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As clinicians and the public move from a pathological (disease-focused) to a salutogenic (health-focused) understanding of the human condition, protective factors contributing to the health of individuals and societies have received more attention. The study of resilience is a foundational aspect of this critical shift and a promising way to understand and interpret our responses to complex multi-domain perturbations from stressful and traumatic experiences. However,as researchers from different fields engage in resilience research, a plethora ofdefinitions and understandings have emerged requiring detailed academic discourse. Rapidly changing global, political, economic and environmental circumstances highlight the need for effective solutions to understand and enhance resilience. These solutions require a multidisciplinary understanding of the concept of resilience.
, 20140057, published 22 August 20144 2014 Interface Focus
Shamini Jain, Meredith Sprengel, Kevin Berry, John Ives and Wayne Jonas
The tapestry of resilience: an emerging picture
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Cite this article: Jain S, Sprengel M, Berry K,
Ives J, Jonas W. 2014 The tapestry of resilience:
an emerging picture. Interface Focus 4:
One contribution of 9 to a Theme Issue
‘Towards a systems model of resilience’.
Subject Areas:
systems biology
resilience, health, systems
Author for correspondence:
Meredith Sprengel
The tapestry of resilience: an emerging
Shamini Jain, Meredith Sprengel, Kevin Berry, John Ives and Wayne Jonas
Samueli Institute, Alexandria, VA 22314, USA
As clinicians and the public move from a pathological (disease-focused) to a
salutogenic (health-focused) understanding of the human condition, protec-
tive factors contributing to the health of individuals and societies have received
more attention. The study of resilience is a foundational aspect of this critical
shift and a promising way to understand and interpret our responses to complex
multi-domain perturbations from stressful and traumatic experiences. However,
as researchers from different fields engage in resilience research, a plethora of
definitions and understandings have emerged requiring detailed academic
discourse. Rapidly changing global, political, economic and environmental
circumstances highlight the need for effective solutions to understand and
enhance resilience. These solutions require a multidisciplinary understanding
of the concept of resilience.
In January 2012, Samueli Institute convened a meeting entitled ‘Towards a
systems model of resilience: state of the science and future directions’ held at the
National Academy of Sciences’ Beckman Center to help bridge the current gaps
in understanding interdisciplinary approaches to the study of resilience and to
encourage cross-discipline dialogue on the potential promise of creating sys-
tems models of resilience. Prominent scientists in scientific fields such as
systems biology, systems engineering, mathematics, biology, psychoneuroim-
munology, psychoneuroendocrinology, sociology, medicine and psychology,
along with key Department of Defense leaders, gathered to both share perspec-
tives and explore the possible utility of creating interdisciplinary, systems-based
models for understanding resilience. The meeting was highly successful in
engendering collaborative education and enthusiasm for forwarding the
study of resilience in an interdisciplinary and systems-oriented fashion. In
this Theme Issue of Interface Focus, we summarize findings that arose from a
first major effort to explore resilience from a diversity of disciplines and per-
spectives. The culmination of these efforts is a rich tapestry of views, ready
to be woven into a coherent whole.
The classical Latin-origin definition of resilience (resili (ens), present participle
of resilire—to spring back, or rebound) was used to describe the tensile properties
of material objects (also known as elastic memory) such as wood and metals
[1]. This conceptualization of resilience is understood as ‘recoiling’ to an original
state after a perturbation. Since the use of the term in the early 1800s, the concept
of resilience has been applied to many fields of human endeavour, including the
study of ecosystems and human responses to adverse conditions such as natural
disasters, war and personal loss [2]. Although this Theme Issue is focused on the
domain of health-oriented resilience, the study has expanded to include many
disciplines such as politics, diplomacy and economics, to name a few.
While the interest and efforts in studying resilience expand, our understand-
ing of what resilience is and how best to enhance it in various contexts remains
fragmented. A consensus definition of the term resilience has not come to frui-
tion, although several themes emerge from the existing data. A literature search
conducted by the RAND Corporation unearthed 122 definitions of resilience.
Three major themes emerge from these varied definitions that indicate our cur-
rent understanding of resilience as (i) a dynamic process (rather than as a ‘trait’)
that evolves across time, (ii) adaptability to change and, generally, to adversity,
and (iii) either a return to homeostasis, or an enhanced state of functioning
(e.g. growth) [3]. When examining resilience as a response to adversity, our cur-
rent understanding needs to expand beyond the concept of a return to
homeostasis, to instead a new normal that is characterized by stability through
&2014 The Author(s) Published by the Royal Society. All rights reserved.
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change. Being resilient entails more than the ability not only to
adjust and adapt to a perturbation, but also to transform when
the perturbation requires a new conceptualization of the way in
which to effectively proceed forward. This process does not
return an individual or system to a previous homeostatic set-
point. Rather, the concept of resilience uses learning from
prior experiences to effectively adapt by anticipating and pre-
dicting current needs, and modifying feedback inputs to
achieve maximal efficiency of that system within a particular
context and timeline. This evolution in understanding resili-
ence from a dynamic perspective is consistent with a control
systems model of allostatic, versus homeostatic, regulation
[4]. The relationship between adversity and enhanced resili-
ence has been documented previously; non-specific resilience
is enhanced by prior moderate stressors [5– 7]. In other
words, resilience does not occur and cannot be detected out-
side of a stressor or changing context. However, individuals
with a history of high adversity report decreased well-being
and psychological functioning. The act of being resilient is an
adaptive response to stressors that is, ultimately, dependent
on context. The most common reaction and/or response to a
traumatic incident is resilient behaviours: ‘although symptom
levels tend to vary for different potentially traumatic events,
resilience has consistently emerged as the most common
outcome trajectory’ [8, p. 136].
Fully understanding resilience requires systems approa-
ches that facilitate the modelling of dynamic interactions in
multiple domains (e.g. psychological, physical and social)
within a person and between his or her social and physical
environment. There is an increasing interest in systems-based
approaches to understanding resilience between people and
their surrounding environments, such as those in socio-
ecological systems [9,10]. Reductionist approaches used by
some researchers when developing and testing hypotheses
about resilience separate the person from his/her environment
or subjugate the environmental variable when performing
analyses. In these analyses, the environment only becomes
an important variable when ‘it provides a forum in which
resilience-promoting-processes that contribute to individual
growth take place’ [11, p. 4]. As a consequence, outcomes
remain void of cultural, historical and political constructs [12].
The structure of our current academic systems facilitates
highly specialized, narrowly focused disciplines that often do
not promote opportunities to effectively communicate across
fields of study. Specialization generates monumental progress
within our isolated fields of discipline and allows us to use
more precise tools for examining parts of the whole. However,
it also constructs barriers to integrated thinking required for
solving complex scientific puzzles such as resilience. Ongoing
cross-discipline dialogue will be essential for fostering a com-
plete understanding of resilience within the whole person
and his/her environment. Models of resilience that incorporate
mental, emotional, social and physical processes will be maxi-
mally effective in helping understand and enhance resilience
within individuals and societies.
The meeting held addressed the pressing need to induce
dialogue across various disciplines and among academics
studying resilience. The publications in this Theme Issue of
Interface Focus on resilience reflect some of the thinking and
research on resilience from academic experts who attended,
as seen through their particular scientific lens. Several articles
reflect the promise of systems-based modelling approaches
for helping solve issues related to physiological resilience.
We now move to a discussion of these articles, starting
with the articles that describe the value of systems modelling
approaches to understanding resilience in medical and phys-
iological settings. We then continue our discussion noting
the articles that discuss systems thinking surrounding
mind–body interventions for enhancing resilience, and con-
clude with the articles that discuss resilience within military
contexts and other social settings.
Csete & Doyle’s [13] article, ‘The mathematician’s toolbox
for management of type 1 diabetes’, offers a non-technical
summary of the utility of control systems modelling in the
development of the artificial pancreas, noting both its
promise and shortcomings. It also provides the reader with
an opportunity to reflect on the utility of control engineering
tools to better understand and enhance resilience within
medical settings. Aschbacher et al.’s [14] study entitled ‘The
hypothalamic–pituitary adrenal– leptin axis and metabolic
health: a systems approach to resilience, robustness and
control’ further explores the utility of control systems tools
and thinking in its exploration of robustness as a key indicator
of stress system resilience. This study employs relatively
simple, yet novel systems-based mathematical tools to examine
the dynamics of the HPA–leptin feedback sensitivity—these
dynamics predicted metabolic risk in the population studied,
whereas traditional neuroendocrine measures did not. The
study, along with Aschbacher’s previous work, points to the
promise of using dynamic systems modelling approaches in
the field of psychoneuroendocrinology to better understand
mind– brain–body relationships as they relate to resilience.
Vodovotz’s [15] article, ‘Computational modelling of the
inflammatory response in trauma, sepsis, and wound healing:
implications for modelling resilience’, also speaks to the promise
of employing systems modelling approaches to the study of
sepsis, an acute inflammatory response to a noxious agent
that can be life-threatening. This article provides an overview
of the relevance of both data-driven and mechanistic models
for understanding and predicting acute inflammation, and
suggeststhe promise of integrating both approaches for under-
standing inflammation that may be used clinically. Vodovotz
provides a provocative hypothesis that inflammation may be a
key factor in understanding resilience at the whole organism,
under the skin, level, and proposes some methods by which
this hypothesis could be tested.
Irwin’s [16] review on ‘Sleep and inflammation in resilient
aging’ builds on this theme by discussing the complex relation-
ships between sleep, inflammation and resilient aging, noting
that high versus poor sleep quality may act as a resilience-
enhancing or perturbing factor, respectively, within the context
of aging. Irwin reviews the data for sleep’s relationship to resi-
lient aging as well as its relationship to resilience-interfering
factors such as depression, pain, morbidity and mortality in
the elderly. Irwin further suggests that proper sleep may
buffer increases in inflammation that are found for aging
populations, speaking to the promise of behavioural inter-
ventions that improve sleep quality as a method of enhancing
psychobiological resilience in the elderly.
Similarly, in Silverman & Deuster’s [17] review, ‘Biological
mechanisms underlying the role of physical fitness in health
and resilience’, the biological systems that may underlie the
impact of physical fitness on resilience and health are discussed.
The authors suggest that physical fitness may enhance psycho-
physiological resilience through multiple pathways, including
by optimizing neuroendocrine and psychosocial reactivity to Interface Focus 4: 20140057
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stressors, as well as by reducing tonic levels of inflammation
and enhancing neuroplasticity and growth factor expression.
Similar to Irwin, the authors call for the need for easily imple-
mentable behavioural strategies such as exercise to enhance
human resilience, as a self-modifiable characteristic.
Understanding resilience includes investigating key bio-
logical factors that may play a role in identifying resilience
within the context of traumatic stress. This is a key to helping
individuals who are required to engage in highly stressful
and life-threatening scenarios such as war fighting, disaster
scene search and rescue, civil disturbance response, fire and
police work. The thoughtful and thorough commentary by
Litz [18] entitled ‘Resilience in the aftermath of war trauma:
a critical review and commentary’ illustrates the complexity
of understanding resilience in the context of war trauma,
and speaks to the need for us to carefully develop effective
assessment, prevention and treatment strategies to enhance
resilience to war trauma within various contexts and across
the deployment cycle.
Yehuda et al.’s [19] article also discusses resilience factors
within the context of traumatic stress. In the article, ‘Gluco-
corticoid related predictors and correlates of post-traumatic
stress disorder treatment response in combat veterans’, the
authors examined the potential relevance of glucocorticoid
variables in predicting responses to psychotherapeutic treat-
ment for post-traumatic stress disorder (PTSD). Interestingly,
the study indicated that both prolonged exposure and a mini-
mal attention control considerably reduced PTSD symptoms
over time. Genotype for the glucocorticoid receptor (BCLI
polymorphism), as well as pre-treatment levels of neuropep-
tide Y, predicted treatment responses, and 24 h urine cortisol
levels as well as glucocorticoid sensitivity appeared to be
sensitive biomarkers of change in response to the interven-
tion. The study indicates the promise of systems-oriented
approaches ( psychoneuroendocrinology) in linking mind
body processes associated with resilience and the potential
value of neuroendocrine biomarkers in predicting risk and
resilience to PTSD. Finally, related to systems models on
social resilience, Pincus’s [20] article, ‘One bad apple: exper-
imental effects of psychological conflict on social resilience’,
demonstrates both the impact of individual-level conflict on
higher-order (group) systems, and the value of dynamic ana-
lyses in assessing potential ‘ripple effects’ related to the social
domain of resilience.
This tapestry of articles reflects the varied approaches and
levels of investigation that are apparent in understanding
human resilience today. We note that this is far from a com-
plete representation of the breadth of the current theory and
investigation that comprises the study of resilience. It does
not at this point reflect the integration of cross-discipline
thinking and collaboration that the future may hold.
However, the integration of these multiple perspectives on
resilience as reflected is the first necessary step towards a
truly whole systems model of resilience. We are confident
that the breadth and overlapping nature of the current articles
will be both informative and interesting to the reader and
help the scientific community better understand the current
terrain of inquiry surrounding the study of resilience.
Funding statement. This Research program is supported by DoD/TATRC
W81XWH1120173, entitled ‘Central Evaluation of Resilience Programs
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... Resilience has received greater interest in the stress and trauma fields in understanding the human condition (Jain et al., 2014;Kalischi et al, 2015). Resilience scholars investigate health, rather than disease; therefore, the focus is on approaches to avert illness (Jain et al., 2014;Kalischi et al, 2015). ...
... Resilience has received greater interest in the stress and trauma fields in understanding the human condition (Jain et al., 2014;Kalischi et al, 2015). Resilience scholars investigate health, rather than disease; therefore, the focus is on approaches to avert illness (Jain et al., 2014;Kalischi et al, 2015). Resilient people possess certain beliefs (Shakespeare-Finch & Wickham, 2010) and the ability to take control of situations and make meaning of their situations (Hutchinson & Dorsett, 2012;Lenette et al. 2012;West et al. 2012). ...
... Socio-ecological approaches emphasize the vital role of environmental resources like support from family, friends, and one's ethnic community (Babatunde-Sowole et al., 2016;Schweitzer et al. 2007;Ungar 2011); and available services rather than individual traits or cognitions alone. Consequently, resilience involves dynamic interactions occurring between an individual and their social and physical environment (Jain et al., 2014;Lenette et al., 2012). Rashid et al. (2013) referred to the post-migration life of migrant women as only a partially visible portion of their existence. ...
Migrants from areas affected by war, especially refugee migrants, are susceptible to mental health issues. In addition to recognising trauma, health professionals, such as mental health nurses, need to be aware of the strength and resilience of refugees and migrants. The capacity to provide trauma‐informed care that is shaped by the recognition of clients’ strength and resilience is required/paramount to meet the current demand of multiculturalism emanating from an increased global migration. To facilitate increased awareness about West African women’s resilience prior to migration and support trauma‐informed care, we used a qualitative strength‐based storytelling approach with 22 West African women residing in Sydney, Australia. Thematic analysis of the women’s stories identified two major themes: When the World Falls Apart and Battered but Strong. Findings revealed that past personal experiences significantly influenced participants’ strength and resilience and contributed to their mental health. Mental health professionals such as nurses can play an important role by incorporating knowledge about the resilience of migrants and refugees into providing appropriate trauma‐informed care.
... Trefois et al. pointed out the potential value of translating the generic hypothesis of dynamical systems theory to medicine [8]. Jain et al. concluded the following about resilience: "When examining resilience as a response to adversity, our current understanding needs to expand beyond the concept of a return to homeostasis, to instead a new normal that is characterized by stability through change" [36]. This accentuates the importance of viewing resilience as a dynamic concept. ...
... Adaptability is the capacity of a system to anticipate changes, so that it retains its stability [36,40]. Jain et al. and Resnick et al. described adaptability as a part of resilience. ...
... Jain et al. and Resnick et al. described adaptability as a part of resilience. It is a trait or characteristic needed in order to be resilient [36,41]. To be clear, it is not a state or basin of attraction. ...
Rationale: Resilience is a relatively new concept in medicine and, more specifically, it is new in geriatrics. It suits the new definition of health as introduced by Machteld Huber. However, resilience still needs a suitable, operationalizable definition for the field of geriatrics, given that it is still an emerging theme in medicine.Resilience in different disciplines: Investigation of the concept of resilience in mechanics, ecology, psychology and sociology shows that resilience is mostly considered as a dynamic, multidimensional and scalable concept. As such it may also apply to the field of medicine and potentially also to the field of geriatrics. However, the idea of resilience is still evolving. Therefore, time is needed to develop a common understanding of the concept. When this understanding is enhanced, operationalization is of great importance. Current operationalization in these disciplines varies from questionnaires to establish (static) characteristics defining a state that is prognostic for the resilience to be shown when perturbated to stress-tests, to mathematical indicators which evaluate the dynamic response or behavior of the system to (standardized) perturbations.Discussion: All measurements for operationalization are indicators of resilience and do therefore not directly measure resilience (if this is indeed possible). In addition, there is not only one concept of resilience. Resilience can be considered objectively as a systems characteristic, or subjectively, for example by gestalt. These different approaches cause a gap between the concepts and different operationalizations, which makes it difficult to operationalize the (general) concept of resilience.Implications and recommendations: Over time, resilience can potentially be measured by the use of new measurements, longitudinal data and wearables. For implementation in the clinic, validation of the measures is key. In addition, qualitative research on how the elderly experience, or would describe, resilience is recommended, in order to gain a better understanding about the concept. Then, there can be thought of intervening in resilience, especially in patients who face transition to another state of health.
... Physical resilience is distinct from the well-studied, and important, construct of psychological resilience. 1,2 Whereas psychological resilience refers to a person's ability to adapt well in the face of adversity, trauma, tragedy, threats, or significant sources of stress, [3][4][5] physical resilience focuses on maintenance or recovery of function after biomedical or pathological challenges. 6 Physical resilience is presumed to reflect adaptive physiological responses at the level of organs, cells, and molecules (e.g., musculoskeletal, neurological, immunological processes) that support homeostasis under changing conditions. ...
... One way to maintain health and function across the life span is to minimize the detrimental effects of injury, illness, or other stressors that inevitably occur in life. The concept of resiliency, the tendency to remain well or "bounce back" in the face of adversity, is not new (5). Resiliency was originally used to denote the elastic property of materials (6), but "resilience" has since been applied to systems, communities, and individuals. ...
Background: Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to characterize the emerging construct of resilience as it pertains to physical health in older adults, and to identify gaps and opportunities to advance research in this area. Methods: We conducted a systematic review to identify English language papers published through January 2015 that apply the term "resilience" in relation to physical health in older adults. We applied a modified framework analysis to characterize themes in implicit or explicit definitions of physical resilience. Results: Of 1,078 abstracts identified, 49 articles met criteria for inclusion. Sixteen were letters or concept papers, and only one was an intervention study. Definitions of physical resilience spanned cellular to whole-person levels, incorporated many outcome measures, and represented three conceptual themes: resilience as a trait, trajectory, or characteristic/capacity. Conclusions: Current biomedical literature lacks consensus on how to define and measure physical resilience. We propose a working definition of physical resilience at the whole person level: a characteristic which determines one's ability to resist or recover from functional decline following health stressor(s). We present a conceptual framework that encompasses the related construct of physiologic reserve. We discuss gaps and opportunities in measurement, interactions across contributors to physical resilience, and points of intervention.
... The military family is critical to a service member's resilience and performance. 2 One of the many roles of the military health system is to support the service member and family. Today, this role is more important than ever. ...
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Research suggests that the development of mind-body skills can improve individual and family resilience, particularly related to the stresses of illness, trauma, and caregiving. To operationalize the research evidence that mind-body skills help with health and recovery, Samueli Institute, in partnership with experts in mind-body programming, created a set of guidelines for developing and evaluating mind-body programs for service members, veterans, and their families. The Guidelines for Creating, Implementing, and Evaluating Mind-Body Programs in a Military Healthcare Setting outline key strategies and issues to consider when developing, implementing, and evaluating a mind-body focused family empowerment approach in a military healthcare setting. Although these guidelines were developed specifically for a military setting, most of the same principles can be applied to the development of programs in the civilian setting as well. The guidelines particularly address issues unique to mind-body programs, such as choosing evidence-based modalities, licensure and credentialing, safety and contraindications, and choosing evaluation measures that capture the holistic nature of these types of programs. The guidelines are practical, practice-based guidelines, developed by experts in the fields of program development and evaluation, mind-body therapies, patient- and family-centered care, as well as, experts in military and veteran׳s health systems. They provide a flexible framework to create mind-body family empowerment programs and describe important issues that program developers and evaluators are encouraged to address to ensure the development of the most impactful, successful, evidence-supported programs possible.
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Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. This blunting appears to contribute to reduced emotional, physiological and metabolic reactivity as well as increased positive mood and well-being. Another mechanism whereby regular exercise and/or physical fitness may confer resilience is through minimizing excessive inflammation. Chronic psychological stress, physical inactivity and abdominal adiposity have been associated with persistent, systemic, low-grade inflammation and exert adverse effects on mental and physical health. The anti-inflammatory effects of regular exercise/activity can promote behavioural and metabolic resilience, and protect against various chronic diseases associated with systemic inflammation. Moreover, exercise may benefit the brain by enhancing growth factor expression and neural plasticity, thereby contributing to improved mood and cognition. In summary, the mechanisms whereby physical fitness promotes increased resilience and well-being and positive psychological and physical health are diverse and complex.
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Past research suggests that small groups are self-organizing systems, and that social resilience may be measured as the meta-flexibility of group dynamics: the ability to shift back and forth from flexiblity to rigidity in response to conflict. This study extends these prior results, examining the impact of experimentally induced internal conflict and group-level conflict resolution on group dynamics-whether one bad apple can spoil the bunch. Six experimental groups with four members each participated in a series of four 25 min discussions. The first two discussions served as a baseline condition. Internal conflict was induced to one or more group members prior to discussion three, with the prediction that higher levels of conflict induction would lead to significant drops in group flexibility-creating a press on the group's resilience, whereas conflict resolution in discussion four was expected to allow for a rebound in group flexibility. Consistent with prior research, the turn-taking dynamics of each the 24 groups were distributed as inverse power laws (R (2) = 0.86-0.99) providing evidence for self-organization. Furthermore, there were significant study-wise negative correlation between levels of personality conflict and two measures of flexibility: information entropy (r = -0.47, p = 0.019) and fractal dimension (r = -0.42, p = 0.037). Altogether, these results suggest that: (i) small groups are self-organizing systems with structure and flexibility providing social resilience and (ii) individual conflict is able to spread to higher level social dynamics, creating pressure on social resilience. Practical implications for assessment of, and intervention with, psychosocial resilience are discussed.
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Glucocorticoids contribute to obesity and metabolic syndrome; however, the mechanisms are unclear, and prognostic measures are unavailable. A systems level understanding of the hypothalamic-pituitary-adrenal (HPA)-leptin axis may reveal novel insights. Eighteen obese premenopausal women provided blood samples every 10 min over 24 h, which were assayed for cortisol, adrenocorticotropin releasing hormone (ACTH) and leptin. A published personalized HPA systems model was extended to incorporate leptin, yielding three parameters: (i) cortisol inhibitory feedback signalling, (ii) ACTH-adrenal signalling, and (iii) leptin-cortisol antagonism. We investigated associations between these parameters and metabolic risk profiles: fat and lean body mass (LBM; using dual-energy X-ray absorptiometry), and insulin resistance. Decreased cortisol inhibitory feedback signalling was significantly associated with greater fat (kg; p = 0.01) and insulin resistance (p = 0.03) but not LBM. Leptin significantly antagonized cortisol dynamics in eight women, who exhibited significantly lower 24 h mean leptin levels, LBM and higher ACTH-adrenal signalling nocturnally (all p < 0.05), compared with women without antagonism. Traditional neuroendocrine measures did not predict metabolic health, whereas a dynamic systems approach revealed that lower central inhibitory cortisol feedback signalling was significantly associated with greater metabolic risk. While exploratory, leptin-cortisol antagonism may reflect a 'neuroendocrine starvation' response.
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Sleep quality is important to health, and increasingly viewed as critical in promoting successful, resilient aging. In this review, the interplay between sleep and mental and physical health is considered with a focus on the role of inflammation as a biological pathway that translates the effects of sleep on risk of depression, pain and chronic disease risk in aging. Given that sleep regulates inflammatory biologic mechanisms with effects on mental and physical health outcomes, the potential of interventions that target sleep to reduce inflammation and promote health in aging is also discussed.
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Resilience refers to the ability to recover from illness or adversity. At the cell, tissue, organ and whole-organism levels, the response to perturbations such as infections and injury involves the acute inflammatory response, which in turn is connected to and controlled by changes in physiology across all organ systems. When coordinated properly, inflammation can lead to the clearance of infection and healing of damaged tissues. However, when either overly or insufficiently robust, inflammation can drive further cell stress, tissue damage, organ dysfunction and death through a feed-forward process of inflammation → damage → inflammation. To address this complexity, we have obtained extensive datasets regarding the dynamics of inflammation in cells, animals and patients, and created data-driven and mechanistic computational simulations of inflammation and its recursive effects on tissue, organ and whole-organism (patho)physiology. Through this approach, we have discerned key regulatory mechanisms, recapitulated in silico key features of clinical trials for acute inflammation and captured diverse, patient-specific outcomes. These insights may allow for the determination of individual-specific tolerances to illness and adversity, thereby defining the role of inflammation in resilience.
As U.S. service members deploy for extended periods on a repeated basis, their ability to cope with the stress of deployment may be challenged. A growing number of programs and strategies provided by the military and civilian sectors are available to encourage and support psychological resilience to stress for service members and families. Though previous research from the field of psychology delineating the factors that foster psychological resilience is available, there has been no assessment of whether and how well the current military resilience programs are addressing these factors in their activities. Further, little is known about the effectiveness of these programs on developing resilience. To assist the Department of Defense in understanding methodologies that could be useful in promoting resilience among service members and their families, the research team conducted a focused literature review to identify evidence-informed factors for promoting psychological resilience. The team also reviewed a subset of military resilience programs to determine the extent to which they included those evidence-informed factors. This article describes the context, approach, and findings from these research activities.
Blood glucose levels are controlled by well-known physiological feedback loops: high glucose levels promote insulin release from the pancreas, which in turn stimulates cellular glucose uptake. Low blood glucose levels promote pancreatic glucagon release, stimulating glycogen breakdown to glucose in the liver. In healthy people, this control system is remarkably good at maintaining blood glucose in a tight range despite many perturbations to the system imposed by diet and fasting, exercise, medications and other stressors. Type 1 diabetes mellitus (T1DM) results from loss of the insulin-producing cells of the pancreas, the beta cells. These cells serve as both sensor (of glucose levels) and actuator (insulin/glucagon release) in a control physiological feedback loop. Although the idea of rebuilding this feedback loop seems intuitively easy, considerable control mathematics involving multiple types of control schema were necessary to develop an artificial pancreas that still does not function as well as evolved control mechanisms. Here, we highlight some tools from control engineering used to mimic normal glucose control in an artificial pancreas, and the constraints, trade-offs and clinical consequences inherent in various types of control schemes. T1DM can be viewed as a loss of normal physiologic controls, as can many other disease states. For this reason, we introduce basic concepts of control engineering applicable to understanding pathophysiology of disease and development of physiologically based control strategies for treatment.
The identification of biomarkers for post-traumatic stress disorder (PTSD) and resilience/recovery is critical for advancing knowledge about pathophysiology and treatment in trauma-exposed persons. This study examined a series of glucocorticoid-related biomarkers prior to and in response to psychotherapy. Fifty-two male and female veterans with PTSD were randomized 2 : 1 to receive either prolonged exposure (PE) therapy or a weekly minimal attention (MA) intervention for 12 consecutive weeks. Psychological and biological assessments were obtained prior to and following treatment and after a 12-week naturalistic follow-up. Response was defined dichotomously as no longer meeting criteria for PTSD at post-treatment based on the Clinician Administered PTSD Scale for DSM-IV (CAPS). Clinical improvement on the CAPS was apparent for both PE and MA, with no significant difference according to treatment condition. Biomarkers predictive of treatment gains included the BCLI polymorphism of the glucocorticoid receptor gene. Additional predictors of treatment response were higher bedtime salivary cortisol and 24 h urinary cortisol excretion. Pre-treatment plasma dehydroepiandrosterone/cortisol ratio and neuropetide Y (NPY) levels were predictors of reductions in PTSD symptoms, and, for NPY only, of other secondary outcomes as well, including anxiety and depression ratings. Glucocorticoid sensitivity changed in association with symptom change, reflecting clinical state. It is possible to distinguish prognostic and state biomarkers of PTSD using a longitudinal approach in the context of treatment. Identified markers may also be relevant to understanding mechanisms of action of symptom reduction.