Patrick Lariccia

ABSTRACTThis study addresses the hypothesis that electrocardiographic T‐wave amplitude is influenced by beta‐adrenergic stimulation of the heart. Beta‐adrenergic activity was manipulated both pharmacologically and through behavioral challenge. Under resting conditions, 12 healthy men underwent infusion of placebo and then the beta‐agonist, isoproterenol, and the beta‐blocker, propranolol, in a counterbalanced, crossover design. During infusion of placebo, subjects also underwent two behavioral challenges, a structured interview and mental arithmetic. Analysis of the resting data indicated that propranolol produced a significant increase in T‐wave amplitude, and isoproterenol produced significant T‐wave amplitude attenuation. As previously reported, drug effects were also in evidence for heart rate. Behaviorally‐induced reduction of T‐wave amplitude was observed for mental arithmetic but not structured interview, which again paralleled heart rate data. Both pharmacological and behavioral data reported in this study support the hypothesis that the T‐wave is significantly affected by beta‐sympathetic influence on the heart. However, a nonspecific effect of heart rate change on T‐wave amplitude would also account for these results. The findings are discussed in terms of their implications for the utility of T‐wave amplitude in psychophysiological research.

Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization. Com-parisons were made between the vitamin D3 at 5000 IU supplementation group and a non-supplemented control group. Costs of care between the groups were not statistically different. Vitamin D3 supplementation reduced healthcare utilization in four major cate-gories: hospitalizations for any reason (rate difference: -0.19 per 1000 person-days, 95%-CI: -0.21 to -0.17 per 1000 person-days, p < 0.0001); ICU admissions for any reason (rate dif-ference: -0.06 per 1000 person-days, 95%-CI: -0.08 to -0.04 per 1000 person-days, p < 0.0001); emergency room ...

Introduction: Designing and conducting clinical trials is challenging for some institutions and researchers due to associated time and personnel requirements. We conducted recruitment, screening, informed consent, study product distribution, and data collection remotely. Our objective is to describe how to conduct a randomized clinical trial using remote and automated methods. Methods: A randomized clinical trial in healthcare workers is used as a model. A random group of workers were invited to participate in the study through email. Following an automated process, interested individuals scheduled consent/screening interviews. Enrollees received study product by mail and surveys via email. Adherence to study product and safety were monitored with survey data review and via real-time safety alerts to study staff. Results: A staff of 10 remotely screened 406 subjects and enrolled 299 over a 3-month period. Adherence to study product was 87%, and survey data completeness was 98.5% ove...

Vitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers. The aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers. We conducted a prospective, controlled trial at a tertiary university hospital. A random group of healthcare workers was invited to receive 5000 IU daily vitamin D3 supplementation for nine months, while other random healthcare system workers served as controls. All healthcare workers were required to self-monitor and report to employee health for COVID-19 testing when experiencing symptoms of ILI. COVID-19 test results were retrieved. Incidence rates were compared between the vitamin D and control groups. Workers in the intervention group were included in the analysis if they comp...

ABSTRACTBackgroundDesigning and conducting randomized controlled trials is not possible for some institutions and researchers due to their associated costs and personnel requirements. Advances in telehealth for patient care and clinical trial methods adaptations were hastened due to the coronavirus 2019 pandemic. We conducted subject recruitment, screening, informed consent, study product distribution, and data collection remotely using Research Electronic Data Capture (REDCap) and other readily available applications for a prospective randomized clinical trial on vitamin D3 supplementation to prevent influenza-like illness in healthcare workers.ObjectivesTo describe how to efficiently and cost-effectively conduct a randomized clinical trial using remote and semi-automated methods.MethodsA previously described prospective, controlled, trial in healthcare workers at a tertiary university hospital that used Zelen’s design to facilitate enrollment is used as a model. A random group of ...

The prevalence of insomnia in the United States is estimated at upwards of 40%, with up to 15% of those cases being chronic. Both alternative andWestern approaches to insomnia agree that sleep disturbance has multiple etiologies. In fact, the revised edition of the International Classification of Sleep Disorders lists more than 100 differential diagnoses of insomnia. Traditional Chinese Medicine (TCM) acupuncture treatment for sleep disorders usually addresses excess-type disturbances of the heart, along with variable excesses or deficiencies of any of the other organ systems. The most common points used include Heart (Ht) 7, Spleen (Sp) 6, and Governing Vessel (GV) 20. The current standard of care for chronic insomnia includes sedative-hypnotic medications, in particular benzodiazepine receptor agonists, or cognitive–behavioral therapy (CBT). Newer agents have also been developed such as orexin receptor inhibitors, which act by selectively binding to orexin-1 and -2 receptors, which in turn inactivate wakefulness. A recent meta-analysis showed that eszopiclone, zolpidem, and suvorexant versus placebo showed small but significant improvements in several sleep parameters, for example total sleep time increased anywhere between 16 and 48.1 minutes, reduction in sleep onset latency between 3 and 15 minutes, and improvement in insomnia severity indexes (ISI) between 2 1.2 to 2 4.6. Similar results have been shown with CBT, with a total sleep time increase of 43.54 minutes, reduction in sleep onset of 11.63 minutes, and ISI of 2 4.78. The comparative and long-term efficacy of pharmacotherapies for insomnia are not known. All pharmacotherapies, per Food and Drug Administration documents, had risks for cognitive and behavioral changes, including driving impairment, while observational studies reveal an association between hypnotics and dementia, fractures, and major injury. Damage of memory, drug resistance, dependency, and addiction are additional concerns. Safer and more efficacious treatments for insomnia are clearly needed. One common type of insomnia is defined by the tendency to wake at the same time every night followed by difficulty returning to sleep, also known as sleep maintenance insomnia. Insomnia in general can lead to significant morbidity, such as daytime lethargy, impairment of daytime activities, nervousness, poor concentration, and a diminished quality of life. However, maintenance insomnia is particularly burdensome. Furthermore, there is evidence that there is a difference in the sleep onset period between onset insomnia and maintenance insomnia as shown on spectral analysis electroencephalogram. Therefore, it would be clinically useful to have a unique and preferably simple acupuncture treatment tailored specifically for patients suffering from maintenance sleep disorders. According to Chinese medicine, each organ system in the human body has a two-hour time of day in which the energy circulates optimally and contributes maximally to the bolus of nourishing qi. To live in balance with the circadian rhythm, the sleep cycle should begin between the hours of 9pm and 11pm at the time of the San Jiao, or triple burner organ network. Circulation is at its peak in the gallbladder from 11pm to 1am, the Liver from 1am to 3am, the Lung from 3am to 5am, and the large intestine from 5am to 7am. A disruption in any of these organ networks may result in disturbed sleep or insomnia. Maintenance insomnia may represent a disruption or blockage of qi between two such sequential acupuncture meridians. Such a blockage can often be detected using pulse diagnosis. For instance, if a patient wakes repeatedly at 3am, one could reasonably expect a block may be detected at the superficial or wei layer between the Liver and Lung meridians, since 3am is where peak energy moves from the Liver to the Lung meridians. This would be palpable as an excess of energy in the Liver pulse and a deficiency in the Lung pulse using the Five Tracy L. Brobyn et al. 2018; Published by Mary Ann Liebert, Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 50-year-old woman with a five-and-a-half-year history of dyspareunia was successfully treated with an integrative medicine approach, including Neural Therapy, osteopathic therapy, acupuncture, and trigger point therapy, resulting in complete resolution which has been maintained to the present day, nineteen years later. Further research is justified and recommended.

ABSTRACTImportanceVitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers.ObjectiveThe aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers.DesignWe conducted an open label, randomized clinical trial wherein a random group of healthcare workers was invited to receive 5000 IU daily vitamin D3 supplementation for nine months, while other random healthcare workers served as passive controls. All healthcare workers were required to self-monitor and report to employee health for COVID-19 testing when experiencing symptoms of ILI. COVID-19 test results were retrieved.SettingThe trial was conducted at a tertiary university hospital.ParticipantsOut of 7,600 healthcare workers, two groups of 4,708 and 2...

Context • Chronically ill patients who have failed standard medical assessment and therapies are often assessed by integrative medical providers for atypical manifestations of allergies as the possible source or contributing factor(s) to their condition. Skin testing and immunoglobulin E (IgE) allergy panels increase the cost of care in these patients. Objective • The objective of this study was to determine the accuracy of autonomic response testing (ART) as compared with IgE allergy panel blood tests. Design • This study was a retrospective chart review of patients who had ART and blood drawn for an IgE allergy panel at the same office visit. Outcome Measures • Sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, phi coefficient, and Cohen's kappa were calculated. Results • A total of 14 charts were reviewed. All measures of accuracy were of either useful or excellent strength. The strength of association measures of the phi coeffic...

Conventional treatment of Bulimia Nervosa is long term, expensive, and often ineffective. Neural therapy holds promise for treating Bulimia Nervosa in a shorter term, lower cost, and more effective manner. Much of neural therapy involves the superficial injection of local anesthetic injections. Implementation into current practice would be feasible.

Chronic nausea and vomiting of uncertain etiology can be debilitating and uncomfortable for patients while frustrating for clinicians. This article presents the case of a young woman with chronic nausea and vomiting of unknown etiology resulting from body piercing and tattoo scars on body areas that Chinese Medicine asserts are related to the gastrointestinal system. The patient had long-term total resolution after 1 treatment session consisting of neural therapy for scars resulting from a tongue ring, belly ring, and tattoo near her left wrist along with acupuncture treatment. The research community is called to further evaluate the possible association of body piercing and tattooing with nausea and vomiting along with the possible treatment options of neural therapy and acupuncture.

Chronic upper gastrointestinal (GI) symptoms of unclear etiology are frustrating to patients and physicians alike. The integrative medicine procedures of acupuncture and neural therapy may provide treatment options. Tongue piercing, which is prevalent in 5.6% of the adolescent population, may be a contributing factor in upper gastrointestinal symptoms. The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (2) To identify scars from tongue piercings as a possible contributing factor in chronic upper GI symptoms of unclear etiology. Two retrospective case studies are presented of young adult females who were seen in a private multi-physician integrative medicine practice in the US. The patients were treated with neural therapy and acupuncture. The desired outcome was the cessati...

The present study examined the acute effects of drugs that stimulate or block sympathetic nervous system activity on components of Type A behavior, affect, and cardiovascular responses to mental stressors. Either propranolol (a beta-adrenergic blocker), isoproterenol (a beta-agonist), or placebo was infused intravenously at different times in 12 healthy males. In two sessions, placebo (saline) was administered first, followed by a structured interview, challenging mental arithmetic test, and completion of affect scales. The procedure was then repeated with one of the active drugs, presented in counterbalanced order. Results indicated reliable drug effects on both heart rate (HR) and systolic blood pressure (SBP) reactivity to the tasks, with change scores to the tasks markedly increased by isoproterenol. Anxiety and hostility ratings paralleled results for HR and BP, with much of this effect being due to higher affect ratings for isoproterenol. The effect of the drugs on Type A behavior was unexpected, with global Type A and several components lowered by isoproterenol and unaffected by propranolol. These data are discussed in terms of the interfering effects of anxiety on Type A speech components. The influence of isoproterenol on affect and reactivity might reflect the physiologic action of a beta 2-adrenergic positive feedback loop which increases release of endogenous norepinephrine, and/or potentiating effects of emotion on reactivity to stress.

Knee osteoarthritis is a chronic disease associated with significant morbidity and economic cost. The efficacy of acupuncture in addition to traditional physical therapy has received little study. The objective of this study was to compare the efficacy and safety of integrating a standardized true acupuncture protocol versus nonpenetrating acupuncture into exercise-based physical therapy (EPT). This was a randomized, double-blind, controlled trial at 3 physical therapy centers in Philadelphia, PA. We studied 214 patients (66% African Americans) with at least 6 months of chronic knee pain and x-ray-confirmed Kellgren scores of 2 or 3. Patients received 12 sessions of acupuncture directly following EPT over 6 to 12 weeks. Acupuncture was performed at the same 9 points dictated by the traditional Chinese "Bi" syndrome approach to knee pain, using either standard needles or Streitberger non-skin-puncturing needles. The primary outcome was the proportion of patients with at least a 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index score at 12 weeks. Both treatment groups showed improvement from combined therapy with no difference between true (31.6%) and nonpenetrating acupuncture (30.3%) in Western Ontario and McMaster Universities Osteoarthritis Index response rate (P = 0.5) or report of minor adverse events. A multivariable logistic regression prediction model identified an association between a positive expectation of relief from acupuncture and reported improvement. No differences were noted by race, sex, or age. Puncturing acupuncture needles did not perform any better than nonpuncturing needles integrated with EPT. Whether EPT, acupuncture, or other factors accounted for any improvement noted in both groups could not be determined in this study. Expectation for relief was a predictor of reported benefit.

... raphe magnus, radiotracer while experiencing pain related to and reticular paragigantocellular nucleus their chronic pain syndrome and just after fin-have been described as part of the efferent ishing scoring the pain assessment test ... Human brain function and biochemistry. ...

Complementary and alternative medicine (CAM) comprises a multitude of disciplines, for example, acupuncture, ayurvedic medicine, biofeedback, herbal medicine, and homeopathic medicine. While research on CAM interventions has increased and the CAM literature has proliferated since the mid-1990s, a number of our colleagues have expressed difficulties in deciding where to publish CAM articles. In response, we created a short guide to peer-reviewed MEDLINE-indexed journals that publish CAM articles. We examined numerous English-language sources to identify titles that met our criteria, whether specific to or overlapping CAM. A few of the resources in which we found the journal titles that we included are Alternative Medicine Foundation, American Holistic Nurses Association, CINAHL/Nursing Database, Journal Citation Reports database, MEDLINE, PubMed, and Research Council for Complementary Medicine. We organized the 69 selected titles for easy use by creating 2 user-friendly tables, one listing titles in alphabetical order and one listing them in topical categories. A few examples of the topical categories are Acupuncture, CAM (general), Chinese Medicine, Herbal/Plant/Phytotherapy, Neuroscience/Psychology, Nursing/Clinical Care. Our study is the first to list general CAM journals, specialty CAM journals, and overlapping mainstream journals that are peer reviewed, in English, and indexed in MEDLINE. Our goal was to assist both authors seeking publication and mainstream journal editors who receive an overabundance of publishable articles but must recommend that authors seek publication elsewhere due to space and priority issues. Publishing in journals indexed by and included in MEDLINE (or PubMed) ensures that citations to articles will be found easily.

Weaning patients from mechanical ventilation can be hindered by both physical and psychologic factors. Biofeedback has been used successfully as an adjunct in difficult weaning problems. We have used a combination of hypnosis and biofeedback to wean a patient with neurologic disease who previously failed weaning by standard procedures. A 30-year-old woman with respiratory failure secondary to multiple sclerosis with transverse myelitis was given eight sessions of biofeedback over 12 days in which the movements of her chest wall, as monitored by magnetometers, were displayed on an oscilloscope. The patient was praised for targeted respiratory rate, amplitude, and rhythm. These sessions included hypnosis in which the patient was given suggestions of well-being and that she could breathe as she had five years earlier. In this manner the patient was successfully weaned. Respiratory biofeedback and hypnosis appear to be useful adjuncts in weaning patients from ventilators.

This study addresses the hypothesis that electrocardiographic T-wave amplitude is influenced by beta-adrenergic stimulation of the heart. Beta-adrenergic activity was manipulated both pharmacologically and through behavioral challenge. Under resting conditions, 12 healthy men underwent infusion of placebo and then the beta-agonist, isoproterenol, and the beta-blocker, propranolol, in a counterbalanced, crossover design. During infusion of placebo, subjects also underwent two behavioral challenges, a structured interview and mental arithmetic. Analysis of the resting data indicated that propranolol produced a significant increase in T-wave amplitude, and isoproterenol produced significant T-wave amplitude attenuation. As previously reported, drug effects were also in evidence for heart rate. Behaviorally-induced reduction of T-wave amplitude was observed for mental arithmetic but not structured interview, which again paralleled heart rate data. Both pharmacological and behavioral data reported in this study support the hypothesis that the T-wave is significantly affected by beta-sympathetic influence on the heart. However, a nonspecific effect of heart rate change on T-wave amplitude would also account for these results. The findings are discussed in terms of their implications for the utility of T-wave amplitude in psychophysiological research.