=5.4%; OR 1.46, p = 0.71). There was large cluster-level heterogeneity in intervention uptake (figure). Highlights from the CHW interviews are described in the figure.

Conclusion: CHW-led home-based counseling, supplemented by regular text messages, led to a slight increase in quit rates, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging options, as an enhanced supplement to CHW based counseling.

Exploring How Trait Mindfulness Relates to Perceived Stress and Cardiovascular Reactivity

BACKGROUND

Mindfulness interventions have been associated with less global perceived stress as well as attenuated cardiovascular reactivity. The aim of the present study was to evaluate whether high levels of trait mindfulness would also be associated with these benefits.

METHODS

Participants were 99 healthy young adults aged 18-25 years. Self-report measures included the Five Facet Mindfulness Questionnaire and the Perceived Stress Scale. Participants completed a laboratory stress protocol comprised of a resting baseline, a mental arithmetic stress task, and a resting recovery period. Blood pressure, heart rate, and heart rate variability were measured throughout the protocol. Regressions were used to analyze whether trait mindfulness predicted global perceived stress, cardiovascular reactivity, and cardiovascular recovery.

RESULTS

Two trait mindfulness facets were found to be associated with less global perceived stress, Acting with Awareness (β = - .306, p = .002) and Nonjudgment (β = - .342, p < .001). Exploratory analyses also revealed an interaction between the Observe and Nonreactivity facets (p = .002), such that the Observe facet was associated with less stress only when Nonreactivity scores were also high. Although trait mindfulness was not a significant predictor of the physiological variables (p > .05, Cohen's f² < .060), exploratory analyses revealed an interaction between the Awareness and Nonjudgment facets (p < .001), such that Awareness is associated with lower diastolic blood pressure reactivity only when Nonjudgment scores are also high.

CONCLUSIONS

Like mindfulness interventions, trait mindfulness is associated with less global perceived stress. Interactions between trait mindfulness facets that reflect attention monitoring and acceptance might predict physiological reactivity in certain contexts, though a mindful state might be necessary for most real-time cardiovascular benefits.

Examination of attention, executive function, and memory as predictors of mortality risk in adults with systolic heart failure

BACKGROUND

The prevalence and impact of cognitive impairment in heart failure is increasingly recognized. Converging evidence points to global cognitive function as predictive of prognosis in adults with heart failure when assessed with screening tools. Additional work is needed to understand which domains of cognitive function are most relevant for prognosis.

AIMS

The present study sought to examine associations between domains of cognitive function and mortality risk in adults with heart failure.

METHODS

In the present prospective, observational cohort study, global cognitive function, attention, executive function, and memory were assessed by means of a comprehensive neuropsychogical battery in adults with systolic heart failure. Mortality data were obtained from the National Death Index (median follow-up 2.95 years). Relationships among each cognitive domain and mortality were assessed with Cox regression. Covariates included age, sex, heart failure severity, comorbidity and depressive symptoms.

RESULTS

Participants were 325 patients with systolic heart failure with a mean age of 68.6 years (59% men, 73% Caucasian). Following covariate adjustment, better global cognitive function, attention, and executive function were related to decreased mortality risk.

CONCLUSIONS

Future research is needed to clarify the underlying mechanisms of the association between cognitive impairment and mortality.

Sleep quality and daytime sleepiness are not associated with cognition in heart failure

BACKGROUND

Individuals with heart failure (HF) exhibit comorbid impairments in both sleep and cognitive performance. Sleep quality has been associated with impaired cognitive performance in HF patients, but reports are inconsistent. In this study, we examined associations between sleep quality, daytime sleepiness, and cognitive function in HF.

METHODS AND RESULTS

Participants were 267 (age = 69.1 ± 9.3) mostly Caucasian (74.9%), male (59.6%) stable HF patients recruited from outpatient settings. This cross-sectional study was a secondary analysis of a prospective observational study. Cognitive function domains assessed included: global cognitive function, attention, memory, and executive function. Sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Separate multiple hierarchical linear regressions were conducted to determine associations between cognitive function and sleep quality and daytime sleepiness, after controlling for sex, New York Heart Association (NYHA) class, education, depressive symptoms, and medical comorbidities. Cognitive function was not associated with sleep quality or daytime sleepiness after alpha inflation corrections were applied.

CONCLUSIONS

Cognitive function in HF is not associated with sleep quality or daytime sleepiness; other factors may exert greater influence on cognitive performance.

Observation of Efficient Lower Hybrid Current Drive at High Density in Diverted Plasmas on the Alcator C-Mod Tokamak

Efficient lower hybrid current drive (LHCD) is demonstrated at densities up to n[over ¯]_{e}≈1.5×10^{20}  m^{-3} in diverted plasmas on the Alcator C-Mod tokamak by operating at increased plasma current-and therefore reduced Greenwald density fraction. This density exceeds the nominal "LH density limit" at n[over ¯]_{e}≈1.0×10^{20}  m^{-3} reported previously, above which an anomalous loss of current drive efficiency was observed. The recovery of current drive efficiency to a level consistent with engineering scalings is correlated with a reduction in density shoulders and turbulence levels in the far scrape-off layer. Concurrently, rf wave interaction with the edge and/or scrape-off-layer plasma is reduced, as indicated by a minimal broadening of the wave frequency spectrum measured at the plasma edge. These results have important implications for sustaining steady-state tokamak operation and indicate a pathway forward for implementing efficient LHCD in a reactor.

Cognitive and Self-regulatory Mechanisms of Obesity Study (COSMOS): Study protocol for a randomized controlled weight loss trial examining change in biomarkers, cognition, and self-regulation across two behavioral treatments

Obesity is a global epidemic, yet successful interventions are rare. Up to 60% of people fail to achieve clinically meaningful, short-term weight loss (5-10% of start weight), whereas up to 72% are unsuccessful at achieving long-term weight loss (5-10% loss for ≥5years). Understanding how biological, cognitive, and self-regulatory factors work together to promote or to impede weight loss is clearly needed to optimize obesity treatment. This paper describes the methodology of the Cognitive and Self-regulatory Mechanisms of Obesity Study (the COSMOS trial). COSMOS is the first randomized controlled trial to investigate how changes in multiple biopsychosocial and cognitive factors relate to weight loss and one another across two weight loss treatments. The specific aims are to: 1) Confirm that baseline obesity-related physiological dysregulation is linked to cognitive deficits and poorer self-regulation, 2) Evaluate pre- to post-treatment change across time to assess individual differences in biomarkers, cognition, and self-regulation, and 3) Evaluate whether the acceptance-based treatment (ABT) group has greater improvements in outcomes (e.g., greater weight loss and less weight regain, improvements in biomarkers, cognition, and self-regulation), than the standard behavioral treatment group (SBT) from pre- to post-treatment and 1-year follow-up. The results of COSMOS will provide critical information about how dysregulation in biomarkers, cognition, and/or self-regulation is related to weight loss and whether weight loss treatments are differentially associated with these factors. This information will be used to identify promising treatment targets that are informed by biological, cognitive, and self-regulatory factors in order to advance obesity treatment.

Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure

Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20-50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.

Controlled testing of novel portion control plate produces smaller self-selected portion sizes compared to regular dinner plate

Background

Obesity is a global health crisis, and portion control is a key method for reducing excess body weight. Given consumers’ familiarity with large portion sizes, reducing portion sizes can be difficult. Smaller plates are often recommended to reduce portion sizes and appear to reduce portion sizes. However, there are no studies evaluating dishes specifically designed to facilitate portion control. The aim of the present study was to validate the efficacy of a novel portion control plate inspired by the Ebbinghaus and Delboeuf visual illusions to promote serving smaller portions compared to a larger dinner plate.

Methods

In two studies with a total of 110 university students, we determined whether the use of the portion control plate would result in smaller food portions compared to a larger dinner plate. The portion control plate was smaller and incorporated portion size indicators. Study 1 used instructions from My Plate based on plate ratios (e.g., “the USDA recommends filling half your plate with vegetables”) and study 2 used absolute portion size recommendations (e.g., “1 cup of vegetables”).

Results

The portion control plate produced smaller self-selected servings in both studies. However, the servings of vegetables selected were smaller than recommended portion sizes for both the portion control plate and the regular dinner plate.

Conclusions

Portion control plates have the potential to reduce self-selected portion sizes. Future research should include studies in a broader range of ages and clinical trials of portion control dishes for weight loss.

Electronic supplementary material

The online version of this article (doi:10.1186/s40608-017-0167-z) contains supplementary material, which is available to authorized users.

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure

OBJECTIVE

Heart failure affects more than 5 million U.S. adults, and approximately 20% of individuals with heart failure experience depressive symptoms. Depression is detrimental to prognosis in heart failure, conferring approximately a 2-fold increase in mortality risk. Medication nonadherence may help explain this relationship because depressed patients are less likely to adhere to the medication regimen.

METHOD

Depression, electronically monitored medication adherence, and mortality were measured in a sample of 308 patients with heart failure participating in a study of self-management behavior. Cardiovascular and all-cause mortality data were obtained from the Centers for Disease Control and Prevention's National Death Index (median 2.9-year follow-up). Cox proportional hazards regression was used to assess the relationship between depression and mortality, with and without adjustment for age, gender, disease severity, and medication nonadherence.

RESULTS

In adjusted analyses, depression was associated with an increased all-cause mortality risk (hazard ratio 1.87; 95% confidence interval 1.04-3.37). Depression was not related to cardiovascular mortality, potentially because of a low number of cardiac-related deaths. When medication nonadherence was added to the model, nonadherence (hazard ratio 1.01; 95% confidence interval 1.004-1.02), but not depression, predicted all-cause mortality risk.

CONCLUSIONS

Depressive symptoms confer increased all-cause mortality risk in heart failure, and medication nonadherence contributes to this relationship. Depression and nonadherence represent potentially modifiable risk factors for poor prognosis. Future research is needed to understand whether interventions that concomitantly target these factors can improve outcomes. (PsycINFO Database Record

Fast Low-to-High Confinement Mode Bifurcation Dynamics in a Tokamak Edge Plasma Gyrokinetic Simulation

Transport barrier formation and its relation to sheared flows in fluids and plasmas are of fundamental interest in various natural and laboratory observations and of critical importance in achieving an economical energy production in a magnetic fusion device. Here we report the first observation of an edge transport barrier formation event in an electrostatic gyrokinetic simulation carried out in a realistic diverted tokamak edge geometry under strong forcing by a high rate of heat deposition. The results show that turbulent Reynolds-stress-driven sheared E×B flows act in concert with neoclassical orbit loss to quench turbulent transport and form a transport barrier just inside the last closed magnetic flux surface.

Internal health locus of control predicts willingness to track health behaviors online and with smartphone applications

Given rising technology use across all demographic groups, digital interventions offer a potential strategy for increasing access to health information and care. Research is lacking on identifying individual differences that impact willingness to use digital interventions, which may affect patient engagement. Health locus of control, the amount of control an individual believes they have over their own health, may predict willingness to use mobile health (mHealth) applications ('apps') and online trackers. A cross-sectional study (n = 276) was conducted to assess college students' health locus of control beliefs and willingness to use health apps and online trackers. Internal and powerful other health locus of control beliefs predicted willingness to use health apps and online trackers while chance health locus of control beliefs did not. Individuals with internal and powerful other health locus of control beliefs are more willing than those with chance health locus of control beliefs to utilize a form of technology to monitor or change health behaviors. Health locus of control is an easy-to-assess patient characteristic providers can measure to identify which patients are more likely to utilize mHealth apps and online trackers.

Turbulence Nonlinearities Shed Light on Geometric Asymmetry in Tokamak Confinement Transitions

A comprehensive study of fully frequency-resolved nonlinear kinetic energy transfer has been performed for the first time in a diverted tokamak, providing new insight into the parametric dependences of edge turbulence transitions. Measurements using gas puff imaging in the turbulent L-mode state illuminate the source of the long known but as yet unexplained "favorable-unfavorable" geometric asymmetry of the power threshold for transition to the turbulence-suppressed H mode. Results from the recently discovered I mode point to a competition between zonal flow (ZF) and geodesic-acoustic modes (GAM) for turbulent energy, while showing new evidence that the I-to-H transition is still dominated by ZFs. The availability of nonlinear drive for the GAM against net heat flux through the edge corresponds very well to empirical scalings found experimentally for accessing the I mode.

Depression increases the risk of mortality in patients with heart failure: A meta-analysis

BACKGROUND

Depression is a risk factor for mortality in cardiovascular diseases. Prior studies confirm that depression predicts adverse outcomes in patients with heart failure (HF). However, data were inconclusive regarding the effect of depression on mortality. This meta-analysis examines the relationship between depression and mortality in HF.

METHODS

Prospective studies of depression and mortality in HF published between 1999 and April 2016 were located using PubMed, PsychINFO, and MEDLINE. Comprehensive Meta-Analysis software was used to compute an aggregated effect size estimates of hazard ratios and to conduct subgroup analyses.

RESULTS

Eighteen studies met inclusion criteria. For 8 aggregated univariate and 14 multivariate estimates, depressive symptoms were related to all-cause mortality. A pooled HR of 3 multivariate analyses indicated that depressive symptoms were not linked to cardiovascular mortality. In subgroup analyses, depression predicted all-cause mortality in samples with a mean age >65. The impact of depression on all-cause mortality also differed by follow-up duration, with samples with shorter follow-up durations demonstrating a larger effect.

CONCLUSIONS

In HF, depression is related to increased all-cause mortality risk, with stronger effects in samples with shorter follow-up and in older adults. In older adults, depression may serve as a marker of more severe HF. However, this possibility is difficult to examine given inconsistent adjustment for HF severity. Additional studies may assist in determining the relationship between depression and cardiovascular mortality, as the low number of studies examining cardiovascular mortality may have precluded detection of an effect.

Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure

BACKGROUND

Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments.

METHODS AND RESULTS

A prospective observational cohort design of 309 community-dwelling patients with HF (59.7% male, 68.7±9.7 years) and no history of dementia or neurological disease. Cognition was assessed using a neuropsychological battery at baseline. Medication adherence was objectively measured for 21 days using an electronic pillbox. Regression analyses tested whether attention, executive function, or memory predicted 21-day medication adherence. In unadjusted analyses, lower scores on all 3 cognitive domains predicted poorer medication adherence (β=0.52-85; P=0.001-0.009). After adjusting for demographic, clinical, and psychosocial variables, memory continued to predict medication adherence (β=0.51; P=0.008), whereas executive function (β=0.24; P=0.075) and attention were no longer a predictor (β=0.34; P=0.131).

CONCLUSIONS

Poorer cognitive function, especially in regard to memory, predicted reduced medication adherence among patients with HF and no history of dementia. This effect remained after adjustment for factors known to predict adherence, such as depressed mood, social support, and disease severity level. Future studies should examine the link from cognitive impairment and medication nonadherence to clinical outcomes (eg, hospitalization and mortality).

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01461629.

Temperature gradient scale length measurement: A high accuracy application of electron cyclotron emission without calibration

Calibration is a crucial procedure in electron temperature (T_e) inference from a typical electron cyclotron emission (ECE) diagnostic on tokamaks. Although the calibration provides an important multiplying factor for an individual ECE channel, the parameter ΔT_e/T_e is independent of any calibration. Since an ECE channel measures the cyclotron emission for a particular flux surface, a non-perturbing change in toroidal magnetic field changes the view of that channel. Hence the calibration-free parameter is a measure of T_e gradient. B_T-jog technique is presented here which employs the parameter and the raw ECE signals for direct measurement of electron temperature gradient scale length.

Cognitive function and health literacy are independently associated with heart failure knowledge

OBJECTIVES

Determine the relationship between cognitive function and health literacy in heart failure (HF) knowledge in patients with HF.

BACKGROUND

HF requires extensive, complex treatment; thus, cognition and health literacy may contribute to understanding and self-management of HF.

METHODS

Participants were 330 HF outpatients. Health literacy was assessed using the Medical Term Recognition Test and the Rapid Estimate of Adult Literacy in Medicine. Global cognitive function was screened with the Modified Mini-Mental Status Examination. HF knowledge was assessed with the Dutch Heart Failure Knowledge Scale (DHFKS).

RESULTS

Health literacy (β = .26, p < .001) and cognition (β = .36, p < .001) were related to DHFKS. Both scores were independently associated with DHFKS (health literacy: β = .13, p = .044 and cognition: β = .30, p < .001).

CONCLUSIONS

Impairments in health literacy and cognition were independently associated with reduced HF knowledge. Interventions should address both factors to be maximally effective.

Perceived Racism and Ambulatory Blood Pressure in African American College Students

Experiences with racial discrimination may contribute to stress-induced blood pressure (BP) elevations among African Americans. It was reported that perceived racism was associated with ambulatory BP (ABP) during waking hours. This study examined perceived racism and ABP among 40 African American college students, who completed an ABP assessment from which daytime and nighttime averages were computed. Perceived frequency of experiences with racism and racial discrimination was measured using the Perceived Racism Scale. Controlling for gender and body mass index, perceived racism in academic settings was associated with higher diastolic BP (DBP) during waking hours and nighttime sleep. Systolic BP (SBP) was unrelated to perceived racism, and perceived racism in the public realm and in statements from Whites was unrelated to ABP. Perceived racism in academic settings predicted ambulatory DBP among college students. Previous laboratory research has found stronger effects of perceived racism for DBP than SBP. The hemodynamic regulation of BP may explain this phenomenon. Future laboratory and ambulatory studies should assess the contributions of vascular resistance and cardiac output to BP elevations associated with perceived racism.

The association between cognitive function and objective adherence to dietary sodium guidelines in patients with heart failure

BACKGROUND

Although cognitive impairment is common in heart failure (HF) patients, its effects on sodium adherence recommendations are unknown.

PURPOSE

Our aim is to examine if cognitive function is associated with patient sodium adherence.

METHODS

Sodium collection/excretion and cognitive function were assessed for 339 HF patients over a 5-8-week period. Neuropsychological testing was performed at baseline (Visit 1), whereas two 24-hour urine samples were collected within 7 weeks postbaseline. The ability to collect two 24-hour urine samples and the estimation of sodium excretion levels from these samples were used to estimate sodium adherence recommendations.

RESULTS

Nearly half (47%) of the study participants (n=159) were unable to give two valid 24-hour urine samples. Participants who were unable to adhere to two valid 24-hour urine samples had significantly poorer attention and global cognition tests (P<0.044), with a trend for poorer executive function (P=0.064). Among those with valid samples, urine sodium level was not associated with global cognitive function, attention, executive function, or memory after adjusting for covariates. Female sex was associated with lower sodium excretion (all P<0.01); individuals with knowledge of sodium guidelines had less intake of sodium, resulting in excretion of less sodium (all P≤0.03). Conversely, higher socioeconomic status (SES) and body mass index (BMI) were associated with greater sodium (all P≤0.02 and P≤0.01).

CONCLUSION

Adherence to urine sodium collection was poor, especially among those with poorer cognitive function. Sodium consumption exceeded recommended amounts and was unrelated to cognitive function. Interventions for improving sodium adherence should focus on at-risk groups (high SES and BMI) and at improving knowledge of recommended salt intake.

Effects of exercise on c-reactive protein in healthy patients and in patients with heart disease: A meta-analysis

Decreases in circulating hsCRP have been associated with increased physical activity and exercise training, although the ability of exercise interventions to reduce hsCRP and which individuals benefit the most remains unclear. This meta-analysis evaluates the ability of exercise to reduce hsCRP levels in healthy individuals and in individuals with heart disease. A systematic review and meta-analysis was conducted that included exercise interventions trials from 1995 to 2012. Forty-three studies were included in the final analysis for a total of 3575 participants. Exercise interventions significantly reduced hsCRP (standardized mean difference -0.53 mg/L; 95% CI, -0.74 to -0.33). Results of sub-analysis revealed no significant difference in reductions in hsCRP between healthy adults and those with heart disease (p = .20). Heterogeneity between studies could not be attributed to age, gender, intervention length, intervention type, or inclusion of diet modification. Exercise interventions reduced hsCRP levels in adults irrespective of the presence of heart disease.​.

Performance of the Automated Neuropsychological Assessment Metrics (ANAM) in detecting cognitive impairment in heart failure patients

OBJECTIVE

Evaluate capacity of the Automated Neuropsychological Assessment Metrics (ANAM) to detect cognitive impairment (CI) in heart failure (HF) patients.

BACKGROUND

CI is a key prognostic marker in HF. Though the most widely used cognitive screen in HF, the Mini-Mental State Examination (MMSE) is insufficiently sensitive. The ANAM has demonstrated sensitivity to cognitive domains affected by HF, but has not been assessed in this population.

METHODS

Investigators administered the ANAM and MMSE to 57 HF patients, compared against a composite model of cognitive function.

RESULTS

ANAM efficiency (p < .05) and accuracy scores (p < .001) successfully differentiated CI and non-CI. ANAM efficiency and accuracy scores classified 97.7% and 93.0% of non-CI patients, and 14.3% and 21.4% with CI, respectively.

CONCLUSIONS

The ANAM is more effective than the MMSE for detecting CI, but further research is needed to develop a more optimal cognitive screen for routine use in HF patients.

What is your patient's cognitive profile? Three distinct subgroups of cognitive function in persons with heart failure

PURPOSE

The aim of this study was to determine whether patients with heart failure (HF) have distinct profiles of cognitive impairment.

BACKGROUND

Cognitive impairment is common in HF. Recent work found three cognitive profiles in HF patients-(1) intact, (2) impaired, and (3) memory-impaired. We examined the reproducibility of these profiles and clarified mechanisms.

METHODS

HF patients (68.6 ± 9.7 years; N=329) completed neuropsychological testing. Composite scores were created for cognitive domains and used to identify clusters via agglomerative-hierarchical cluster analysis.

RESULTS

A 3-cluster solution emerged. Cluster 1 (n=109) had intact cognition. Cluster 2 (n=123) was impaired across all domains. Cluster 3 (n=97) had impaired memory only. Clusters differed in age, race, education, SES, IQ, BMI, and diabetes (ps ≤ .026) but not in mood, anxiety, cardiovascular, or pulmonary disease (ps ≥ .118).

CONCLUSIONS

We replicated three distinct patterns of cognitive function in persons with HF. These profiles may help providers offer tailored care to patients with different cognitive and clinical needs.

Adherence to antidepressant medications: a randomized controlled trial of medication reminding in college students

OBJECTIVES

To determine if medication reminding via smartphone app increases adherence to antidepressant medications in college students.

PARTICIPANTS

College students (N = 57) enrolled at a state-funded institution who had a current prescription for an antidepressant and regularly used a smartphone device.

METHODS

Participants were randomized to either a reminder group or a control group. Both groups were asked to complete a survey and undergo a manual pill count at the beginning of the study and 30 days later.

RESULTS

There was a strong trend suggesting that the use of a medication reminder app was beneficial for adherence to antidepressant medication regimens. Factors influencing medication adherence in college students included health beliefs, use of illicit drugs, and type of professional care received.

CONCLUSIONS

Use of a medication reminder may increase adherence to antidepressant medications in college students.