Brain Training: Treating IBS Patients Through Hypnosis

If you have seen Dracula or The Jungle Book, this scene may seem familiar: a creepy hypnotist stares deeply into someone’s eyes, causing them to fall into a trancelike state. However, despite its over-romanticization in popular media, hypnotism is a legitimate phenomenon with proven psychological effects. Hypnotherapy–medical hypnosis–was declared an official form of medical treatment in the 1950s, and is widely implemented today to address a variety of conditions, including chronic pain, trauma, eating disorders, labor, asthma, and more [1]. 

In particular, hypnosis can be used to treat Irritable Bowel Syndrome, or IBS. This chronic bowel disorder affects about 15-20% of the general population, and induces painful gastrointestinal symptoms such as abdominal pain, bloating, and altered bowel habits [2]. Pharmacological treatments can only address one symptom at a time; therefore, hypnotherapy offers a unique psychological treatment with holistic physical benefits. Patients typically undergo about twelve 60-minute sessions on a once-per-week basis, and are instructed to practice at home between sessions [3]. 

During a typical appointment, a patient will be inducted into the hypnotic state while focusing on muscular relaxation. Meanwhile, the hypnotherapist provides personalized suggestions to relieve symptoms [2]. For example, a patient may be asked to imagine clearing a blocked river so that it runs smoothly. This specific exercise mimics the feelings of a digestive system clearing, giving the patient the illusion of symptom relief. The overall goal of the hypnosis sessions is to familiarize the patient with their inner workings, encouraging them to develop control over bodily functions like breathing and, eventually, gastrointestinal symptoms [3]. 

Although the exact neurological effects of hypnosis vary from person to person, hypnotherapy alleviates patients’ symptoms by affecting their neural activity. In order to visualize the way hypnotherapy impacts an IBS patient’s brain activity, one can use functional magnetic resonance imaging (fMRI) to study blood oxygen level dependent (BOLD) responses to the distension of a rectal balloon simulating gastrointestinal discomfort. Without treatment, IBS patients normally show higher BOLD activity in brain regions associated with visceral (gut-related) signal processing and emotional arousal. However, after hypnotherapy, there was no difference in rectal balloon distension response between IBS patients and healthy patients [2]. This data can be seen in the fMRI image in the image inset: the bottom row (healthy patients) more strongly resembles the middle row (IBS patients post-hypnotherapy) than the top (IBS patients). 

BOLD responses to rectal balloon distension. From top to bottom: IBS patients, IBS patients post-hypnotherapy, healthy patients [2].

BOLD data additionally reveals that gastrointestinal discomfort was reduced as a result of hypnosis, an observation which is backed by patients themselves. A survey provided to IBS hypnotherapy patients proves that 71% of patients saw immediate symptom improvement, and 81% of these experienced prolonged symptom relief up to one year post-treatment. More specifically, these patients felt a gastrointestinal pain reduction from 58/100 to 26.4/100, which rose only to a 32.2/100 over the course of the year [4]. Therefore, hypnotherapy not only alleviates IBS symptoms, but also can have long-lasting beneficial effects on patients’ wellbeing. 

Perhaps the next time you encounter hypnosis in a movie or book, feel free to laugh along with your friends, but remember this: if you are experiencing IBS, chronic pain, or a variety of other conditions, this seemingly goofy phenomenon may be a surprising solution to your pain. 

References:

1. Simon, E.P.; James, L.C. Clinical applications of hypnotherapy in a medical setting. Hawaii Med J. 1999, 58 (12), 344-347.

2. Lowén, M.B.; Mayer, E.A.; Sjöberg, M.; et al. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther. 2013, 37 (12), 1184-1197. 

3. Lindfors, P.; Unge, P.; Arvidsson, P.; et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings–results from two randomized, controlled trials. Am J Gastroenterol. 2012, 107 (2), 276-285. 

4. Gonsalkorale, W.M.; Miller, V.; Afzal, A.; Whorwell, P.J. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003, 52 (11), 1623-1629.

5. Header source: https://www.istockphoto.com/vector/monochrome-hypnotic-spiral-gm857332236-141375005
   
   

Vietnam’s National HIV PrEP and Its Impact on Transgender Women

Back in 2018, Vietnam announced a national PrEP (pre-exposure prophylaxis) program to curb the rising number of HIV cases in the country, making it the second Asian country to implement a nationwide PrEP program right after Thailand [1]. PrEP is a daily medicine that allows individuals who are negative for HIV but still at risk to decrease their chances of getting infected by 92%. Under this plan, Vietnam plans on making PrEP available to at least 13,923 people in about 11 provinces by 2020 [2].

The burden of HIV in Vietnam is concentrated in several key populations: gay and bisexual men, people who inject drugs, sex workers, and transgender women [1]. In fact, HIV prevalence is about 18% in transgender women [3]. As a result, the Vietnamese government and international donors have supported creating “one-stop-shop” clinics, community-led HIV healthcare services for at risk populations. VAAC (Vietnam Administration for HIV/AIDS Control), USAID (United States Agency of International Development), and the Vietnamese Ministry of Health have worked with community leaders in local provinces to launch pilot PrEP services to these local clinics. When PrEP became available at these clinics, community leaders realized that the medicine required better promotion towards the transgender community, as only about 7.6% of the transgender women who heard about PrEP actually used it in a 2018 survey [3].

Moreover, a 2018 study done by the Center for Applied Research on Men and Health found high levels of indications for PrEP but low awareness of of PrEP among transgender women, highlighting the need for more effective dissemination of PrEP and its benefits in tackling HIV among the transgender community in Vietnam [4]. After reaching out into the transgender community, community leaders realized that one of the main reasons why transgender women were hesitant in using PrEP was that there was a fear that PrEP interfered with levels of gender-affirming hormones. Therefore, transgender leaders, clinic staff, and PrEP experts needed to create an approach that would directly address these valid concerns. Additional services such as routine hormone-level testing, referrals for gender-affirming surgery, and substance abuse and mental health support were integrated into these clinics [3].

The expansion of transgender services within these clinics have had promising results. There was an immediate increase in PrEP initiations to about 20 enrollments a month. Enrollments went from 266 in the fourth quarter of 2019 to 409 in March of 2020 [3]. The three-monthly refill rate has also increased, as 74% of transgender women returned for refills and testing from October 2018 to September 2019 [3].

The promising results of these new implementations have been used to inform health officials in Vietnam about further developments and guidelines for PrEP use within the transgender community. The newfound successful promotion of PrEP among transgender is a lesson that emphasizes the idea of reaching to minority communities and understanding their struggles when implementing health policies.

References:

[1] Vietnam Launches National Program for Pre-exposure Prophylaxis for HIV | Press Release | Vietnam | U.S. Agency for International Development. https://www.usaid.gov/vietnam/press-releases/nov-30-2018-vietnam-launches-national-program-pre-exposure-prophylaxis (accessed Oct 17, 2020).

[2] Vietnam launches national program for pre-exposure prophylaxis for HIV. https://www.path.org/media-center/vietnam-launches-national-program-pre-exposure-prophylaxis-hiv/ (accessed Oct 17, 2020).

[3] Cairns, G. Community-run PrEP programme for Vietnamese trans women sees hundredfold rise in users in three years. https://www.aidsmap.com/news/jul-2020/community-run-prep-programme-vietnamese-trans-women-sees-hundredfold-rise-users-three (accessed Oct 17, 2020).

[4] Oldenburg, C.; Le, B.; Toan, T.; Thien, D.; Huyen, H.; Friedman, M.; Stall, R.; Colby, D. HIV Pre-Exposure Prophylaxis Indication And Readiness Among HIV-Uninfected Transgender Women In Ho Chi Minh City, Vietnam. AIDS and Behavior 2016, 20 (S3), 365-370.

The New Climate History Record: An Unsettling Future

Forty-five years ago, scientists J.P. Kennett and N.J. Shackleton found that deep-sea microscopic plankton (benthic foraminifera) could provide a reliable isotope record of Earth’s fluctuations in global carbon emissions, sea water composition, and deep-sea temperature [1]. Ever since, scientists have been studying these creatures to develop a comprehensive record of the major climate shifts over the last 66 million years (the Cenozoic era).

However, this record was compiled nonlinearly over the course of decades, and it lacked the completeness needed to analyze climate variability resulting from changes to Earth’s orbit. On September 10 of this year, Westerhold et al. at the University of California-Santa Cruz published a paper that detailed a more comprehensive climate record of the Cenozoic, which they developed by refining some of the previously collected isotope data, as well as collecting some of their own [2]. This record had a high enough resolution to perform analysis that was once thought impossible, providing valuable insight on the state of our climate in comparison to Earth’s orbital variations over the past 66 million years.

After compiling this comprehensive history into a dataset called CENOGRID, the team discovered important correlations between the climate’s response to orbital variations and variables such as greenhouse gas levels, global temperature, and polar ice caps. They found that Earth’s climate could be divided into four distinctive states throughout the Cenozoic: Hothouse, Warmhouse, Coolhouse, and Icehouse. Each of these states are characterized by differences in the climate’s responsiveness to astronomical occurrences (i.e. changes to Earth’s orbit that affect solar energy access) [2].

In the Hothouse and Warmhouse states, the climate tended to respond to orbital variations in a more predictable manner, whereas the Coolhouse and Icehouse periods saw a much less predictable response in the climate to astronomical changes. The cause of unpredictability is an increase in responsiveness to orbital events attributable to the existence of ice caps, as well as the lower greenhouse gas levels characteristic of the Icehouse and Cool House eras [2]. It is important to note that unpredictable responsiveness is actually beneficial to us because it means there is a buffer between astronomical changes to Earth’s orbit and climatic changes here on Earth.

So how does this bit of history relate to our problems today?

According to the study’s co-author, James Zachos, the modern trends of rising greenhouse gasses and diminishing polar ice caps means we are approaching a new Hothouse period at an alarming rate (on the scale of hundreds of years rather than millions). If we reach a Hothouse state similar to the one 50 million years ago, we will be at the mercy of eccentricity changes and have less of a barrier to astronomical events [3]. This could lead to major climatic unrest and completely alter our way of life.

To a country about to leave the Paris Climate Agreement, this record should be especially terrifying. The more steps we take away from changing our habits, the closer we are to this type of future.

References:

[1] KENNETT, J., SHACKLETON, N. Oxygen isotopic evidence for the development of the psychrosphere 38 Myr ago. Nature 260, 513–515 (1976). https://doi.org/10.1038/260513a0

[2] Westerhold, Thomas et al. “An Astronomically Dated Record of Earth’s Climate and Its Predictability over the Last 66 Million Years.” Science (American Association for the Advancement of Science) 369.6509 (2020): 1383–1387. Web.

[3] Earth barreling toward “Hothouse” state not seen in 50 million years, epic new climate record shows | Live Science https://www.livescience.com/oldest-climate-record-ever-cenozoic-era.html (accessed Oct 11, 2020).

Mathematical Patterns in Plants

Ever wondered how your middle school algebra lessons could possibly apply to real life? It turns

out that math is ever-present in the world around us, and your garden may be the first place to start

looking. Studies of phyllotaxis, the arrangement of leaves on plants, have led to discoveries that traits

like divergence angles of leaves from stems can form fascinatingly exact patterns [1]. One of the most

prevalent patterns in plants is the well-known Fibonacci sequence (1, 1, 2, 3, 5, 8, …), which is also found

in many other iterations within the natural world [1]. The resulting spirals align with primordium plant

growth and are evident in the center of a sunflower, the aerial view of a radial succulent, and the

polygons of Brassica oleracea in the image above [2]. Aside from the Fibonacci spiral, common formulas

that plant branches follow include distichous (alternating), decussate (paired at right angles), and

tricussate (whorled trios of leaves) patterns [3].

But why would plants need to follow this math? There is substantial evolutionary justification

for this visually stunning geometry; plants are largely immobile creatures who adapt to their

environments primarily through their own growth (or lack thereof). As such, a plant’s best chance of

survival requires using growth forms to maximize a leaf’s exposure to sunlight and protection from the

elements – and then doing the same for every other leaf [4]. Leaves must grow in close proximity to

conserve space and resources on the plant, but current hypotheses state that they also biochemically

repel other leaves from growing too near them in order to fully utilize their environment [3]. This level

of complexity requires the absolute precision that is found in the mathematical formulas we use to

describe these natural phenomena.

While it’s true that certain patterns are far more recognizable than others – the golden ratio and

Fibonacci sequence are rarely inconspicuous – that doesn’t mean that plants with seemingly irregular or

random branching patterns don’t follow discernable equations. For instance, the species Orixa japonica

has the eponymous orixate arrangement, which was long thought to be mathematically inexplicable [3].

Its leaves grow asymmetrically rather than in a spiral or radial form and occur in a repeating series of

four different angles from consecutive leaves. Surprisingly, this highly specific pattern occurs in other

plant species across the evolutionary tree, indicating that there must be some mathematically driven

mechanism causing it. Researchers only came up with an appropriate model for its manifestation in the

past few years using computer simulations, and in doing so revised a previous phyllotaxis formula to

better describe several other plants [3].

Despite the longstanding fascination of the relationship between mathematical concepts and

the botanical world, concepts of it being leaf-inhibitory based remain in speculation and there is no

unifying theory for determining formulas or the mechanisms behind this [2]. There is undoubtedly a

great deal of complexity in this phenomenon, and yet its amazing visual effects can be appreciated by

even the most untrained eye in the simplest plant in a garden.

References:

1. Shipman, P.D.; Newell, A.C. Phyllotactic Patterns on Plants. Physical Review Letters 2004, 92, 1-4.

2. Newell, A.C.; Shipman, P.D. Plants and Fibonacci. Journal of Statistical Physics 2005, 121 937-968.

3. Yonekura, T.; Iwamoto, A.; Fujita, H.; Sugiyama, M. Mathematical model studies of the comprehensive generation of major and minor phyllotactic patterns in plants with a predominant focus on orixate phyllotaxis. PLoS Computational Biology 2019, 15, e1007044.

4. Burakoff, M. Decoding the Mathematical Secrets of Plants’ Stunning Leaf Patterns. Smithsonian Magazine 2019. https://getpocket.com/explore/item/decoding-the-mathematical-secrets-of-plants-stunning-leaf-patterns?utm_source=pocket-newtab (accessed September 1, 2020).

5. Image source: Hesselink, A. romanesco; 2005.

Flattening the Curve: Why We Shouldn't Stop Social Distancing and Wearing Masks

A few weeks ago, my family decided to do something outside the house together for once. Picking a wide, outdoor venue to minimize the risk of contracting COVID-19, we wore our masks and drove to our destination— a cute little café called “Mozart’s Coffee Roasters” in Austin, TX. However, it was only when we got there that I sat up in my seat and stared. I could not differentiate this certain evening from the first time I had visited the café, which was pre-COVID, last year. The only slight difference was a few face masks on select families. Shocked, we did not leave our car and drove back home instead.

I was appalled. Am I just too careful, or was the café advertised as COVID-19-repellant? I concluded that neither was the case; rather, this lack of precaution came down to a lack of knowledge (or concern) about the importance of precautionary measures against COVID-19. 

The two biggest, substantial actions to upkeep are also the simplest: wearing masks, and social distancing. Why are these important? Big-picture: we want to continue to flatten the curve. This means reducing coronavirus transmissions so that medical facilities can handle it, enabling proper care for those contracted with COVID-19 as opposed to the drastic overwhelming of healthcare systems that we are seeing currently. 

More specifically, mask-wearing and social distancing reduce coronavirus spread by preventing the transmission of droplets or aerosols expelled while talking, breathing, coughing, or sneezing to others. Since these droplets originate from mucous or saliva from the respiratory tract, they may contain the virus particles, which can then infect another individual upon landing on surfaces such as the eyes, nose, and mouth (i.e. the “T-zone”).

Face masks

Face masks have been shown to block droplets of as small as 20 micrometers that are produced while talking [1]. Moreover, mandating face masks in 15 US states was found to significantly decrease COVID-19 cases by up to 2% per state as compared to their pre-mandate condition within as little as three weeks [2]. Lastly, a cross-cultural comparison of 198 countries revealed that countries who enforced masks within one month of their first case showed an almost 100-fold reduction in COVID-19 mortality rates within three months, as compared to countries who did not [3]. 

Social distancing 

The cruciality of social distancing is similarly supported by robust evidence. Mathematical models indicate that if 25% of the population social distances for three months, the number of coronavirus cases could be reduced by up to 80% compared to if no social distancing occurred [4]. Moreover, research has found that social distancing measures were associated with a significant decline in coronavirus cases across several countries within six months [5]. 

To conclude: Students at Rice are knowledgeable, cautious, and caring. More than that, however, they are influential. As the phrase “with great power comes great responsibility” highlights, mindfulness about the importance of masks and social-distancing can maximize our potential to slow the spread in our community. 

References

1. Laser Light-Scattering Experiment Showing Speech-Generated Droplets. (00:42); Editors, T.; J. H. Beigel and Others; E. E. Walsh and Others. Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering: NEJM. https://www.nejm.org/doi/full/10.1056/NEJMc2007800 (accessed Oct 28, 2020). 

2. Wei Lyu and George L. Wehby. Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US. https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818 (accessed Oct 28, 2020). 

3. (PDF) Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks (Update June 15, 2020). https://www.researchgate.net/publication/342198360_Association_of_country-wide_coronavirus_mortality_with_demographics_testing_lockdowns_and_public_wearing_of_masks_Update_June_15_2020 (accessed Oct 28, 2020). 

4. T;, M. L. L. Evaluating the Effectiveness of Social Distancing Interventions to Delay or Flatten the Epidemic Curve of Coronavirus Disease. https://pubmed.ncbi.nlm.nih.gov/32343222/ (accessed Oct 28, 2020). 

5. Thu, T. P. B.; Ngoc, P. N. H.; Hai, N. M.; Tuan, L. A. Effect of the social distancing measures on the spread of COVID-19 in 10 highly infected countries. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307990/ (accessed Oct 28, 2020).