Daniel L. Hall

Stress management skills, cortisol awakening response, and post-exertional malaise in Chronic Fatigue Syndrome.

Chronic Fatigue Syndrome (CFS) is characterized in part by debilitating fatigue typically exacerbated by cognitive and/or physical exertion, referred to as post-exertional malaise (PEM). In a variety of populations, the cortisol awakening response (CAR) has stood out as a marker of endocrine dysregulation relevant to the experience of fatigue, and may therefore be particularly relevant in CFS. This is the first study to examine PEM and the CAR in a sample of individuals with CFS. The CAR has also been established as a stress-sensitive measure of HPA axis functioning. It follows that better management of stress could modulate the CAR, and in turn PEM. In this cross-sectional study, we hypothesized that greater Perceived Stress Management Skills (PSMS) would relate to lower reports of PEM, via the impact of PSMS on the CAR. A total of 117 adults (72% female) with a CFS diagnosis completed self-report measures of PSMS and PEM symptomatology and a two-day protocol of saliva collection. Cortisol values from awakening and 30 min post-awakening were used to compute the CAR. Regression analyses revealed that greater PSMS related to greater CAR and greater CAR related to less PEM severity. Bootstrapped analyses revealed an indirect effect of PSMS on PEM via the CAR, such that greater PSMS related to less PEM, via a greater CAR. Future research should examine these trends longitudinally and whether interventions directed at improving stress management skills are accompanied by improved cortisol regulation and less PEM in individuals with CFS.

Translation of the Diabetes Prevention Program to Ethnic Communities in the United States

The Diabetes Prevention Program (DPP), an evidenced-based lifestyle intervention for type 2 diabetes (T2D), has been translated for use with ethnic minority communities throughout the United States that are disproportionately at-risk for T2D. The present paper sought to critically review ethnic translation studies of the DPP with respect to translation methods utilized, the success of these methods, and alternative or supplemental methodologies for future translation efforts. Manuscripts reviewed were found by searching PubMed and PsycINFO, using the terms: “diabetes prevention program” AND [“translation” or “ethnic”]. Of 89 papers found, only 6 described ethnic translations of the DPP in the United States, and were included in this review. Translations of the DPP to African American, Hispanic/Latino, Native Hawaiian and Other Pacific Islander, Arab American, and American Indian and Native Alaskan communities were identified and reviewed. The most common translation strategies included group-based delivery and use of bilingual study personnel. Generally, these factors appeared to increase acceptability of the intervention within the ethnic communities reviewed, and should be considered in future efforts to implement and translate the DPP to ethnic communities in the United States.

Integrity of Literature on Expressed Emotion and Relapse in Patients with Schizophrenia Verified by a p-Curve Analysis

There is growing concern that much published research may have questionable validity due to phenomena such as publication bias and p-hacking. Within the psychiatric literature, the construct of expressed emotion (EE) is widely assumed to be a reliable predictor of relapse across a range of mental illnesses. EE is an index of the family climate, measuring how critical, hostile, and overinvolved a family member is toward a mentally ill patient. No study to date has examined the evidential value of this body of research as a whole. That is to say, although many studies have shown a link between EE and symptom relapse, the integrity of the literature from which this claim is derived has not been tested. In an effort to confirm the integrity of the literature of EE predicting psychiatric relapse in patients with schizophrenia, we conducted a p-curve analysis on all known studies examining EE (using the Camberwell Family Interview) to predict psychiatric relapse over a 9- to 12-month follow-up period. Results suggest that the body of literature on EE is unbiased and has integrity, as there was a significant right skew of p-values, a nonsignificant left skew of p-values, and a nonsignificant test of flatness. We conclude that EE is a robust and valuable predictor of symptom relapse in schizophrenia.

Poor sleep quality is associated with greater circulating pro-inflammatory cytokines and severity and frequency of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) symptoms in women

OBJECTIVE Poor sleep quality has been linked to inflammatory processes and worse disease outcomes in the context of many chronic illnesses, but less is known in conditions such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This study examines the relationships between sleep quality, pro-inflammatory cytokines, and CFS/ME symptoms. METHODS Sixty women diagnosed with CFS/ME were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Symptom Inventory (FSI) and Center for Disease Control and Prevention (CDC)-based CFS/ME symptom questionnaires. Circulating plasma pro-inflammatory cytokine levels were measured by ELISA. Multiple regression analyses examined associations between sleep, cytokines and symptoms, controlling for age, education, and body mass index. RESULTS Poor sleep quality (PSQI global score) was associated with greater pro-inflammatory cytokine levels: interleukin-1β (IL-1β) (β=0.258, p=0.043), IL-6 (β=0.281, p=0.033), and tumor necrosis factor-alpha (TNF-α) (β=0.263, p=0.044). Worse sleep quality related to greater fatigue severity (β=0.395, p=0.003) and fatigue-related interference with daily activities (β=0.464, p<0.001), and more severe and frequent CDC-defined core CFS/ME symptoms (β=0.499, p<0.001, and β=0.556, p<0.001, respectively). CONCLUSIONS Results underscore the importance of managing sleep-related difficulties in this patient population. Further research is needed to identify the etiology of sleep disruptions in CFS/ME and mechanistic factors linking sleep quality to symptom severity and inflammatory processes.

Telephone-administered versus live group cognitive behavioral stress management for adults with CFS

OBJECTIVE Chronic fatigue syndrome (CFS) symptoms have been shown to be exacerbated by stress and ameliorated by group-based psychosocial interventions such as cognitive behavioral stress management (CBSM). Still, patients may have difficulty attending face-to-face groups. This study compared the effects of a telephone-delivered (T-CBSM) vs a live (L-CBSM) group on perceived stress and symptomology in adults with CFS. METHODS Intervention data from 100 patients with CFS (mean age 50years; 90% female) participating in T-CBSM (N=56) or L-CBSM (N=44) in previously conducted randomized clinical trials were obtained. Perceived Stress Scale (PSS) and the Centers for Disease Control and Prevention symptom checklist scores were compared with repeated measures analyses of variance in adjusted and unadjusted analyses. RESULTS Participants across groups showed no differences in most demographic and illness variables at study entry and had similar session attendance. Both conditions showed significant reductions in PSS scores, with L-CBSM showing a large effect (partial ε2=0.16) and T-CBSM a medium effect (partial ε2=0.095). For CFS symptom frequency and severity scores, L-CBSM reported large effect size improvements (partial ε2=0.19-0.23), while T-CBSM showed no significant changes over time. CONCLUSIONS Two different formats for delivering group-based CBSM-live and telephone-showed reductions in perceived stress among patients with CFS. However, only the live format was associated with physical symptom improvements, with specific effects on post-exertional malaise, chills, fever, and restful sleep. The added value of the live group format is discussed, along with implications for future technology-facilitated group interventions in this population.

Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis

Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind‐body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR.

Depression, evening salivary cortisol and inflammation in chronic fatigue syndrome: A psychoneuroendocrinological structural regression model

INTRODUCTION Chronic Fatigue Syndrome (CFS) is a poorly understood illness that is characterized by diverse somatic symptoms, hypothalamic pituitary adrenal (HPA) axis dysfunction and heightened inflammatory indicators. These symptoms are often exacerbated and accompanied by psychological distress states and depression. Since depression is known to be associated with HPA axis dysfunction and greater inflammation, a psychoneuroendocrinological (PNE) model of inflammation was examined in persons diagnosed with CFS in order to uncover underlying biopsychosocial mechanisms in this poorly understood chronic illness. METHODS Baseline data were drawn from two randomized controlled trials testing the efficacy of different forms of psychosocial intervention, and included psychological questionnaires, di-urnal salivary cortisol, and blood samples. Data were analyzed with structural equation modeling (SEM). RESULTS The sample (N=265) was mostly middle-aged (Mage=49.36±10.9, range=20-73years), Caucasian (67.7%), female (81.7%), highly educated (85.5% completed some college, college, or graduate program), and depressed (CES-D M=23.87±12.02, range 2-57). The SEM supporting a psychoneuroendocrinological model of immune dysregulation in CFS fit the data χ2 (12)=17.725, p=0.1243, RMSEA=0.043, CFI=0.935, SRMR=0.036. Depression was directly related to evening salivary cortisol and inflammation, such that higher evening cortisol predicted greater depressive symptoms (β=0.215, p<0.01) and higher pro-inflammatory cytokines (interleukin-2 [IL-2], IL-6, and tumor necrosis factor-alpha [TNF-α] levels (β=0.185, p<0.05), when controlling for covariates. DISCUSSION Results highlight the role of depression, cortisol and inflammation in possible biological mechanisms involved in the pathophysiology of CFS. Time-lagged, longitudinal analyses are needed to fully explore these relationships.

Project reach: Piloting a risk-tailored smoking cessation intervention for lung screening

The purpose of this study was to explore the feasibility, acceptability, and efficacy of a telephone-based smoking cessation intervention for lung screening patients. Participants (N = 39) were enrolled in a single-arm pilot study of a four-session telephone-based intervention. Self-report measures were completed at baseline, post-intervention, and 3-month follow-up. Participants were long-term smokers; 62 percent were not motivated to quit. Twenty-three percent attempted quitting, 29 percent decreased their smoking, and 11 percent reported abstinence. Confidence increased (p < .001) and there were trends toward increased importance (p = .09) and comparative disease risk (p = .02). This intervention was acceptable and associated with improvements in smoking-related beliefs and behaviors.

Supervision of clinical assessment: The Multilevel Assessment Supervision and Training (MAST) approach

Supportive and effective clinical supervision is imperative to the training and development of assessment skills in clinical psychology. This article presents the development of the Multilevel Assessment Supervision and Training approach, a clinic-based method to supervision of assessment. This approach utilizes advanced predoctoral students to serve as peer supervisors for beginning predoctoral trainees conducting psychoeducational assessments. It offers several advantages, providing a peer mentoring supervisory experience during graduate education, improving the training experience and oversight for beginning trainees, and improving service delivery. Satisfaction ratings were collected from graduate trainees and their peer supervisors who support the utility of this approach.

Performance of the Cornell ERL Main Linac Prototype Cryomodule

Cornell has designed, fabricated, and completed initial cool down test of a high current (100 mA) CW SRF main linac prototype cryomodule for the Cornell ERL. This paper will report on the design and performance of this very high Q0 CW cryomodule including design issues and mitigation strategies. INTRODUCTION Cornell University has proposed to build Energy Recovery Linac (ERL) as drivers for hard x-ray sources because of their ability to produce electron bunches with small, flexible cross sections and short lengths at high repetition rates. The proposed Cornell ERL is designed to operate in CW at 1.3GHz, 2ps bunch length, 100mA average current in each of the accelerating and decelerating beams, normalized emittance of 0.3mmmrad, and energy ranging from 5GeV down to 10MeV, at which point the spent beam is directed to a beam stop [1, 2]. The design of main linac prototype cryomodule (MLC) for Cornell ERL had been completed in 2012. The fabrication and testing of MLC components (cavity, high power input coupler, HOM dampers, tuners, etc.,) and assembly of MLC cold mass had been completed in 2014. MLC installation and cooldown preparations began in this summer. We will describe about MLC and initial cool down results in this proceeding. MLC GENERAL LAYOUT The general layout of an ERL main linac cryomodule (MLC) is shown in Fig. 1. It is 9.8 m long and houses six 1.3 GHz 7-cell superconducting cavities with Individual HOM absorbers and one magnet/BPM section. Each cavity has a single coaxial RF input coupler which transfers power from an RF power source to the beam loaded cavity. The specification values of 7-cell cavities are Qo of 2.0e10 at 16.2MV/m, 1.8K. Due to the high beam current combined with the short bunch operation, a careful control and efficient damping of higher order modes (HOMs) is essential. So HOMs are installed next to each cavity. To minimize ambient magnetic field of high-Q 7-cell cavities, MLC has three layers of magnetic shielding; 1) Vacuum Vessel (carbon steel), 2) 80/40 K magnetic shield enclosing the cold mass, and 3) 2 K magnetic shield enclosing individual cavities. All components within the cryomodule are suspended from the Helium Gas Return Pipe (HGRP). This large diameter (280mm) titanium pipe will return the gaseous helium boiled off the cavity vessel to the liquefier and act as a central support girder. The HGRP will be supported by 3 support post. The middle one is fixed; the other side posts are not and will slide by 7-9mm respectively during the cooldown from room temperature to cold. 7-CELL CAVITIES FOR MLC Vertical Test Results All 7-cell cavities for MLC were fabricated in house. Three of six cavities were stiffened cavity and the other three were un-stiffened cavity. Cavity surface preparation recipe consists of bulk Buffered Chemical Polishing (BCP, 140um), degassing (650degC*4days), frequency and field flatness tuning, light BCP (10um), low temperature baking (120degC*48hrs), and HF rinse [3]. Figure 2 shows best Q(E)curve of MLC 7-cell cavities during vertical test (VT) at 1.8K. All 7-cell cavities had surpassed the specification values of Qo=2.0e10 at 16.2MV/m, 1.8K. In fact, average Qo=(3.0±0.3)*1e10 had been achieved during VT at 16.2MV/m, 1.8K. All VT was limited by administrative limit, no radiation or no quench were detected during VT. ____________________________________________ * Work is supported by NSF Grants NSF DMR-0807731 and NSF #ff97@cornell.edu PHY-1002467 Figure 1: Cornell ERL Main Linac Prototype Cryomodule Proceedings of SRF2015, Whistler, BC, Canada FRAA04 SRF Technology Cavity E06-Elliptical performance ISBN 978-3-95450-178-6 1437 C op yr ig ht