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Background: The insula is instrumental in integrating the emotional, cognitive, and sensory-motor systems. This manuscript lays a foundational framework for understanding the insula’s mechanistic role in moderating brain networks in illness and wellness. Methods: Reviewed here is the select literature on the brain anatomy and function relevant to the insula’s role in psychiatrically ill and normative populations. Results: The insula is a hub for moderating social cognition, empathy, reward-driven decision-making, arousal, reactivity to emotional stimuli, and somatic pain processing. Findings indicate a spectrum of increasing complexity in insular function – from receiving and interpreting sensorimotor sensations in the posterior insula to subjective perception of emotions in the anterior insula. The insula plays a key role at the interface of cognitive and emotional domains, functioning in concert with other brain regions that share common cytoarchitecture, such as the ventrolateral prefrontal cortex and the anterior cingulate cortex. Pharmacotherapy and mindfulness-based interventions can alter insular activation. Conclusion: The insula serves as a receiver and interpreter of emotions in the context of cognitive and sensory-motor information. Therefore, insular function and connectivity may potentially be utilized as a biomarker for treatment selection and outcome.

Session 6 of the RAINBOW treatment protocol focuses on promoting self-efficacy in the parent and child (ingredient I: I can do it! of RAINBOW) and developing coping skills in parents (ingredient N: No negative thoughts, live in the now of RAINBOW), and it is conducted with the parent/caregivers. Therapist and parents first work to identify the child’s positive qualities and ways these can be promoted and reinforced through positive language and mastery activities. Parents are then encouraged to develop their own positive scripts and self-talk to improve their feelings of self-efficacy. Last, parents are instructed in cognitive and mindfulness skills to learn ways to reframe negative thoughts and increase their focus on the present moment.

Session 9 of the RAINBOW treatment protocol focuses on improving family problem-solving and coping (ingredient O: Oh, how do we solve this problem? of RAINBOW), and is conducted with the parent/caregiver(s), child, and siblings. It is important for all family members to have opportunities to talk about their experiences and to have that experience respected by the family. The therapist works with the family to improve interactions at home by problem-solving difficult situations and developing a family plan to minimize behavioral escalation once it occurs. In addition, the session aims to foster affiliation among family members through emphasizing shared experiences, positive feelings, and common goals.

RAINBOW: A Child- and Family-Focused Cognitive-Behavioral Treatment for Pediatric Bipolar Disorder is a comprehensive, evidence-based treatment manual designed specifically for children ages 7–13 with bipolar spectrum disorders and their families. Developed by experts in pediatric mood disorders and tested in a randomized clinical trial (RCT), RAINBOW integrates psychoeducation and cognitive-behavioral therapy (CBT) with complementary techniques from mindfulness-based intervention, positive psychology, and interpersonal therapy to address the range of therapeutic needs of families affected by this disorder. Guided by the evidence on the neurobiological and psychosocial difficulties accompanying pediatric bipolar disorder, this treatment targets the child and family across seven core components: Routine, Affect Regulation, I Can Do It, No Negative Thoughts and Live in the Now, Be a Good Friend/Balanced Lifestyle for Parents, Oh How Do We Solve This Problem, and Ways to Get Support. Throughout the treatment, the child and family will learn how to identify mood states and triggers of mood dysregulation, and develop cognitive and behavioral strategies for improving mood stability. Children will build social skills, and caregivers will develop greater balance and self-care in their own lives. The family will learn ways to use routines, problem-solving, and social support to improve overall family functioning. Intended for qualified child-focused mental health professionals, this manual includes the conceptual background of the treatment and user-friendly step-by-step instruction in delivering RAINBOW with families, including handy session outlines and engaging worksheets for the child and caregiver(s).

Session 7 of the RAINBOW treatment protocol focuses on helping the child develop communication skills to improve peer and family relationships (ingredient B: Be a good friend of RAINBOW), and the session is conducted primarily with the child. For various reasons, children with bipolar disorder often have poor communication skills. Like most other skills, however, social skills can be taught and learned. The therapist and the child practice ways of expressing feelings nonverbally (“Feelings Charades”) and other nonverbal communication skills (such as making eye contact, listening). In addition, respectful communication skills are developed and practiced, including instruction in “I Messages” for emotional expression.

The Introduction describes how the Rainbow Manual provides the user with the empirical foundation for RAINBOW and for each of the RAINBOW treatment components, as well as detailed session-by-session guides for delivering RAINBOW. Each of the 12 session guides includes the RAINBOW ingredient(s) covered in the session, the agenda, the objective(s) for the session, the conceptual background for treatment objectives, and specific instructions and language for each objective and related activities. Recommended time lengths for each session activity are provided. The conceptual manual is intended to be used by the practitioner as the background and training for learning how to deliver the RAINBOW manual to children and families.

Session 5 of the RAINBOW treatment protocol is primarily conducted with the child and focuses on improving self-efficacy through development of cognitive and behavioral coping skills (ingredients I: I can do it, N: No negative thoughts, and O: Oh, how do we solve this problem? of RAINBOW). Key skills developed in this session include positive-thinking strategies and “think and do” skills to manage emotional responses to identified triggers of negative moods. The therapist explains the connections between thoughts, feelings, and behaviors, and ways to respond more adaptively to the child’s triggers are role-played in the session. In addition, mood charts are reviewed, and mood monitoring along with practicing Think and Do skills are assigned as a between-session task for the child and family.

Session 10 of the RAINBOW treatment protocol focuses on maximizing social support (ingredient W: Ways to find social support of RAINBOW), and it is conducted with the parent/caregivers and child. The therapist provides psychoeducation regarding the importance of social support for effective parenting and child affect regulation. Parents and therapist discuss and evaluate methods of widening and utilizing social support networks for parents and child, as well as strategies to work through barriers to increasing social contacts. In addition, the child is engaged in role-play to practice adaptive help-seeking behaviors. Last, parents and child create a “Support Tree” to help identify and recall those in their support network.

Session 3 of the RAINBOW treatment protocol focuses on developing routines (ingredient R: Routine of RAINBOW) and improving affect regulation (ingredient A: Affect regulation of RAINBOW), and is conducted individually with the parent/caregiver(s). After a review of the previous week’s work by the therapist and parents, the parents are first engaged in a task to help establish predictable routines at home to minimize their child’s emotional reactivity. Parents are then encouraged to share their own feelings surrounding parenting a child with bipolar disorder. Last, the therapist and the parents develop ways to improve the identification, communication, and management of difficult feelings.

Session 4 of the RAINBOW treatment protocol is primarily conducted with the child and focuses on developing affect-regulation skills (ingredient A: Affect regulation of RAINBOW). Key skills developed in this session include recognizing and labeling emotions, identifying physiological cues of anger and other feelings, and recognizing triggers of anger. These skills are taught in order to help the child to normalize the experience of intense emotion, and to teach the child how to cope with intense negative emotion. In addition, the child’s completed mood charts are reviewed, and mood monitoring is assigned again as a between-session task for the child and the family.

The RAINBOW program was developed through a review of the literature and clinical experience relevant to the developmental psychopathology and treatment of pediatric bipolar disorder (PBD). Session 1 is the first session of the RAINBOW treatment protocol, and it is conducted with child and parent/caregiver(s). The primary objective of this session is to orient the child and family to the RAINBOW program and engage them in the treatment process. The session agenda includes introductions and identification of goals for treatment, introducing the concept of RAINBOW treatment and the integral components, addressing issues that may affect the family’s engagement in treatment, and building rapport with the child.

Session 8 of the RAINBOW treatment protocol focuses on promoting the child’s social skills as well as on enhancing parental self-care (ingredient B: Be a good friend and Balanced life for parents of RAINBOW), and it is conducted with the parent/caregiver(s). Parent(s) are provided with psychoeducation regarding the importance of friendships, and engaged in problem-solving to identify key opportunities to promote their child’s social skills as well as ways to minimize difficulties during stressful social situations. The session also focuses on parental well-being and how they can maximize their opportunities for parental self-care, via discussion and completion of a “balanced lifestyle” activity.

Session 11 of the RAINBOW treatment protocol focuses on the internalization and consolidation of treatment gains, as well as reflections on the treatment process and experience, in preparation for the end of treatment. Session 11 is conducted individually with the child, followed by a portion with child and parents. The child and therapist create a Rainbow Binder with all of child’s therapy materials completed during the course of treatment. Through this activity, therapist and child review the concepts and skills learned in RAINBOW and ways to apply RAINBOW skills to future situations. The RAINBOW binder is shared with the parents to facilitate further consolidation of treatment skills and gains, as well as to celebrate the family’s successes. Last, the family is prepared for the end of treatment via discussion of ways to maintain gains post-treatment.

The effects of metal ion exposure on osteocytes, the most abundant cell type in bone and responsible for coordinating bone remodeling, remain unclear. However, several studies have previously shown that exposure to cobalt (Co(2+) ) and chromium (Cr(3+) ), at concentrations equivalent to those found clinically, affect osteoblast and osteoclast survival and function. In this study, we tested the hypothesis that metal ions would similarly impair the normal physiology of osteocytes. The survival, dendritic morphology and response to fluid shear stress (FSS) of the mature osteocyte-like cell-line MLO-Y4 following exposure to clinically relevant concentrations and combinations of Co and Cr ions was measured in 2D-culture. Exposure of MLO-Y4 cells to metal ions reduced cell number, increased dendrites per cell and increased dendrite length. We found that combinations of metal ions had a greater effect than the individual ions alone, and that Co(2+) had a predominate effect on changes to cell numbers and dendrites. Combined metal ion exposure blunted the responses of the MLO-Y4 cells to FSS, including reducing the intracellular calcium responses and modulation of genes for the osteocyte markers Cx43 and Gp38, and the signaling molecules RANKL and Dkk-1. Finally, we demonstrated that in the late osteoblasts/early osteocytes cell line MLO-A5 that Co(2+) exposure had no effect on mineralization, but Cr(3+) treatment inhibited mineralization in a dose dependent manner, without affecting cell viability. Taken together these data indicate that metal exposure can directly affect osteocyte physiology, with potential implications for bone health including osseointegration of cementless components, and periprosthetic bone remodeling. This article is protected by copyright. All rights reserved.

Postoperative central nervous system infections (PCNSIs) are serious complications following neurosurgical intervention. We previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in south Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system.This was a retrospective study of all neurosurgical cases performed between December 1, 2013, and March 31, 2016 at our center. Providers, patient demographic data, case types, perioperative care, rate of PCNSI, and rates of other complications were reviewed. These results were then compared with the findings of our previous study of neurosurgical cases between June 1, 2012, and June 30, 2013.All 623 neurosurgical operative cases over the study period were reviewed. Four patients (0.6%) had a PCNSI, and no patients had a positive cerebrospinal fluid (CSF) culture. In the previous study, among 363 cases, 71 patients (19.6%) had a PCNSI and 7 (1.9%) had a positive CSF culture (all Gram-negative organisms). The differences in both parameters are statistically significant (P0.001). Between the 2 studies, there was no change in treatment providers, case types, case durations, antibiotic administration practices, and patient demographics.The rates of PCNSI and positive CSF culture were significantly lower in our present cohort compared with the cohort in our previous study. The sole apparent change involves the air filtration system inside the neurosurgical operating rooms; this environmental change occurred during the 5 months between the 2 studies. This study demonstrates the impact of environmental factors in reducing infections.

Injury to the thoracic duct during anterior cervical spine surgery is a rare occurrence. A delayed chyle leak following an elective anterior cervical spinal surgery has not been reported in the literature. We present a report of a 59-year-old female with multiple prior neck surgeries who underwent an anterior cervical corpectomy and fusion (ACCF). The patient developed a delayed thoracic duct injury on postoperative day (POD) one, as no injury was noted intraoperatively. She was managed with conservative care involving a low-fat diet along with octreotide which led to the resolution of her symptoms. We present this case report because of its unique presentation and to assist spine surgeons with initial management. Surgeons should have increased awareness when performing anterior cervical approaches to the lower cervical and upper thoracic levels from the left side.

“In reality, it is the interpretation of symptomatology that leads to accurate diagnosis, rather than the short-term training and inter-rater reliability attained by conducting semi-structured research diagnostic interviews.”

This article offers a pragmatic model of conceptualizing attention deficit hyperactivity disorder and pediatric bipolar disorder when they present alone, together, or as overlapping subsyndromes. Evidence-based findings from the US Food and Drug Administration-approved medications and randomized controlled trials of psychotherapy are quilted together to design a personalized treatment model. The treatment paradigm consists of an “ABCD” model of components: (A) Assessment of psychopathology toward individual diagnosis or comorbidity, (B) Brain circuitry function offering explanatory power for the phenomenology that includes affective and cognitive domain difficulties common in both the disorders, (C) Chemical imbalance addressed through pharmacotherapy for mania, mixed mania, depression, and attention deficit hyperactivity disorder, and (D) Delivery of proven psychosocial treatment coupled with addressing the key dynamics of interpersonal relationships. This intervention, based on empirical findings, is applicable to clinical practice. Identifying the neurocircuitry of cognitive and emotional impairment in pediatric bipolar disorder and attention-deficit/hyperactivity disorder guides the application of targeted treatments: a paradigm of translating science to clinical service. [ Psychiatr Ann . 2014; 44(10):471–480.]

Land Surface Temperature (LST) is an important phenomenon in global climate change. As the green house gases in the atmosphere increases, the LST will also increase. This will result in melting of glaciers and ice sheets and affects the vegetation of that area. Its impact will be more in the monsoon areas, because the rainfall is unpredictable, failure of monsoon and there will be heavy down pour of rainfall. LST can be estimated through many algorithms viz., Split-Window (SW), Dual-Angle (DA), Single-Channel (SC), Sobrino and Mao. With the advent of satellite images and digital image processing software, now it is possible to calculate LST. In this study, LST for Dindigul District, Tamil Nadu, India, was derived using SW algorithm with the use of Landsat 8 Optical Land Imager (OLI) of 30 m resolution and Thermal Infrared Sensor (TIR) data of 100 m resolution. SW algorithm needs spectral radiance and emissivity of two TIR bands as input for deriving LST. The spectral radiance was estimated using TIR bands 10 and 11. Emissivity was derived with the help of NDVI threshold technique for which OLI bands 2, 3, 4 and 5 were used. The output revealed that LST was high in the barren regions whereas it was low in the hilly regions because of vegetative cover. As the SW algorithm uses both the TIR bands (10 and 11) and OLI bands 2, 3, 4 and 5, the LST generated using them were more reliable and accurate.