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My Bad, You Got This: witnessing, therapist attitude and the synergy between psychedelics and inner healing intelligence in the treatment of trauma
No full textThe MAPS (Multidisciplinary Association for Psychedelic Studies) sponsored MDMA-assisted therapy protocol has had greater success in treating trauma in preliminary clinical trials than any prior psychotherapeutic, pharmacologic, or combined approach. It is predicated on a synergy between drug action and the participant\u27s inner healing intelligence. The latter is described mainly by analogy with the body\u27s capacity to heal itself, and the treatment is characterized as a means of activating or accessing this capacity. How is this rather mysterious-sounding process so effective? I suggest that the therapist\u27s full commitment to, and trust in this treatment framework, along with the medication\u27s subjective enhancement of trust, encourages individuals who have suffered trauma and have difficulty trusting others to engage the therapist as a kind of witness. I discuss parallels between the therapeutic attitude implied in the inner healing intelligence model and the way a therapist can act as witness in the resolution of dissociative enactment in relational psychoanalysis. Trusting the healing capacity of one\u27s inner healing intelligence is dynamically equivalent to trusting the relational process. This makes trusting one\u27s inner healing intelligence a process of feeling witnessed. In both settings, the therapist\u27s willingness to acknowledge her technical limitations or failings, coupled with a conviction that the participant/patient\u27s primary need in processing trauma is to feel witnessed, facilitates the integration of dissociated experience
Equity in epidemic response: an action-oriented framework for guiding public health in equitable responses to major infectious disease emergencies
No full textBACKGROUND: A rapid and equitable response is paramount to mitigating the spread and impact of an infectious disease public health emergency. Unfortunately, public health responses often integrate equity as a secondary component rather than a foundational one-a decision that can result in disproportionate effects of the epidemic on vulnerable populations and that may further fuel or worsen the ongoing health emergency. This paper introduces a framework grounded in health equity principles to guide the design and implementation of response efforts during infectious disease emergencies. METHODS: The Equity in Epidemic Response framework was developed by critically appraising and synthesizing several established models into an integrated framework, with active engagement from health professionals specializing in epidemiology, medicine, global health, mental health, community health, and health policy. RESULTS: The framework covers six high-impact areas that should be addressed during an infectious disease public health emergency: community partnerships and engagement; communication; social and economic conditions; data systems and methods; health infrastructure and supply chains for preventives, therapeutics, and diagnostics; and accessibility of outbreak resources and essential health services. Key priorities and assessment indicators within each area were identified. CONCLUSIONS: Given the increasing threat of emerging and re-emerging infectious diseases, this framework reinforces the need to prioritize equitable approaches in responding to infectious disease public health emergencies to minimize health consequences, particularly among vulnerable populations. This framework is designed as a practical tool for public health professionals to guide major aspects of an epidemic response, ensuring thorough and equitable implementation of response efforts
Visuomotor Integration Assessment Using Immersive Virtual Reality for Children With Cerebral Palsy: A Pilot Study
No full textBACKGROUND: Visuomotor integration (VMI) impairments are common in children with cerebral palsy (CP) and can impact performance of goal-directed upper-extremity tasks. VMI impairment is clinically assessed using the gold-standard Beery-Buktenica test, whereas research paradigms use computerized assessments incorporating eye and hand movement tracking with touchscreen displays. Immersive virtual reality (VR) may potentially enable more ecologically valid VMI assessments through the inclusion of 3D tasks and visual distractions. However, the potential of immersive VR as a VMI assessment method in children with CP has not been evaluated. The current study aims to investigate how VR can assess VMI impairments in children with CP. METHODS: Twelve children with CP completed the Beery-Buktenica VMI test and performed eye-only, hand-only and eye-hand VMI tasks in touchscreen, visually simple VR and visually complex VR conditions. Eye and hand endpoint accuracy and task completion time quantified VMI performance. We compared performance on each task and in each environment between children with below- versus above-average Beery-VMI scores. RESULTS: There were no significant relationships between Beery-VMI score and eye-hand task performance in visually simple VR. Compared to the touchscreen task, participants demonstrated significantly reduced eye and hand endpoint accuracy in visually simple VR, with no difference between Beery-VMI groups. Children with below-average Beery-VMI scores decreased eye endpoint accuracy and increased trial completion time in visually complex VR. CONCLUSION: Findings from this pilot study do not support immersive VR as a VMI assessment method in children with CP
Periprosthetic Joint Infection Centers of Excellence: Moonshot or Misstep? A Survey of the American Association of Hip and Knee Surgeons Members
No full textBACKGROUND: Periprosthetic joint infection (PJI) centers of excellence (COE) have been discussed as an innovative model to improve healthcare quality and value in treating PJI. A national network of regional PJI centers may have the ability to improve patient outcomes, standardize treatment protocols, accelerate research, and provide economies of scale while caring for this patient population with complex needs. This study surveyed perceptions towards establishing a PJI COE among members of the American Association of Hip and Knee Surgeons (AAHKS). METHODS: A 16-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,529 fellow-level members of AAHKS. Study results were analyzed using descriptive statistics. RESULTS: There were 626 survey responses (24.8% response rate). More than two-thirds of survey participants (69%) reported that they would consider participation in some form of PJI COE. Most surgeons believe managing PJI is a cost to their hospital system. The top concern among respondents was that PJI COE may become a \u27dumping ground\u27 for inappropriate referrals. Participants reported financial concerns regarding the possibility that establishing such a program may trigger a re-evaluation of reimbursement for primary total joint arthroplasty (TJA) procedures. CONCLUSION: While primary TJA is a target of national healthcare cost containment efforts, PJI has yet to be addressed. This gives AAHKS the opportunity to prospectively advocate for reform. A PJI COE designed to perform a high volume of infection revision procedures may be advantageous in providing the specialized and longitudinal care required by PJI patients. The AAHKS surgeons expressed interest and reservations in the establishment of PJI COEs that can inform future policy
2025 John R. Darby Simulation Grand Rounds Presentation
No full textTitle: Now What? How to Show Up for Health Equity
Presented by: Dr. Samreen Vora and Brittany Dahlen, Shifting Frames Consulting
Shifting Frames Consulting, LLC – Shifting Frames Consultin
Passive Tick Surveillance at The University of Maine Cooperative Extension Tick Lab: A 6 Year Retrospective
Get PDFIntroduction: Maine has experienced a rise in tick-borne diseases over the past several decades, reflecting broader trends in the northeastern United States. Ixodes scapularis is now found statewide and is the primary vector of Borrelia burgdorferi, Anaplasma phagocytophilum, Babesia microti, Borrelia miyamotoi, and Powassan virus. Other emerging tick species pose additional threats.
Methods: The University of Maine Cooperative Extension Tick Lab conducts a public tick-testing program. Ticks submitted by the public between 2019 and 2024 were microscopically identified and tested with multiplex quantitative polymerase chain reaction and reverse transcription-quantitative polymerase chain reaction panels for known and emerging pathogens, including B. burgdorferi, A. phagocytophilum, B. microti, B. miyamotoi, Rickettsia rickettsii, Francisella tularensis, Ehrlichia spp., Powassan virus, and Heartland virus.
Results: A total of 22 151 ticks were submitted from 466 municipalities. Ixodes scapularis was the most commonly submitted tick species, followed by Dermacentor variabilis. Midcoastal counties exhibited both high submission rates and elevated pathogen prevalence. B. burgdorferi was most frequently detected, followed by A. phagocytophilum and B. microti. Powassan virus and B. miyamotoi were detected at low rates.
Discussion: Our study confirms the important role I. scapularis plays in Maine’s tick-borne disease landscape and highlights the need for surveillance of emerging tick species and their associated pathogens. We also note geographic clusters of tick submissions and elevated pathogen prevalence from Maine’s midcoastal region.
Conclusions: This passive surveillance initiative highlights Maine’s evolving tick-borne disease risks. Ongoing monitoring, improved diagnostic techniques, and community engagement will be important for guiding public health responses and mitigating the burden of emerging and established tick-borne threats