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"Worrell, David"
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The treatment of attachment disorders in the context of the foster care system
Relevant research analyzing the psychosocial characteristics of foster children was reviewed in order to provide a context to explore the empirical literature on the treatment of attachment disorders with this population. The literature related to the psychosocial characteristics of foster children suggested that children entering foster care are more psychologically disturbed than in previous years and are at a greater risk for psychopathology than their home-reared counterparts. There was sparse literature on the treatment of attachment disorders and few actual outcome studies on the effectiveness of a specific treatment approach on a population of children identified as having attachment disorders. Various studies of a more empirical nature were reviewed and included in this review on the basis of their author's conceptions of their subjects as having either attachment disorder or some disruption in the subject's attachment relationships. The treatment approaches found in these studies were discussed in terms of their possible contributions to clinicians working specifically with foster children in the context of the foster care system.
Dissertation
Remember how cuts targeted our schools
Throughout the state, teachers and education staff professionals are losing their jobs, schools are being closed, arts and music programs curtailed or eliminated, after-school programs and summer classes canceled or scaled back, and school resource officers and crossing guards are being cut.
Newspaper Article
Optogenetic perturbation of preBötzinger complex inhibitory neurons modulates respiratory pattern
The authors investigated the role of glycinergic preBötC neurons in respiratory rhythmogenesis in mice using viral delivery of Channelrhodopsin-2 (ChR2) or Archaerhodopsin (Arch) genes. They conclude that glycinergic preBötC neurons modulate inspiratory pattern and are important for reflex apneas but that the rhythm can persist after significant dampening of their activity.
Inhibitory neurons make up a substantial fraction of the neurons in the preBötzinger complex (preBötC), a site that is critical for mammalian eupneic breathing. We investigated the role of glycinergic preBötC neurons in respiratory rhythmogenesis in mice using optogenetically targeted excitation and inhibition. Channelrhodopsin-2 (ChR2) or Archaerhodopsin (Arch) were expressed in glycinergic preBötC neurons of glycine transporter 2 (
Glyt2
, also known as
Slc6a5
)-
Cre
mice. In ChR2-transfected mice, brief inspiratory-phase bilateral photostimulation targeting the preBötC prematurely terminated inspiration, whereas expiratory-phase photostimulation delayed the onset of the next inspiration. Prolonged photostimulation produced apneas lasting as long as the light pulse. Inspiratory-phase photoinhibition in Arch-transfected mice during inspiration increased tidal volume without altering inspiratory duration, whereas expiratory-phase photoinhibition shortened the latency until the next inspiration. During persistent apneas, prolonged photoinhibition restored rhythmic breathing. We conclude that glycinergic preBötC neurons modulate inspiratory pattern and are important for reflex apneas, but that the rhythm can persist after substantial dampening of their activity.
Journal Article
Long-term wireless streaming of neural recordings for circuit discovery and adaptive stimulation in individuals with Parkinson’s disease
Neural recordings using invasive devices in humans can elucidate the circuits underlying brain disorders, but have so far been limited to short recordings from externalized brain leads in a hospital setting or from implanted sensing devices that provide only intermittent, brief streaming of time series data. Here, we report the use of an implantable two-way neural interface for wireless, multichannel streaming of field potentials in five individuals with Parkinson’s disease (PD) for up to 15 months after implantation. Bilateral four-channel motor cortex and basal ganglia field potentials streamed at home for over 2,600 h were paired with behavioral data from wearable monitors for the neural decoding of states of inadequate or excessive movement. We validated individual-specific neurophysiological biomarkers during normal daily activities and used those patterns for adaptive deep brain stimulation (DBS). This technological approach may be widely applicable to brain disorders treatable by invasive neuromodulation.
An implanted device in the brain enables wireless neural monitoring and stimulation for up to 15 months following implantation.
Journal Article
Investigating the effects of indoor lighting on measures of brain health in older adults: protocol for a cross-over randomized controlled trial
Background
The worldwide number of adults aged 60 years and older is expected to double from 1 billion in 2019 to 2.1 billion by 2050. As the population lives longer, the rising incidence of chronic diseases, cognitive disorders, and behavioral health issues threaten older adults’ health span. Exercising, getting sufficient sleep, and staying mentally and socially active can improve quality of life, increase independence, and potentially lower the risk for Alzheimer’s disease or other dementias. Nonpharmacological approaches might help promote such behaviors. Indoor lighting may impact sleep quality, physical activity, and cognitive function. Dynamically changing indoor lighting brightness and color throughout the day has positive effects on sleep, cognitive function, and physical activity of its occupants. The aim of this study is to investigate how different indoor lighting conditions affect such health measures to promote healthier aging.
Methods
This protocol is a randomized, cross-over, single-site trial followed by an exploratory third intervention. Up to 70 older adults in independent living residences at a senior living facility will be recruited. During this 16-week study, participants will experience three lighting conditions. Two cohorts will first experience a static and a dynamic lighting condition in a cluster-randomized cross-over design. The static condition lighting will have fixed brightness and color to match lighting typically provided in the facility. For the dynamic condition, brightness and color will change throughout the day with increased brightness in the morning. After the cross-over, both cohorts will experience another dynamic lighting condition with increased morning brightness to determine if there is a saturation effect between light exposure and health-related measures. Light intake, sleep quality, and physical activity will be measured using wearable devices. Sleep, cognitive function, mood, and social engagement will be assessed using surveys and cognitive assessments.
Discussion
We hypothesize participants will have better sleep quality and greater physical activity during the dynamic lighting compared to the static lighting condition. Additionally, we hypothesize there is a maximal threshold at which health-outcomes improve based on light exposure. Study findings may identify optimal indoor lighting solutions to promote healthy aging for older adults.
Trial registration
ClinicalTrials.gov Identifier: NCT05978934.
Journal Article
Centromedian Nucleus of the Thalamus Deep Brain Stimulation for Genetic Generalized Epilepsy: A Case Report and Review of Literature
There is a paucity of treatment options for cognitively normal individuals with drug resistant genetic generalized epilepsy (GGE). Centromedian nucleus of the thalamus (CM) deep brain stimulation (DBS) may be a viable treatment for GGE. Here, we present the case of a 27-year-old cognitively normal woman with drug resistant GGE, with childhood onset. Seizure semiology are absence seizures and generalized onset tonic clonic (GTC) seizures. At baseline she had 4-8 GTC seizures per month and weekly absence seizures despite three antiseizure medications and vagus nerve stimulation. A multidisciplinary committee recommended off-label use of CM DBS in this patient. Over 12-months of CM DBS she had two GTC seizure days, which were in the setting of medication withdrawal and illness, and no GTC seizures in the last 6 months. There was no significant change in the burden of absence seizures. Presently, just two studies clearly document CM DBS in cognitively normal individuals with GGE or idiopathic generalized epilepsy (IGE) (in contrast to studies of cognitively impaired individuals with developmental and epileptic encephalopathies (DEE)). Our results suggest that CM DBS can be an effective treatment for cognitively normal individuals with GGE and underscore the need for prospective studies of CM DBS.
Journal Article
Deep learning identifies brain structures that predict cognition and explain heterogeneity in cognitive aging
Specific brain structures (gray matter regions and white matter tracts) play a dominant role in determining cognitive decline and explain the heterogeneity in cognitive aging. Identification of these structures is crucial for screening of older adults at risk of cognitive decline. Using deep learning models augmented with a model-interpretation technique on data from 1432 Mayo Clinic Study of Aging participants, we identified a subset of brain structures that were most predictive of individualized cognitive trajectories and indicative of cognitively resilient vs. vulnerable individuals. Specifically, these structures explained why some participants were resilient to the deleterious effects of elevated brain amyloid and poor vascular health. Of these, medial temporal lobe and fornix, reflective of age and pathology-related degeneration, and corpus callosum, reflective of inter-hemispheric disconnection, accounted for 60% of the heterogeneity explained by the most predictive structures. Our results are valuable for identifying cognitively vulnerable individuals and for developing interventions for cognitive decline.
Graphical abstract
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Journal Article
Population-based spectral characteristics of normal interictal scalp EEG inform diagnosis and treatment planning in focal epilepsy
Normal routine electroencephalograms (EEGs) can cause delays in the diagnosis and treatment of epilepsy, especially in drug-resistant patients and those without structural abnormalities. There is a need for alternative quantitative approaches that can inform clinical decisions when traditional visual EEG review is inconclusive. We leverage a large population EEG database (
N
= 13,652 recordings, 12,134 unique patients) and an independent cohort of patients with focal epilepsy (
N
= 121) to investigate whether normal EEG segments could support the diagnosis of focal epilepsy. We decomposed expertly graded normal EEGs (
N
= 6,242) using unsupervised tensor decomposition to extract the dominant spatio-spectral patterns present in a clinical population. We then, using the independent cohort of patients with focal epilepsy, evaluated whether pattern loadings of normal interictal EEG segments could classify focal epilepsy, the epileptogenic lobe, presence of lesions, and drug response. We obtained six physiological patterns of EEG spectral power and connectivity with distinct spatio-spectral signatures. Both pattern types together effectively differentiated patients with focal epilepsy from non-epileptic controls (mean AUC 0.78) but failed to classify the epileptogenic lobe. Spectral power-based patterns best classified drug-resistant epilepsy (mean AUC 0.73) and lesional epilepsy (mean AUC 0.67), albeit with high variability across patients. Our findings support that visibly normal patient EEGs contain subtle quantitative differences of clinical relevance. Further development may yield normal EEG-based computational biomarkers that can augment traditional EEG review and epilepsy care.
Journal Article