Search

Background: Current pharmacological and behavioral treatment options for mild cognitive impairment (MCI) are limited, motivating a search for alternative therapies that might slow the progression of cognitive decline. Objective: We investigated the effectiveness of a cognition-focused mindfulness-based intervention. Methods: An open-label, three arm randomized controlled trial was conducted at a public tertiary medical center. Older persons (ages 45–75; N = 76) diagnosed with MCI were recruited and randomized into either mindfulness-based training (MBT), cognitive rehabilitation therapy (CRT), or treatment as usual (TAU). Participants in the intervention arms received 8 weekly 2-h sessions delivered in a group setting and engaged in home practice. Primary outcomes measures included changes in index scores for attention, immediate memory, and delayed memory as measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Depression was a secondary outcome. Results: Using intent-to-treat analysis, we found that participants receiving MBT showed significant improvements in global cognition (d = 0.26; [95%CI 0.03–0.56]) and delayed memory (d = 0.36; [95%CI 0.17–0.57]), with significantly greater improvements in delayed memory than CRT (ηp2 = 0.10). However, there was no benefit of MBT over TAU. No change in depression was observed in the MBT group. Reductions in depression were associated with improvements in cognitive functioning in the MBT group only. Conclusion: Our results suggest that a cognition-focused MBT did not improve cognitive functioning in MCI patients substantially more than spontaneous reversion rates, possibly as mood symptoms were not significantly alleviated in this group.

This article explores the history of the little-known polygamy exclusion in the 1891 Immigration Act. Tracing the development of this polygamy restriction in the late nineteenth century, the article shows how anxieties about the European migration of Mormon converts shaped immigration legislation, which was then almost immediately redirected to regulate the migration of Turkish immigrants by the early 1900s. Racialized as “American Mohammedans,” Mormons came to embody a foreign, “uncivilized,” and semi-imperial threat for many nineteenth-century Americans. As the persecution of Mormons receded in the 1890s, however, the increasing visibility of Muslim immigrants from the Ottoman Empire fed new fears about religious difference, racial inferiority, and sexual and marital deviance. US immigration officials addressed such concerns by attempting to apply the polygamy exclusion on Turkish immigrants, but soon found themselves at the center of diplomatic tensions between US and Ottoman officials. Analyzing the imperial negotiations at play as US immigration law ran up against the power of the Ottoman Empire, the article brings deeper attention to the ways in which the policing of polygamy and “proper” marital formations were ultimately shaped by anxieties over race, religion, and empire.

ObjectivePoor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults.MethodsWe conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO).ResultsIntention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects.ConclusionsMBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

Older adults with poor sleep tend to show a discrepancy between objective and self-reported sleep parameters, which can trigger a vicious cycle that worsens their sleep complaints. Cognitive-behavioural therapy can reduce this discrepancy, but alternative behavioural therapies remain untested. The present exploratory study aimed to investigate the effects of mindfulness-based therapy for insomnia (MBTI) on reducing sleep discrepancies in comparison with a sleep hygiene, education, and exercise programme (SHEEP). Older adults were randomly allocated into the mindfulness-based therapy for insomnia group (n = 55) or the sleep hygiene, education, and exercise programme group (n = 58). Subjective and objective sleep parameters were measured using sleep diaries, polysomnography (PSG), and actigraphy. Sleep discrepancies were calculated using the Bland-Altman method for sleep onset latency (SOL) and wake after sleep onset (WASO). Additionally, correlations between the change in sleep discrepancies and the change in subjective sleep quality and trait mindfulness were measured within each group. Sleep onset latency discrepancy measured by polysomnography and actigraphy decreased significantly after the MBTI and SHEEP interventions. In contrast, there was no significant change in wake after sleep onset discrepancy in either group. The change in sleep onset latency discrepancy was correlated with the change in insomnia symptoms and objectively measured trait mindfulness. Mindfulness-based therapy for insomnia was effective in reducing sleep onset latency discrepancies and improving sleep perception in older adults with sleep disturbances, which in turn drove an improvement in sleep quality and insomnia symptoms. Increases in trait mindfulness may have been an important mechanism in improving sleep perception in the mindfulness-based therapy for insomnia group.

Previous literature suggests that cross-frequency phase synchronization is a mechanism by which information is transmitted and coordinated in the brain. Since cross-frequency phase synchronization is only strictly possible when two oscillators form a harmonic frequency ratio (e.g., 2:1, 3:1), a recent theory posited that interactions between brain oscillations at different frequencies are facilitated/hindered by the transient occurrence of harmonic/non-harmonic cross-frequency arrangements. In this line, recent evidence has shown that 2:1 harmonic relationships between alpha (8–14 Hz) and theta (4–8 Hz) rhythms are reduced during meditative states in experienced practitioners. In the present study, we investigated whether mindfulness training in novices is associated with longitudinal changes in alpha-theta cross-frequency dynamics during meditation practice. Thirty-six participants (mean age = 30.3; 2 men) underwent an 8-week mindfulness training program based on the mindfulness-based stress reduction (MBSR) syllabus and electroencephalography (EEG) recordings (64 electrodes) were performed during a guided meditation before and after the training. Mindfulness training compliance (quantified by minutes of attendance and practice at home) was significantly correlated to decreased 3:1 harmonicity and cross-frequency phase synchrony between alpha and theta rhythms during meditation. Mindfulness training in novices was shown to be associated with a reduction in alpha-theta cross-frequency coupling during meditation. EEG parameters based on alpha-theta cross-frequency dynamics may be adequate for quantifying and/or facilitating mindfulness meditation training.

Mindful attitudes and practices may help individuals respond to stressors in a more positive way. By limiting reactivity to stress, mindfulness may buffer people against its ill effects. In this study, we examined whether individual differences in trait mindfulness predict psychological and physiological responses to a laboratory stress induction. Trait mindfulness and stress reactivity were assessed using salivary cortisol and a subjective stress scale in a sample of young healthy males (N = 40) who underwent the Trier Social Stress Test (TSST). Higher trait mindfulness was associated with lower subjective stress (r = − 0.41, p = 0.009) and cortisol stress reactivity (r = − 0.38, p = 0.017). In particular, men who are more proficient in describing their emotions had lower perceived stress to the TSST (r = − 0.42, p

This essay surveys the changes and continuities in U.S. immigration law and policy between the Gilded Age and the 1990s–2010s. It points to how the administration of immigration law today is rooted in doctrines established in late nineteenth-century immigration cases. In particular, the essay connects current anxieties over immigration, borders, and national sovereignty to the “plenary power” doctrine that came out of the Supreme Court's decision inChae Chan Ping v. United States(1889). Examining recent federal actions to “secure” the border and enforce immigration law, this essay begins to address the ways in which current policy continues to reflect Gilded Age anxieties about territory, sovereignty, migration, and diverse populations during an era of constantly shifting borders.

Study Objectives We attempted to predict vigilance performance in adolescents during partial sleep deprivation using task summary metrics and drift diffusion modelling measures (DDM) derived from baseline vigilance performance. Methods In the Need for Sleep studies, 57 adolescents (age = 15–19 years) underwent two baseline nights of 9-h time-in-bed (TIB), followed by two cycles of weekday sleep-restricted nights (5-h or 6.5-h TIB) and weekend recovery nights (9-h TIB). Vigilance was assessed daily with the Psychomotor Vigilance Task (PVT), with the number of lapses (response times ≥ 500 ms) as the primary outcome measure. The two DDM predictors were drift rate, which quantifies the speed of information accumulation and determines how quickly an individual derives a decision response, and non-decision time range, which indicates within-subject variation in physical, non-cognitive responding, e.g. motor actions. Results In the first week of sleep curtailment, faster accumulation of lapses was significantly associated with more lapses at baseline (p = .02), but not the two baseline DDM metrics: drift and non-decision time range (p > .07). On the other hand, faster accumulation of lapses and greater increment in reaction time variability from the first to the second week of sleep restriction were associated with lower drift (p < .007) at baseline. Conclusions Among adolescents, baseline PVT lapses can predict inter-individual differences in vigilance vulnerability during 1 week of sleep restriction on weekdays, while drift more consistently predicts vulnerability during more weeks of sleep curtailment. Clinical Trial Information Effects of Napping in Sleep-Restricted Adolescents, clinicaltrials.gov, NCT02838095. The Cognitive and Metabolic Effects of Sleep Restriction in Adolescents (NFS4), clinicaltrials.gov, NCT03333512.

We conducted a secondary analysis of the Mindfulness Sleep Therapy study, a randomized controlled trial testing Mindfulness-Based Therapy for Insomnia (MBTI) against a sleep hygiene education and exercise program (SHEEP). We investigated whether the interventions led to changes in sleep macroarchitecture (N2, N3 and REM), and microarchitecture (sleep fragmentation, slow wave activity, spectral band power) measured by ambulatory polysomnography (PSG).48 MBTI and 46 SHEEP participants provided usable PSG and subjective sleep quality data both pre- and post intervention. The interventions consisted of 8 weekly 2-hour group sessions, and daily practice. PSG data were staged according to the American Academy of Sleep Medicine criteria by 2 technicians blind to time point and condition. Repeated-measures ANOVA and permutation analysis were used to test for differences over time and between the interventions.Self-reported sleep quality improved in both study groups. We observed significant increases in N2 in MBTI but not SHEEP (p = .045), and significant increases in N3 in SHEEP but not MBTI (p = .012). No significant differences over time or between group were observed in N1, REM, or sleep fragmentation. Higher frequency non-REM EEG power decreased in SHEEP but not MBTI. Slow wave activity and slow wave activity dissipation did not differ over time or between groups. Among all variables, significant time by group interactions were observed in only N3 and non-REM alpha power.MBTI and sleep hygiene education had different effects on sleep macro and microarchitecture, suggesting that the underlying mechanisms of mindfulness training in improving sleep quality may differ from traditional interventions.

Mindfulness has received increasing interest in the scientific community due to its proved benefits within clinical settings and in increasing well-being. One challenge for mindfulness researchers is how to measure the construct without relying on self-report instruments, which are prone to biases. Here we tested two different computer-based tasks that aimed to get an objective measure of non-attachment (the Behavioral Attachment Task, BAT) and non-reactivity (the Non-Reactivity Assessment Task, NORAT). The BAT leverages the endowment effect, a concept from behavioral economics describing the attachment developed over time towards something we own, to measure increased reactions times to decisions to sell an object gifted to participants. We correlated changes in these reaction times after participants had owned these objects over a delay period with a Non-Attachment Scale commonly used in mindfulness studies using several versions of the test. However, the BAT failed to replicate the original endowment effect, and no significant correlations with mindfulness scores were found. The NORAT investigated the effect of non-task related emotional stimuli (Negative and Positive pictures) on response times to a two-alternative forced choice task, and correlated the degree of emotional interference with the non-reactivity subscale from the Five Facet Mindfulness Questionnaire. While negative pictures significantly increased reaction times, we did not find a correlation between this change and non-reactivity. In conclusion, the BAT and NORAT were not successful as objective measures of trait mindfulness, and further research is needed to explore novel ways of measuring these constructs.

End-of-life care may constitute a vast proportion of health care expenditure globally. In the US, one-quarter of all medicare spending goes towards healthcare for people near the end of life. This is especially true for cancer patients. Our study aimed to estimate hospital spending in cancer patients in the last six months of life. Patients with cancer who died between June 2015 to December 2016 (n=653) were extracted from Singapore’s electronic medical records. A two-part model was used to estimate hospitalization spending. In the last month of life, we found that 85% of the patients did not have chemotherapy, 43% had good quality care, and 31% had palliative care. The average total hospitalization spending in the last six months of life was S$59,180. Further analysis by month from death revealed that spending increased sharply by 62%, from $7,591 in the sixth month of life to $12,315 in the last month of life. Decedents who received chemotherapy in the last month of life spent $6,925 more on hospitalization expenditure than those who did not ($17,915 vs $10,990). Among decedents seen by a palliative doctor, hospital expenditures in the last month were $8,745 higher compared to those who did not ($16,119 vs $7,374). The study depicted the huge hospitalization spending during the end-of-life for cancer patients in Singapore. Expenditure on end-of-life care can be further reduced with investment in community-based services and integrated care across the community and acute sectors, where hospital-to-home services and earlier palliative care can provide potential cost-effective solutions.

Mindfulness-based training has shown potential in reducing anxious and ruminative thoughts before sleep, and improving sleep quality. A majority of experiments on this topic have studied Mindfulness-Based Stress Reduction, or related 8-week programs. In this study, we measured the effects of a 4-week Mindfulness Foundation course on sleep quality assessed via subjective report and actigraphic recording. Ninety-six participants were recruited from a pool of Mindfulness Foundation course attendees and studied in a waitlist-control design. Although sleep complaints were not an inclusion criterion for this study, sleep quality was poor in the sample as a whole at baseline. We found that sleep quality improved in both groups across the study period (ηp2 = 0.22), with no statistical difference between groups. In contrast, pre-sleep cognitive arousal was significantly reduced in the treatment, but not the waitlist group (ηp2 = 0.058). Exploratory analysis revealed that reductions in cognitive arousal were correlated with improvements in sleep quality in the treatment group, but not the waitlist group. In the actigraphy data, a small but statistically significant interaction favoring the treatment group was found in the amount of time spent awake during the night (i.e., wake after sleep onset) (ηp2 = 0.070). Overall, our data demonstrate that some of the benefits to sleep commonly seen over 8 weeks of mindfulness practice can also be observed over a shorter intervention period, and add to the growing body of evidence that mindfulness can help those with poor sleep quality.

Sleep deprivation (SD) consistently degrades performance in tasks requiring sustained attention, resulting in slower and more variable response times that worsen with time-on-task. Loss of motivation to exert effort may exacerbate performance degradation during SD. To test this, we evaluated sustained performance on a vigilance task, combining this with an effort-based decision-making task and pupillometry. Vigilance was tested at rest and after sleep deprivation, under different incentive conditions (1, 5 or 15 cents for fast responses). Subsequently, preference measures were collected from an effort-discounting task, in which a commensurate reward was offered for maintaining attentional performance for different durations (1, 5, 10, 20 or 30 min). Vigilance was impaired during SD, in a manner modulated by reward value. Preference metrics showed that the value of available rewards was discounted by task duration, an effect compounded by SD. Pupillometry revealed that arousal was modulated during SD in a value-based manner, and moment-to-moment fluctuations in pupil diameter were directly predictive of performance. Together, these data demonstrate that attentional performance can be interpreted within a value-based effort allocation framework, such that the perceived cost of attentional effort increases after sleep deprivation.