Multi-omics microsampling for the profiling of lifestyle-associated changes in health

Current healthcare practices are reactive and use limited physiological and clinical information, often collected months or years apart. Moreover, the discovery and profiling of blood biomarkers in clinical and research settings are constrained by geographical barriers, the cost and inconvenience of in-clinic venepuncture, low sampling frequency and the low depth of molecular measurements. Here we describe a strategy for the frequent capture and analysis of thousands of metabolites, lipids, cytokines and proteins in 10 μl of blood alongside physiological information from wearable sensors. We show the advantages of such frequent and dense multi-omics microsampling in two applications: the assessment of the reactions to a complex mixture of dietary interventions, to discover individualized inflammatory and metabolic responses; and deep individualized profiling, to reveal large-scale molecular fluctuations as well as thousands of molecular relationships associated with intra-day physiological variations (in heart rate, for example) and with the levels of clinical biomarkers (specifically, glucose and cortisol) and of physical activity. Combining wearables and multi-omics microsampling for frequent and scalable omics may facilitate dynamic health profiling and biomarker discovery.

Relationship of Heterologous Virus Responses and Outcomes in Hospitalized COVID-19 Patients

The clinical trajectory of COVID-19 may be influenced by previous responses to heterologous viruses. We examined the relationship of Abs against different viruses to clinical trajectory groups from the National Institutes of Health IMPACC (Immunophenotyping Assessment in a COVID-19 Cohort) study of hospitalized COVID-19 patients. Whereas initial Ab titers to SARS-CoV-2 tended to be higher with increasing severity (excluding fatal disease), those to seasonal coronaviruses trended in the opposite direction. Initial Ab titers to influenza and parainfluenza viruses also tended to be lower with increasing severity. However, no significant relationship was observed for Abs to other viruses, including measles, CMV, EBV, and respiratory syncytial virus. We hypothesize that some individuals may produce lower or less durable Ab responses to respiratory viruses generally (reflected in lower baseline titers in our study), and that this may carry over into poorer outcomes for COVID-19 (despite high initial SARS-CoV-2 titers). We further looked at longitudinal changes in Ab responses to heterologous viruses, but found little change during the course of acute COVID-19 infection. We saw significant trends with age for Ab levels to many of these viruses, but no difference in longitudinal SARS-CoV-2 titers for those with high versus low seasonal coronavirus titers. We detected no difference in longitudinal SARS-CoV-2 titers for CMV seropositive versus seronegative patients, although there was an overrepresentation of CMV seropositives among the IMPACC cohort, compared with expected frequencies in the United States population. Our results both reinforce findings from other studies and suggest (to our knowledge) new relationships between the response to SARS-CoV-2 and Abs to heterologous viruses.

Developmental venous anomaly thrombosis in a patient with coronavirus disease 2019-associated hypercoagulability: illustrative case

BACKGROUND

Spontaneous thrombosis of a developmental venous abnormality (DVA) is a rare complication associated with hypercoagulability. The objective of this case report is to describe an association between DVA thrombosis and mild coronavirus disease 2019 (COVID-19) infection in a vaccinated patient.

OBSERVATIONS

A 28-year-old male with hypertension presented with severe headache and left-sided hemiparesis. Five weeks prior to presentation, the patient experienced mild respiratory symptoms and tested positive for COVID-19. Admission brain computed tomography (CT) showed a large right parieto-occipital intracerebral hemorrhage with surrounding edema. CT venography and catheter angiography showed a thrombosed DVA with associated venous infarction as the hemorrhage etiology. He was treated with decompressive hemicraniectomy, external ventricular drain placement, and systemic anticoagulation. The patient was functionally independent (modified Rankin Scale score, 2) at 4-month follow-up. Hypercoagulability work-up was unremarkable.

LESSONS

Delayed DVA thrombosis after the COVID-19 infectious period may represent an association between the infection and a protracted systemic viral-induced hypercoagulable state. The severity of COVID-19 symptomatology does not appear to correlate with risk of DVA thrombosis. Young patients with a recent history of COVID-19 infection who present with venous infarction should be evaluated for an underlying thrombosed DVA.

Robust identification of temporal biomarkers in longitudinal omics studies

MOTIVATION

Longitudinal studies increasingly collect rich 'omics' data sampled frequently over time and across large cohorts to capture dynamic health fluctuations and disease transitions. However, the generation of longitudinal omics data has preceded the development of analysis tools that can efficiently extract insights from such data. In particular, there is a need for statistical frameworks that can identify not only which omics features are differentially regulated between groups but also over what time intervals. Additionally, longitudinal omics data may have inconsistencies, including non-uniform sampling intervals, missing data points, subject dropout and differing numbers of samples per subject.

RESULTS

In this work, we developed OmicsLonDA, a statistical method that provides robust identification of time intervals of temporal omics biomarkers. OmicsLonDA is based on a semi-parametric approach, in which we use smoothing splines to model longitudinal data and infer significant time intervals of omics features based on an empirical distribution constructed through a permutation procedure. We benchmarked OmicsLonDA on five simulated datasets with diverse temporal patterns, and the method showed specificity greater than 0.99 and sensitivity greater than 0.87. Applying OmicsLonDA to the iPOP cohort revealed temporal patterns of genes, proteins, metabolites and microbes that are differentially regulated in male versus female subjects following a respiratory infection. In addition, we applied OmicsLonDA to a longitudinal multi-omics dataset of pregnant women with and without preeclampsia, and OmicsLonDA identified potential lipid markers that are temporally significantly different between the two groups.

AVAILABILITY AND IMPLEMENTATION

We provide an open-source R package (https://bioconductor.org/packages/OmicsLonDA), to enable widespread use.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Effects of hyperoxemia on aneurysmal subarachnoid hemorrhage outcomes: a systematic review and meta-analysis

OBJECTIVE

In recent years, hyperoxemia in the intensive care unit has received attention as potentially contributing to negative outcomes in the setting of cardiac arrest, ischemic stroke, and traumatic brain injury. The authors sought to evaluate whether hyperoxemia contributes to worse outcomes in the setting of aneurysmal subarachnoid hemorrhage (aSAH) and to summarize suggested pathophysiological mechanisms.

METHODS

A systematic literature review was conducted without date restrictions on the PubMed and Web of Science databases on September 15, 2021. All studies that assessed the relationship between patients treated for aSAH and hyperoxemia were eligible independent of the criteria used to define hyperoxemia. All nonclinical studies and studies that did not report outcome data specific to patients with aSAH were excluded. A total of 102 records were found and screened, resulting in assessment of 10 full-text studies, of which 7 met eligibility criteria. Risk of bias was assessed using the Downs and Black checklist. A meta-analysis on the pooled 2602 patients was performed, and forest plots were constructed. Additionally, a review of the literature was performed to summarize available data regarding the pathophysiology of hyperoxemia.

RESULTS

The included studies demonstrated an association between hyperoxemia and increased morbidity and mortality following aSAH. The criteria used to determine hyperoxemia varied among studies. Pooling of univariate data showed hyperoxemia to be associated with poor neurological outcome (OR 2.26, 95% CI 1.66-3.07; p < 0.001), delayed cerebral ischemia (DCI) (OR 1.91, 95% CI 1.31-2.78; p < 0.001), and increased incidence of poor neurological outcome or mortality as a combined endpoint (OR 2.36, 95% CI 1.87-2.97; p < 0.001). Pooling of multivariable effect sizes showed the same relationship for poor neurological outcome (OR 1.28, 95% CI 1.07-1.55; p = 0.01) and poor neurological outcome and mortality as a combined endpoint (OR 1.17, 95% CI 1.11-1.23; p < 0.001). Additionally, review of preclinical studies underlined the contribution of oxidative stress due to hyperoxemia to acute secondary brain injury and DCI.

CONCLUSIONS

Reported outcomes from the available studies have indicated that hyperoxemia is associated with worse neurological outcome, mortality, and DCI. These findings provide a general guideline toward avoiding hyperoxemia in the acute setting of aSAH. Further studies are needed to determine the optimal ventilation and oxygenation parameters for acute management of this patient population.

Early detection of SARS-CoV-2 and other infections in solid organ transplant recipients and household members using wearable devices

The increasing global prevalence of SARS-CoV-2 and the resulting COVID-19 disease pandemic pose significant concerns for clinical management of solid organ transplant recipients (SOTR). Wearable devices that can measure physiologic changes in biometrics including heart rate, heart rate variability, body temperature, respiratory, activity (such as steps taken per day) and sleep patterns, and blood oxygen saturation show utility for the early detection of infection before clinical presentation of symptoms. Recent algorithms developed using preliminary wearable datasets show that SARS-CoV-2 is detectable before clinical symptoms in >80% of adults. Early detection of SARS-CoV-2, influenza, and other pathogens in SOTR, and their household members, could facilitate early interventions such as self-isolation and early clinical management of relevant infection(s). Ongoing studies testing the utility of wearable devices such as smartwatches for early detection of SARS-CoV-2 and other infections in the general population are reviewed here, along with the practical challenges to implementing these processes at scale in pediatric and adult SOTR, and their household members. The resources and logistics, including transplant-specific analyses pipelines to account for confounders such as polypharmacy and comorbidities, required in studies of pediatric and adult SOTR for the robust early detection of SARS-CoV-2, and other infections are also reviewed.

Pre-symptomatic detection of COVID-19 from smartwatch data

Consumer wearable devices that continuously measure vital signs have been used to monitor the onset of infectious disease. Here, we show that data from consumer smartwatches can be used for the pre-symptomatic detection of coronavirus disease 2019 (COVID-19). We analysed physiological and activity data from 32 individuals infected with COVID-19, identified from a cohort of nearly 5,300 participants, and found that 26 of them (81%) had alterations in their heart rate, number of daily steps or time asleep. Of the 25 cases of COVID-19 with detected physiological alterations for which we had symptom information, 22 were detected before (or at) symptom onset, with four cases detected at least nine days earlier. Using retrospective smartwatch data, we show that 63% of the COVID-19 cases could have been detected before symptom onset in real time via a two-tiered warning system based on the occurrence of extreme elevations in resting heart rate relative to the individual baseline. Our findings suggest that activity tracking and health monitoring via consumer wearable devices may be used for the large-scale, real-time detection of respiratory infections, often pre-symptomatically.

Glucotypes reveal new patterns of glucose dysregulation

Diabetes is an increasing problem worldwide; almost 30 million people, nearly 10% of the population, in the United States are diagnosed with diabetes. Another 84 million are prediabetic, and without intervention, up to 70% of these individuals may progress to type 2 diabetes. Current methods for quantifying blood glucose dysregulation in diabetes and prediabetes are limited by reliance on single-time-point measurements or on average measures of overall glycemia and neglect glucose dynamics. We have used continuous glucose monitoring (CGM) to evaluate the frequency with which individuals demonstrate elevations in postprandial glucose, the types of patterns, and how patterns vary between individuals given an identical nutrient challenge. Measurement of insulin resistance and secretion highlights the fact that the physiology underlying dysglycemia is highly variable between individuals. We developed an analytical framework that can group individuals according to specific patterns of glycemic responses called "glucotypes" that reveal heterogeneity, or subphenotypes, within traditional diagnostic categories of glucose regulation. Importantly, we found that even individuals considered normoglycemic by standard measures exhibit high glucose variability using CGM, with glucose levels reaching prediabetic and diabetic ranges 15% and 2% of the time, respectively. We thus show that glucose dysregulation, as characterized by CGM, is more prevalent and heterogeneous than previously thought and can affect individuals considered normoglycemic by standard measures, and specific patterns of glycemic responses reflect variable underlying physiology. The interindividual variability in glycemic responses to standardized meals also highlights the personal nature of glucose regulation. Through extensive phenotyping, we developed a model for identifying potential mechanisms of personal glucose dysregulation and built a webtool for visualizing a user-uploaded CGM profile and classifying individualized glucose patterns into glucotypes.

Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience

Introduction

Completed randomized trials on endovascular thrombectomy (ET) did not independently assess the efficacy of ET in the elderly (≥80 years old) who were often excluded or under-represented in trials. There were also inconsistent criteria for patient selection in this population across the different trials. This work evaluates outcomes after ET for acute ischemic stroke (AIS) in the elderly at a high volume stroke center.

Methods

We reviewed all cases of AIS that underwent a direct aspiration first pass technique (ADAPT) thrombectomy for large vessel occlusions between March 2013 and October 2017 while comparing outcomes in the elderly with younger counterparts. We also reviewed AIS cases in elderly patients undergoing medical management who were matched to the ET counterparts by demographics, comorbidities, baseline deficits, and stroke severity.

Results

Of 560 patients undergoing ET for AIS, 108 patients were in the elderly group (≥80 years of age), and had a significantly lower likelihood of functional independence (defined as a modified Rankin Scale score of 0–2) at 90 days compared with younger patients (20.5% vs 44.4%, P<0.001), and higher mortality rates (34.3% vs 20%, P<0.001). When compared with patients undergoing medical management, elderly patients did not have a significant improvement in rates of good outcomes (20.5% vs 19.5%, P>0.05), and had significantly higher rates of hemorrhage (40.7% vs 9.3%, P<0.001). We also identified baseline stroke severity and the incidence of hemorrhage as two independent predictors of outcome in the elderly patients.

Conclusions

ET in the elderly did not show a similar benefit to younger patients when compared with medical management. These findings emphasize the need for more optimal selection criteria for the elderly population to improve the risk to benefit ratio of ET.

Incorporation of a Physical Education and Nutrition Program Into Neurosurgery: A Proof of Concept Pilot Program

BACKGROUND

Balancing the demands of a busy medical career with personal wellness can be daunting, and there is little education on these principles available to physicians in training.

OBJECTIVE

To implement a voluntary wellness initiative in our neurosurgery department to promote healthy lifestyle choices. This report details the baseline data collected as part of this quality improvement initiative.

METHODS

The wellness initiative was implemented in July 2015 and available to all faculty and resident physicians in the Department of Neurological Surgery in collaboration with the Medical University of South Carolina Wellness Center. All participants were provided a Fitbit Surge HR wrist monitor (Fitbit, Boston, Massachusetts) and underwent baseline physical and psychological testing.

RESULTS

Six faculty physicians and 9 residents participated. Overall physical fitness levels varied widely between subjects. Health screening demonstrated abnormalities in 80% of participants (elevated systolic blood pressure in 60%, elevated diastolic in 47%, elevated serum low-density lipoprotein in 53%). Body composition analysis demonstrated body weight higher than ideal in 69% (47% overweight; 13% obese). Recommended average body fat mass reduction was 25.4 pounds. Seventy-nine percent reported below-average quality of life compared with the average healthy adult. All subjects reported wanting more time for personal health.

CONCLUSION

Baseline health and psychological screenings in our department demonstrated alarmingly prevalent, previously undiagnosed abnormalities on cardiovascular and body weight screenings. Obstacles to leading a healthier lifestyle have been identified and solutions have been incorporated into the program. This quality improvement initiative may serve as a template for other programs seeking to improve physician physical and mental well-being.

ABBREVIATIONS

BMI, body mass indexESS, Epworth Sleepiness ScaleHR, heart rate.

Effects of agricultural conservation practices on N loads in the Mississippi-atchafalaya river basin

A modeling framework consisting of a farm-scale model, Agricultural Policy Environmental Extender (APEX); a watershed-scale model, Soil and Water Assessment Tool (SWAT); and databases was used in the Conservation Effects Assessment Project to quantify the environmental benefits of conservation practices on cropland. APEX is used to simulate conservation practices on cultivated cropland and Conservation Reserve Program land to assess the edge-of-field water-quality benefits. Flow and pollutant loadings from APEX are input to SWAT. SWAT simulates the remaining noncultivated land and routes flow and loads generated from noncultivated land, point sources, and cropland to the basin outlet. SWAT is used for assessing the effects of practices on local and in-stream water-quality benefits. Each river basin is calibrated and validated for streamflow and loads at multiple gauging stations. The objectives of the current study are to estimate the effects of currently existing and additional conservation practices on total N (TN) loads in the Mississippi-Atchafalaya River Basin (MARB) and draw insights on TN load reductions necessary for reducing the hypoxic zone in the Gulf of Mexico. The effects of conservation practice scenarios on local and in-stream (riverine) water quality are evaluated. Model results indicate that conservation practices currently on cropland have reduced the TN losses to local waters between 20 and 59% in the six river basins within MARB and the TN load discharged to the Gulf by 17%. Further water-quality improvement can be obtained in the MARB with additional conservation treatment.

Spontaneous NF-κB activation by autocrine TNFα signaling: a computational analysis

NF-κB is a key transcription factor that regulates innate immune response. Its activity is tightly controlled by numerous feedback loops, including two negative loops mediated by NF-κB inducible inhibitors, IκBα and A20, which assure oscillatory responses, and by positive feedback loops arising due to the paracrine and autocrine regulation via TNFα, IL-1 and other cytokines. We study the NF-κB system of interlinked negative and positive feedback loops, combining bifurcation analysis of the deterministic approximation with stochastic numerical modeling. Positive feedback assures the existence of limit cycle oscillations in unstimulated wild-type cells and introduces bistability in A20-deficient cells. We demonstrated that cells of significant autocrine potential, i.e., cells characterized by high secretion of TNFα and its receptor TNFR1, may exhibit sustained cytoplasmic-nuclear NF-κB oscillations which start spontaneously due to stochastic fluctuations. In A20-deficient cells even a small TNFα expression rate qualitatively influences system kinetics, leading to long-lasting NF-κB activation in response to a short-pulsed TNFα stimulation. As a consequence, cells with impaired A20 expression or increased TNFα secretion rate are expected to have elevated NF-κB activity even in the absence of stimulation. This may lead to chronic inflammation and promote cancer due to the persistent activation of antiapoptotic genes induced by NF-κB. There is growing evidence that A20 mutations correlate with several types of lymphomas and elevated TNFα secretion is characteristic of many cancers. Interestingly, A20 loss or dysfunction also leaves the organism vulnerable to septic shock and massive apoptosis triggered by the uncontrolled TNFα secretion, which at high levels overcomes the antiapoptotic action of NF-κB. It is thus tempting to speculate that some cancers of deregulated NF-κB signaling may be prone to the pathogen-induced apoptosis.

Hand and microvascular replantation call availability study: a national real-time survey of level-I and level-II trauma centers

BACKGROUND

Inconsistent availability of subspecialty hand and microvascular emergency call services could influence patient outcomes and the efficiency of a system dependent on limited resources and timely intervention because declining reimbursements, increased medicolegal risk, lack of confidence in microsurgical skills, and the disruption of elective schedules present a deterrent to call panel participation. This study assessed the availability of hand and microvascular replantation surgery call services at all level-I and level-II trauma centers in the United States.

METHODS

Between May and December 2010, all level-I (N = 137) and level-II (N = 153) trauma centers across the U.S. were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our institutional review board-approved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital.

RESULTS

Level-I trauma centers: 117 (85%) of 137 participated, and sixty-four (55%) of these had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services for fifteen to thirty-one days per month, and three hospitals supported services for one to fifteen days per month. Ten hospitals indicated inconsistent coverage, which was difficult to estimate, and thirty-four hospitals reported no coverage. Level-II trauma centers: 132 (86%) of 153 participated, and thirty-eight (29%) of these had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services for fifteen to thirty-one days per month, and three hospitals provided coverage for one to fifteen days per month. Eighty-four hospitals reported no specific coverage protocol.

CONCLUSIONS

Inconsistency in the definition and coverage of emergency hand and microvascular replantation services was identified at level-I and level-II trauma centers across the U.S. Many hospitals indicated the presence of subspecialty hand surgery coverage; however, the determination of microvascular replantation resources was not available consistently. The results of our study strengthen previous conclusions about the need for a more defined and coordinated system of emergency microvascular replantation surgery services in order to improve the efficiency of a limited resource and, ultimately, improve patient care.

Cannabinoid CB1 receptor-dependent long-term depression in autaptic excitatory neurons

Long-term depression (LTD) of synaptic signaling-lasting from tens of minutes to hours or longer-is a widespread form of synaptic plasticity in the brain. Neurons express diverse forms of LTD, including autaptic LTD (autLTD) observed in cultured hippocampal neurons, the mechanism of which remains unknown. We have recently reported that autaptic neurons express both endocannabinoid-mediated depolarization-induced suppression of excitation (DSE) and metabotropic suppression of excitation (MSE). We now report that activating cannabinoid CB(1) receptors is necessary for the induction of autLTD. Most surprisingly, CB(1) does not induce autLTD via the G(i/o) proteins typically activated by this receptor nor with G(s). Rather, the requirements of presynaptic phospholipase C and filled calcium stores suggest G(q). In autLTD, a 3- to 4-min activation of the receptor by the endocannabinoid 2-arachidonoyl glycerol leads to prolonged inhibition while leaving short-term inhibition (e.g., DSE) intact. autLTD requires activation of both metabo- and ionotropic glutamate receptors. autLTD also requires MEK/ERK activation. Under certain conditions, one or more DSE stimuli will elicit autLTD. It is becoming evident that cannabinoids mediate multiple forms of plasticity at a single synapse, stretching temporally from tens of seconds (DSE/MSE) to tens of minutes (autLTD) to hours (CB(1) desensitization). Our findings imply a remarkable flexibility for the cannabinoid signaling system whereby discrete mechanisms of CB(1) activation within a single neuron yield temporally and mechanistically distinct forms of plasticity.

Specialty newborn care: trends and issues

OBJECTIVE

This report explores the availability of neonatal special care services in the US and examines the variation in those services from both the staffing and service perspectives.

STUDY DESIGN

The American Hospital Association survey of hospitals and a special national survey of hospitals with special care services were used as data sources to describe changes in the status of high-risk care between 1983 and 1997. The latter survey had a 69% response rate and was a collaborative effort among the March of Dimes, the Maternal and Child Health Bureau, the American Hospital Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, Ross Labs, and the National Perinatal Information Center (NPIC).

RESULTS

The study found that across all regions of the US, the special care supply has expanded. However, the study shows wide variation in medical staffing even among those hospitals offering the most intensive services; 25% had no physician in-house coverage 24 hr/d.

CONCLUSION

There is wide availability of high-risk newborn care which is a possible oversupply; however, differential physician staffing raises issues regarding the need for more standardized care.

Administrative data for quality improvement

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.

Effects of electrical and electromagnetic stimulation after anterior cruciate ligament reconstruction

A need exists to develop new methods of neuromuscular electrical stimulation (NMES) that are both effective and relatively pain-free. The purpose of this pilot study was to determine the effects of both NMES and a new method of electromagnetic (NMES/PEMF) stimulation for reducing girth loss and for reducing pain and muscle weakness of the knee extensor muscles in patients during the first 6 weeks after reconstructive surgery of the anterior cruciate ligament (ACL). Seventeen patients receiving ACL reconstructive surgery participated as a control group (N = 3), as an NMES group (N = 7), and with combined NMES and magnetic field stimulation (NMES/PEMF) (N = 7). Patients receiving NMES/PEMF rated each type of stimulation for perceived pain and were measured for their torque. Torque results revealed a mean decrease of 13.1% for NMES/PEMF patients. The mean percent of thigh girth decreased 8.3% for controls, 0.5% for NMES, and 2.3% for NMES/PEMF patients. The NMES/PEMF patients rated NMES as causing about twice the pain intensity as NMES/PEMF during treatments. As a result of this data, the authors conclude that both NMES and NMES/PEMF are effective in reducing girth loss and that NMES/PEMF is less painful than NMES alone in treating patients after ACL reconstruction.

Attribution theory, insomnia, and the reverse placebo effect: a reversal of Storms and Nisbett's findings

Storms and Nisbett found that insomniacs got to sleep faster than usual on nights when they took placebos believed to be arousal pills. Our study attempted: (a) to replicate the reverse placebo effect using a method of measurement considered more accurate than the original technique, (b) to evaluate the effect of an arousal pill therapy after therapy is discontinued, and (c) to clarify which of two hypotheses better accounts for the effect. Using 42 insomniacs, the design varied whether pills were administered (pill) or withheld (no pill) and whether or not high justification was provided for taking the pills. The high-justification-pill and the high-justification-no-pill groups were given information intended to justify their participation, while the no-justification-pill and no-pill-no-justification groups were treated like the original arousal and control groups. Instead of a decrease in latency to sleep, the no-justification-pill group but not the high-justification-pill troup displayed a typical placebo reaction on nights they took the pills. Our results cast suspicion on the original finding. The lack of response by the high-justification-pill group is discussed in terms of Bem and Kelley's views of attribution theory.

Attribution theory, insomnia, and the reverse placebo effect: A reversal of Storms and Nisbett's findings

Storms and Nisbett found that insomniacs got to sleep faster than usual on nights when they took placebos believed to be arousal pills. Our study attempted: (a) to replicate the reverse placebo effect using a method of measurement considered more accurate than the original technique, (b) to evaluate the effect of an arousal pill therapy after therapy is discontinued, and (c) to clarify which of two hypotheses better accounts for the effect. Using 42 insomniacs, the design varied whether pills were administered (pill) or withheld (no pill) and whether or not high justification was provided for taking the pills. The high-justification-pill and the high-justification-no-pill groups were given information intended to justify their participation, while the no-justification-pill and no-pill-no-justification groups were treated like the original arousal and control groups. Instead of a decrease in latency to sleep, the no-justification-pill group but not the high-justification-pill troup displayed a typical placebo reaction on nights they took the pills. Our results cast suspicion on the original finding. The lack of response by the high-justification-pill group is discussed in terms of Bem and Kelley's views of attribution theory.