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March 29, 2024 BlogHolidays

We’ve all been there: we finally ask out the total hottie we’ve been crushing on for months, only for them to reply with “…who are you?” Oof and ow. Hands tremble, eyes water, we turn away in shame, and our heart literally breaks in half. This is very dangerous! The heart actually works best when it’s all in one piece, pumping blood, and not when it’s in many pieces crying.

Scientists have long looked for ways to mend a broken heart. The classic adage “time heals all wounds” has been the primary standard of care, but that has been deemed “very boring” by experts. Other researchers have looked into things like “sad music,” “eating,” and “partying.” In spite of these classical treatments, over the course of someone’s life, there is a nearly 100% chance they will experience hurt feelings! Clearly, a new approach is needed.

Previous methods of dealing with heartbreak have all been focused on the mental state; our psychological health. Now research scientists have been looking into physically reassembling the heart. Initial attempts at welding and gluing failed. Researchers went back to first principles to find the proper adhesive. Then, Dr. Jimmy Scientist – who was having an HVAC system installed in his house – looked up what a duct was. The first Google result says a duct is “a bodily tube or vessel.” The heart is a pump, sure, but it still has blood flow through it, which sorta makes it a duct. Using the axiom of “well technically…” scientists recently announced a new way to fix a broken heart: duct tape!

Using duct tape to fix a broken heart is not an easy process. Taping it all back together requires open heart surgery which has been described as “ouchie” and “yucky.” On top of this, the tape doesn’t stick if the heart is all wet and bloody, so they have to drain all the blood out of you first, which can make you light-headed. Then surgeons have to find most (at least a few) of the little broken pieces and tape it all together. At the end of the procedure, a really good doctor will even remember to put the blood back in the body.

So how does this work? A healthy heart pumps blood using the power of squishy-wishy. This blood reaches your whole body, including the brain. Some scientists suspect the brain might actually be a vampire because it really likes blood. In fact, the brain drinks ~2 ½ cups of blood every minute, which has been described as “radical” and “totally metal.” The brain is happy when it drinks this blood, and that makes you happy. When the heart is all leaky and broken, however, the brain can’t get enough blood. It gets angry and starts fluttering its bat wings or whatever. This can wobble your tear ducts, causing them to leak, and also makes your feelings hurt.

Duct tape keeps the heart watertight (bloodtight?!?) and gives it a chance to squish-wish blood up to your endraculated brain. With luck, we’ll be able to bounce back from heartbreak with speed. So if you experience heartbreak before the next April Fool’s, consider the duct tape method: all it takes is some open-heart surgery, a roll of adhesive tape, and a surgeon with no scruples.

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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February 9, 2024 BlogHolidays

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If there’s one thing I learned in elementary school… well, it was probably how to read. But if there’s one thing I learned every year around this time, it’s that Valentine’s Day isn’t just for lovers but for friends and classmates, too. Valentine’s Day is the time of year we celebrate the most special people in our lives – and it’s a good time to investigate the health effects of love and social relationships.

Love is a curious word. I love my wife and child, but also my cats, parents, siblings, friends, cookies, pizza, and ice cream. While some of my loves are potentially dangerous (or so my blood pressure tells me), my love of friends, family, and community might keep me alive – or at least balance the carbs. Studies have shown that maintaining social relationships can lower the rate of all-cause mortality: love literally increases your lifespan. This has been suspected for centuries and can be seen anecdotally in extreme examples with hermits, but it has been causally validated in recent years. Multiple studies in several countries have found that those with healthy social relationships are around half as likely to die over a given time span than isolated people. These relationships included marriage, contact with friends and family, and participation in communities like church, and other formal and informal groups. But how could our social lives affect our health? And what is the scientific definition of love anyway?

Love is… hard to define. One of the best ways to describe love is as a motivation system. It’s not only an emotion because it lasts much longer and shapes how we act over long periods of time. Instead, it’s the part of our personality that recognizes our need for social relationships to survive and reproduce. A skillful lone person can survive in the wilderness or on a deserted island for a while, but they will have trouble if they break an arm or try to have children without anyone else around. We need each other, and one of the parts that ensures we will act prosocially is love. So what’s that look like inside the brain?

Experiments show that a brain on love has a few hallmarks. The brain activates the reward system and parts of the cortex (medial insula, anterior cingulate cortex, hippocampus). The reward system encourages us to keep loving others and boosts dopamine, which makes us feel good, raises our desire, and acts in an almost addictive way similar to cocaine. The brain also lowers the activation of the amygdala, which is responsible for fear, the sympathetic “fight or flight” response, and chemicals like cortisol. Love also deactivates parts of the brain associated with social judgment, assessing other people’s intentions, and “negative emotions” like sadness. Serotonin is also suppressed, which may lead to obsessive symptoms similar to OCD. Love is both addictive and obsessive!

Two hormones are released by the hypothalamus: oxytocin and vasopressin. Oxytocin is known as the “love hormone” and increases attachment and bonding. It’s released in romantic love and during childbirth. It is thought to help mothers bond with babies. Vasopressin also increases bonding and attachment while affecting blood pressure and the kidneys. This gives a clue as to how love can be healthy.

In most developed nations (including the USA), the biggest causes of death aren’t from infectious diseases but from chronic ones. Diseases like heart disease are exacerbated by stress and stress hormones like cortisol and those of the sympathetic nervous system. Studies have shown that animals with social relationships have fewer ulcers and neurotic conditions and have lower blood pressure. Social support is able to mitigate stress and its negative effects. Love also has positive effects on the big picture of how we run our lives, giving us meaning, coherence, and promoting healthy behaviors like self-improvement and getting enough sleep (after college at least).

So this Valentine’s Day, tell those around you that you love them. Appreciate the relationships and communities you are a part of and activate those obsessive and addictive parts of your brain on something healthy. It’s elementary, really.

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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Cuzzo, B., Padala, S. A., & Lappin, S. L. (2023). Physiology, vasopressin. In StatPearls [Internet]. StatPearls Publishing.

House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.

Seshadri, K. G. (2016). The neuroendocrinology of love. Indian journal of endocrinology and metabolism, 20(4), 558.

Zeki, S. (2007). The neurobiology of love. FEBS letters, 581(14), 2575-2579.


December 29, 2023 BlogClinical TrialsHolidays

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This year has been exciting for clinical research. Our ENCORE sites completed 65 clinical trials (studies), and the FDA approved 66 new medications and vaccines nationwide. There is a long time between when a research organization or site, such as ours, completes a study and when a medication is ready for FDA review. Out of the 66 new medications or vaccines that were approved this year, ENCORE sites conducted seven of those clinical trials. That means all of you fantastic research volunteers helped get seven new medications or vaccines to market! In this article, we’ll review this year’s approvals and what they mean.

Three new vaccines that received FDA approval this year had trials at ENCORE sites. Arexvy and Abrysvo were both approved for the treatment of Respiratory Syncytial Virus (RSV) in adults. This disease hospitalizes 177 thousand adults over 65 each year and causes over ten thousand deaths. Arexvy was the first vaccine approved against RSV in adults, and Abrysvo is intended for both prevention and treatment of RSV and is approved for use in pregnant women. Arexvy was studied at the Westside Center for Clinical Research and Abrysvo at Nature Coast Clinical Research – Crystal River. Ixchiq is the world’s first vaccine to be approved for Chikungunya. Chikungunya is spread to people by infected mosquitoes and causes fevers and joint pain. St. Johns Center for Clinical Research participated in two phase III clinical trials for Ixchiq.

Two more ENCORE-researched medications approved this year were the first of their kind. Vowst has become the first medication to become FDA-approved for the treatment of C. difficile, also known as C. diff. C. difficile is a major health threat and causes colon inflammation. ENCORE Borland Groover Clinical Research investigated Vowst in the ECOSPOR trials. Veozah (fezolinetant) is the first non-hormonal treatment for moderate to severe vasomotor symptoms in women with menopause. These symptoms include hot flashes and night sweats, and Veozah targets the temperature centers of the brain to help with these symptoms. Three ENCORE research sites participated in the SKYLIGHT trials to investigate Veozah, Fleming Island Center for Clinical Research, St. Johns Center for Clinical Research, and Nature Coast Clinical Research – Crystal River.

Two medications were approved, which may help with established diseases. Rinvoq (upadacitinib) is a daily pill for those with Crohn’s disease, an autoimmune disorder. Rinvoqwas the first oral treatment for Crohn’s disease to be approved. It was studied at ENCORE Borland Groover Clinical Research. Inpefa (sotagliflozin) has been approved as a daily pill to reduce cardiovascular death, hospitalization, and urgent heart failure by 33% in patients with heart failure. It was studied at the Jacksonville Center for Clinical Research.

We at ENCORE Research Group are very excited about a year of amazing approvals. It validates the hard work and effort of all of our research staff and doctors, and – most importantly – it goes to show just how important our patient volunteers are! With the help of these heroes, we have new and effective options to help with six different diseases. Many thanks to everyone who has participated in any of our clinical trials, and we’ll see you next year!

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Abbvie. (18 May, 2023). U.S. FDA Approves RINVOQ® (upadacitinib) as a Once-Daily Pill for Moderately to Severely Active Crohn’s Disease in Adults.

Astellas. (13 May, 2023). Astellas’ VEOZAHTM (fezolinetant) Approved by U.S. FDA for Treatment of Vasomotor Symptoms Due to Menopause.

GSK plc. (3 May, 2023). US FDA approves GSK’s Arexvy, the world’s first respiratory syncytial virus (RSV) vaccine for older adults.

Lexicon Pharmaceuticals. (26 May, 2023). Lexicon Announces FDA Approval of INPEFA™ (Sotagliflozin) for Treatment of Heart Failure.

Schneider, M., Narciso-Abraham, M., Hadl, S., McMahon, R., Toepfer, S., Fuchs, U., … & Wressnigg, N. (2023). Safety and immunogenicity of a single-shot live-attenuated chikungunya vaccine: a double-blind, multicentre, randomised, placebo-controlled, phase 3 trial. The Lancet.

Seres Therapeutics, Nestle Health Science. (26 April, 2023). Seres Therapeutics and Nestlé Health Science Announce FDA Approval of VOWST™ (fecal microbiota spores, live-brpk) for Prevention of Recurrence of C. difficile Infection in Adults Following Antibacterial Treatment for Recurrent CDI.

Velena SE. (10 November, 2023). Valneva Announces U.S. FDA Approval of World’s First Chikungunya Vaccine, IXCHIQ®.

U.S. Food & Drug Administration. (27 November, 2023). 2023 Biological License Application Approvals.

U.S. Food & Drug Administration. (19 December, 2023).  Novel Drug Approvals for 2023.


December 22, 2023 BlogHolidays

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The holidays are a time for giving. We give gifts, hugs, support, unsolicited advice, and time. Of those, time can make the most significant difference to society at large if we provide it in the form of volunteering. Over 1 in 4 Americans volunteer their time. To count as volunteering, one has to freely choose to do the activity (no getting volun-told) and it should be altruistic. There are different categories of volunteering broken down into self-oriented and other-oriented. Self-oriented volunteering involves some kind of personal benefit, like potential career advancement. Other-oriented volunteering is instead focused on helping others in areas like health, education, religious groups, and youth development. Regardless of the category, any volunteering is good volunteering. Anyone who volunteers knows that besides helping others, it also gives you a warm fuzzy feeling inside, but did you know that fuzzy feeling might help keep you alive?

Before we get into studies and possible health benefits, we must cover caveats. Studying the effects of volunteering on the body and brain is hard. You literally can’t force people to volunteer, so most of our information comes from observational studies. This is where researchers will follow people over time and compare those who volunteer to those who don’t. This can give us some great data, but it’s hard to know if volunteering is the cause or the effect. A senior citizen with a painful condition who works 60 hours a week will probably volunteer less than a healthy retiree (clinical research tries to mitigate these needs by providing compensation for time and travel to help make volunteering easier). Good studies therefore compare people with similar health, economic, and other factors in an attempt to isolate any effects volunteering has.

With that in mind, volunteering seems to be associated with great outcomes. It appears to be associated with improvements in depression and life satisfaction. In a 14-year study of those above 60, a 2016 study found a reduced risk of cognitive decline due to volunteering. Most amazingly, a 2013 meta-analysis, which looked at the results of 40 other studies, found a 22% reduction in death! Even when taken with a McDonald’s french fry of salt, these results are very promising. But what’s going on to make this happen? There are no definite answers, but three suspected ones:

  • Physical activity: volunteering usually requires people to get up and move. This is particularly helpful for those whose social networks are shrinking
  • Social interaction: volunteering uses the social parts of your brain. Increasing these has been shown to increase survivability by up to 50%
  • Prosocial behavior: volunteering increases our social networks, which act as reinforcement systems for health

How can we gain these benefits? By volunteering, of course! Food banks, schools, refugee services, and youth development programs can always use volunteers. The internet is a great place to look for opportunities to grow your social networks and help others. Clinical research is another great way to volunteer. One of the biggest draws for clinical research volunteers is knowing that the medicines they help research can help future generations. Today’s trials can help pave the way for medications and procedures that may persist into the future. This holiday season, if you can, volunteer and give the gift that keeps on giving.

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS medicine, 7(7), e1000316.

Infurna, F. J., Okun, M. A., & Grimm, K. J. (2016). Volunteering is associated with lower risk of cognitive impairment. Journal of the American Geriatrics Society, 64(11), 2263-2269.

Jenkinson, C. E., Dickens, A. P., Jones, K., Thompson-Coon, J., Taylor, R. S., Rogers, M., … & Richards, S. H. (2013). Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC public health, 13(1), 1-10.

Kwon, S. J., van Hoorn, J., Do, K. T., Burroughs, M., & Telzer, E. H. (2023). Neural representation of donating time and money. Journal of Neuroscience, 43(36), 6297-6305.

Webster, N. J., Ajrouch, K. J., & Antonucci, T. C. (2021). Volunteering and health: The role of social network change. Social Science & Medicine, 285, 114274.


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Previously, we explored how the character trait of gratitude can have long-lasting impacts on our health and well-being. Unfortunately, character traits are internal and can be hard to change. Thankfully, scientists are a creative lot and have been working for decades attempting to find out how to increase gratitude. Note that the following methods are still experimental; positive results have been found, but the sample sizes have been relatively small. These interventions have shown increased psychological well-being in the form of increased happiness and satisfaction, as well as fewer depressive symptoms in adults. Please note that this is not a substitute for professional psychological or medical help! Instead, these are interventions that may have positive effects when adhered to. The interventions are: Gratitude journaling, Gratitude letters, Mental subtraction, and Experiential consumption.

Gratitude journaling is easy and effective; you just write down things you are thankful for. Various methods have been studied, including the amount (3-5 things) and the frequency (daily or weekly) of journaling. The most effective method I’ve seen is to write three things you are grateful for that happened on the same day. Generally, people wrote a sentence or two about each event. Keeping it limited to daily events helps keep this task from becoming stale. In addition, writing the causes of those events seems to help make the results long-lasting. In one study, a week of gratitude journaling led to increased measures of happiness for the next six months. The idea behind gratitude journaling is that by focusing on the positives, we reinforce those mental pathways and make it more likely that we think about positive things.

Gratitude letters are a little more intense than gratitude journaling. In this task, participants write a letter to someone who has been particularly kind to them but hasn’t been properly thanked before. Ideally, the letter should be hand-delivered for maximum effect. By showing gratitude to others, participants had higher scores associated with gratitude themselves. This one is a particularly tactile activity, which may be helpful to some. The effects of this intervention were shown to last over a month on average.

Mental subtraction is an interesting intervention. In this activity, participants imagined and wrote about a positive event that occurred in their lives and what their lives would be like had the event never taken place. Alternatively, participants were asked to describe how a positive event was surprising to them, forcing them to think of ways it may not have occurred. This was shown to have positive effects on people’s mental state. By looking at the ways things may not have occurred, it might make people more grateful that they occurred at all.

Experiential consumption is an interesting “intervention.” When looking at habits of what people buy, scientists have found that spending money on experiences (trips, music events, etc.) seems to increase people’s happiness and gratitude more than buying tangible items (furniture, clothes, etc.).The thinking behind why experiences may be beneficial is that they are more personal and intrinsic. Experiences are less likely to be compared to others, more likely to be incorporated into who you are, and more likely to be social. Material items are easy to compare to others and unlikely to make lasting impacts on how you see yourself. In addition, ownership is defined as exclusive use, making it an inherently antisocial state.

These methods of increasing our gratitude may not be the end-all of increasing our happiness, but they are a good start. We have a few tips to increase the success rate of these interventions. First, a desire for self-improvement helps a lot. If you want to be more thankful this season, it will make each of these tasks easier. Second, expectations matter. The benefits of these interventions may not change your life, but they are pretty sure to improve how you feel about it; plus, they are basically no-risk (unless your experiential consumption is skydiving). Finally, it is easier to follow through on engaging activities. Things like writing the causes of a thankful event may help keep things engaging and fun, making you more likely to complete the task. Feel free to modify these as needed to keep yourself engaged and having fun with them. Hopefully, these ideas help increase your gratitude this Thanksgiving season. Thank you, as always, for reading!

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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Allen, S. (2018). The science of gratitude (pp. 1217948920-1544632649). Conshohocken, PA: John Templeton Foundation.

Dickens, L. R. (2017). Using gratitude to promote positive change: A series of meta-analyses investigating the effectiveness of gratitude interventions. Basic and Applied Social Psychology, 39(4), 193-208.

Enmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377-389.

Geraghty, A. W., Wood, A. M., & Hyland, M. E. (2010). Attrition from self-directed interventions: Investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention. Social science & medicine, 71(1), 30-37. 

Kaczmarek, L. D., Kashdan, T. B., Kleiman, E. M., Baczkowski, B., Enko, J., Siebers, A., … & Baran, B. (2013). Who self-initiates gratitude interventions in daily life? An examination of intentions, curiosity, depressive symptoms, and life satisfaction. Personality and Individual Differences, 55(7), 805-810. 

Koo, M., Algoe, S. B., Wilson, T. D., & Gilbert, D. T. (2008). It’s a wonderful life: Mentally subtracting positive events improves people’s affective states, contrary to their affective forecasts. Journal of personality and social psychology, 95(5), 1217. 

Renshaw, T. L., & Olinger Steeves, R. M. (2016). What good is gratitude in youth and schools? A systematic review and meta‐analysis of correlates and intervention outcomes. Psychology in the Schools, 53(3), 286-305. 

Seligman, M. E., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: empirical validation of interventions. American psychologist, 60(5), 410.

Walker, J., Kumar, A., & Gilovich, T. (2016). Cultivating gratitude and giving through experiential consumption. Emotion, 16(8), 1126.


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Clinical research has many benefits. There are the obvious ones, like a stipend for time and travel and the potential benefits of an investigational medication, but also more esoteric benefits, like increased quality of care, attention from medical staff, and knowledge about the conditions people face. We recently had a chance to talk with one of our repeat patients, Brendle, who will walk us through her clinical research experience and why she keeps signing up for more studies.

“I’ve learned so much,” she stated. One of the big benefits of clinical research is the knowledge gained through experience. Brendle said “Dr. Koren explains things so well.” Not only do patients get access to podcasts from Dr. Michael Koren and articles from our knowledgeable staff, but they also get a lot of direct face-to-face time with medical professionals and support staff. Transparency is key in clinical research, so we spend a lot of time talking through the full medical history of every patient. We also make sure everyone understands the science, risks, benefits, and process of a trial before enrolling. We typically schedule an hour or two for patients to talk through medical history, medications, and the specifics of a clinical trial before enrolling. Compare this to a typical doctor’s visit with a wait time of 15-30 minutes and only 10-20 minutes of time with a doctor and it’s easy to see why people like Brendle enjoy the clinical trial experience so much. Imagine how many complications could be avoided if primary care practices were able to spend an hour with each patient before prescribing a new medication!

Of course, medications and procedures are the major benefit most people think of when it comes to clinical research. Participants rank risks and benefits as the most important information before participating. The importance of understanding the potential risks of investigational medications or procedures should not be taken lightly. We ensure that patients are given the information needed to make well-informed decisions. Obviously, potential benefits are different in every study. Registry studies only collect information, and the benefit is in drug development down the road (and compensation). Phase 3 studies, in contrast, can have long-lasting effects on biological markers of health.

Brendle notes, “when I first came here, my Ejection Fraction (EF) was only 10%. Now it’s up!” This information is exactly what we want to know for statistical analysis, but the real-world consequences can be even better. Brendle continues, “I could only go from the bed to the couch and back, but now I can do much more.” Amazingly, it’s possible that benefits like this may be realized even when a patient is given a placebo. Not only is the placebo effect real, but the increased attention from doctors and medical staff makes sure we catch any health changes as soon as they happen.

Brendle finished up her chat with us saying “This is the best experience. I am thankful to get into studies.” We are very thankful for patients like Brendle – and you, dear reader – who help push science forward by volunteering for clinical trials!

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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Business Wire, (March 22, 2018). 9th annual vitals wait time report released

CISCRP, (2021). Perceptions and insights study 2021. 

Tai‐Seale, M., McGuire, T. G., & Zhang, W. (2007). Time allocation in primary care office visits. Health services research, 42(5), 1871-1894.


November 3, 2023 BlogHolidays

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The long-dead philosopher Cicero once said, “There is no quality I would rather have, and be thought to have, than gratitude. For it is not only the greatest virtue, but is the mother of all the rest.” Gratitude is when we are thankful and appreciate kindness, people, and the world around us. It goes beyond a quick emotion. When we get a thoughtful or meaningful gift, it makes us happy, but that feeling may only stay with us short term. The long-term nature of gratitude is what makes it powerful. Simple appreciation can change into a general mood, and with enough gratitude, our personality can change (hopefully for the better). If we live a life choosing gratitude, we feel happy when we get gifts, but also at smaller things. The long-term personality trait associated with gratitude can increase positive emotions, leave us satisfied, and may help decrease envy, anxiety, and depression.

Persistent personality traits are a neat thing. They affect our mood and emotional response to everyday things. Gratitude as a personality trait increases the intensity (amplitude) and duration of positive thankful emotions and makes it easier to feel thankful. It also increases the number of other people you feel thankful for (like being appreciative that your sister’s cousin’s best friend’s thrash metal band got a record deal). This happens because personality traits indicate that the brain has specific structures and wiring paths built over time. With gratitude, we can see that these changes are in a few key areas of the brain: those responsible for social bonding, perspective-taking, moral judgment and decision-making, and the reward system. They aren’t just emotional areas; they include intentional and calculated parts of the brain that help change our overall outlook. Overall, brain areas increased by gratitude are prosocial; they promote good social behaviors like friendship.

Being thankful is great for making friends and feeling good, but it may also have health benefits! Psychological effects include increased positive emotions, satisfaction, and spirituality as well as decreased indicators of depression, anxiety, and envy. Gratitude-filled people also tend to be more empathetic, forgiving, helpful, and supportive. This makes sense; recognizing good things focuses our attention on more good things. Thankfully, gratitude may also affect our physical health! Measuring gratitude is difficult, so take the following with a grain of salt. Beneficial biomarkers of health measured by people with high gratitude include improved inflammation, diastolic blood pressure, heart rate, and A1C (blood sugar). These are associated with some pretty serious conditions like asthma, cardiovascular disease, and the effects of diabetes. It is unclear how feeling thankful can cause all of these changes, but it may be due to eating and sleeping habits. Gratitude has been linked with lowering dysfunctional eating habits and with improving sleep quality. A good diet is always important, but a good night’s sleep may be even more important for gratitude. So this November, let’s all be thankful for the ability to feel thankful!

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

Listen to the article here:


Allen, S. (2018). The science of gratitude (pp. 1217948920-1544632649). Conshohocken, PA: John Templeton Foundation.

Boggiss, A. L., Consedine, N. S., Brenton-Peters, J. M., Hofman, P. L., & Serlachius, A. S. (2020). A systematic review of gratitude interventions: Effects on physical health and health behaviors. Journal of Psychosomatic Research, 135, 110165.

McCullough, M. E., Emmons, R. A., & Tsang, J. A. (2002). The grateful disposition: a conceptual and empirical topography. Journal of personality and social psychology, 82(1), 112.


October 26, 2023 BlogHolidays

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Boo! This Halloween many of us will dress as spooky things, visit houses with creepy decorations, go into haunted houses, watch scary movies, and enjoy other horror-related entertainment. But being scared kinda sucks. Why do many of us actively subject ourselves to being scared on purpose?

One of the big draws of scary things is dichotomy: the contrast between two ideas that can’t both be true. When we watch a scary movie, we are safe in a theater, but feel the danger and emotion as if we were ourselves being chased by a shark with a knife (or whatever). In a haunted house we may get an even more visceral experience, as our neighbor jumps out at us with a rubber knife in his realistic shark costume. Knowing we are safe makes our brains bounce back and forth between danger and safety. Another big pull of Halloween scares is that they rely on expectations. Most of us would be pretty upset to come home and find a giant spider and some skeletons on our bed. But when given the proper context and expectation, we can be excited and find scary decorations fun and exciting.

Fear is the major emotion at play here, but what is fear? Our emotions can be roughly divided along two lines: valence and amplitude. Valence describes the positive or negative quality of an emotion and amplitude is how strong the emotion is felt. In this organization scheme, fear has a negative valence and a high amplitude, it makes us feel bad and we feel it strongly. On top of this, amplitude seems a little more persistent than valence, so there is a delay period where we still feel excited but can change from a negative to positive valence. So fear with the right context (such as a haunted house or scary movie) makes us switch between the negative valence of fear and the logical knowledge that we are safe.

We can look inside the brain to get a better understanding of what’s happening. There are two competing pathways that activate with fear, depending on the distance to danger. The midbrain pathway activates for close, immediate threats. It is the “fight or flight” response to fear. The frontal cortex is for threats that are further away and is in charge of planning and strategizing. With spooky halloween fears, these two systems are in direct opposition. Trying to overcome the midbrain pathway is hard, but rewarding. We are also rewarded when successfully surviving a scary situation. When we conquer our fear we have the high amplitude of fear combined with the positive valence of relief. So this Halloween, indulge in a little emotional hijacking and enjoy your fear a little bit!

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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Anders, S., Lotze, M., Erb, M., Grodd, W., & Birbaumer, N. (2004). Brain activity underlying emotional valence and arousal: A response‐related fMRI study. Human brain mapping, 23(4), 200-209.

Dewey, J. (1894). “The theory of emotion: I: Emotional attitudes”. The Psychological Review. 1(6), 553–569.

Nummenmaa, L. (2021). Psychology and neurobiology of horror movies. PsyArXiv.


January 1, 2016 BlogHolidays

As each year comes and goes we seem to go through the same cycle. We end the year by reflecting on what we accomplished (or didn’t) over the course of the past year and how we can improve over the next year. Many of us set specific goals which we call our ‘New Year’s Resolutions’. These goals range from budgeting to personal growth to accomplishing a specific task. One topic we all seem to consider though is improving our own health. One person may try a new fad diet and another may set a goal to start exercising once a week. One thing most people don’t consider is participating in a clinical trial.


Why would you make participating in a clinical trial part of your New Year’s Resolution? There are many reasons that participating in a clinical trial can improve your health. In the very least people should consider participating due to the Hawthorne effect. Patients receiving individual care in a trial tend to do better than those not in a trial regardless of whether or not they receive placebo. Also, patients may improve their health by receiving new medications or feeling more compelled to take their medications regularly. The many beneficial effects of participating in a trial can combine to make a real difference!


Here at ENCORE we are thankful for the patients that have put their trust in us over the past year. Our patients make us who we are and are an integral part of the ENCORE family. Moving forward into 2017 our New Year’s Resolution is to give our patients their best experience with us yet! Our goal is to help you with your health goals. If there is something we can help you with then we would love to go on that journey with you. Happy New Year!



January 1, 2017 BlogHolidays

I recently stumbled across the work of Professor John Norcross, the “undisputed” guru on all matters related to New Year’s resolutions. Who knew? I guess a guru may exist for nearly all things. Professor Norcross surveyed and followed a few hundred folks who made New Year’s resolutions and compared them to those who did not commit themselves to goals as the calendar year turned.

Here are a few fun facts from the Professor’s findings:

  1. About 50% of Americans make New Year’s resolutions on any given year and 38% absolutely will not make one in principle (er, they’ve resolved not to resolve);
  2. 25% of resolutions fail within one week;
  3. Older folks have greater difficulty keeping resolutions than younger people – 20-somethings beat 50-somethings for one-year resolution success rates – 39% versus 14%. Of course, success rates were self-reported so we can either conclude that the adage about old dogs and new tricks rings true or that millennials tend to grade on a curve.

We can draw solace from Professor’s Norcross’s most persuasive finding:  those who made New Year’s Resolution were 10 times more likely to change unwanted behaviors than those who didn’t make them. Yes, setting goals works and the New Year, fresh with the feelings of optimism and renewal, seems like the perfect time to make them.

We have an exciting agenda of educational programs called “Learn with the Leaders” that we will highlight throughout the year. In January, we will talk to people about how they can help themselves with autoimmune disease, cholesterol problems, diabetes, and memory loss. Please make an effort to attend these sessions.

Participating in a research study has lots of unintended benefits but perhaps most importantly the benefit of having a team help you stick with a program. Let’s resolve to keep our resolutions this year, or at least double the amount of time until we break them.

– Michael J. Koren, MD FACC CPI FAPCR


Reference:  Journal of Clinical Psychology, 58(4), 397-405

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As a proven clinical research organization, we take every precaution to ensure the safety of and maximize the value for our research volunteers. Qualified doctors, nurses and study coordinators on staff provide support and care throughout the research trial. Participation is always voluntary. We appreciate the time and effort that research volunteers bring to this important process.

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