Learning under stress impairs memory formation

Improving the Efficiency and Effectiveness of Parent Education in the Neonatal Intensive Care Unit

Background:

March of Dimes partners with hospitals across the country to implement NICU Family Support (NFS) Core Curriculum, a program providing education to parents in neonatal intensive care units (NICUs) across the country.

Purpose:

This NFS project's goal was to increase the efficiency and effectiveness of NICU parent education by establishing consistency, improving quality, and identifying best practices.

Methods/Search Strategy:

A 5 topic curriculum was developed and implemented across NFS program sites. The project studied 4 main outcomes of interest related to efficiency and effectiveness: increase in parenting confidence, parent learning, knowledge change, and satisfaction. Data were collected from speakers and attendees immediately following educational sessions. Analytical approaches included descriptive statistics such as frequency, percentage, and response rate, and inferential approaches such as t test, χ², and analysis of variance.

Findings/Results:

Findings suggest that the NFS Core Curriculum improved both program efficiency and effectiveness. Sessions fully implemented according to recommended strategies had better outcomes than sessions not fully implemented according to recommended strategies (P < .0001). Across the 3648 attendees at 41 sites, 77% of parents reported learning “a lot” at the session they attended and 85% of attendees reported increased confidence. Attendees also reported positive knowledge change and high satisfaction.

Implications for Practice:

Parent education best practices identified through this initiative can be utilized for future NFS Core Curriculum topics and potentially generalized to all NICU parent education and family education in other hospital intensive care units.

Implications for Research:

Content and best practices identified through this project will require regular review to ensure medical accuracy and appropriateness of best practices as the physical design of NICUs evolves.

Striatal reactivity to reward under threat-of-shock and working memory load in adults at increased familial risk for major depression: A preliminary study

INTRODUCTION

Anhedonia, a core symptom of Major Depressive Disorder (MDD), manifests as a lack or loss of motivation as reflected by decreased reward responsiveness, at both behavioral and neural (i.e., striatum) levels. Exposure to stressful life events is another important risk factor for MDD. However, the mechanisms linking reward-deficit and stress to MDD remain poorly understood. Here, we explore whether the effects of stress exposure on reward processing might differentiate between Healthy Vulnerable adults (HVul, i.e., positive familial MDD) from Healthy Controls (HCon). Furthermore, the well-described reduction in cognitive resources in MDD might facilitate the stress-induced decrease in reward responsiveness in HVul individuals. Accordingly, this study includes a manipulation of cognitive resources to address the latter possibility.

METHODS

16 HVul (12 females) and 16 gender- and age-matched HCon completed an fMRI study, during which they performed a working memory reward task. Three factors were manipulated: reward (reward, no-reward), cognitive resources (working memory at low and high load), and stress level (no-shock, unpredictable threat-of-shock). Only the reward anticipation phase was analyzed. Imaging analyses focused on striatal function.

RESULTS

Compared to HCon, HVul showed lower activation in the caudate nucleus across all conditions. The HVul group also exhibited lower stress-related activation in the nucleus accumbens, but only in the low working memory (WM) load condition. Moreover, while stress potentiated putamen reactivity to reward cues in HVul when the task was more demanding (high WM load), stress blunted putamen reactivity in both groups when no reward was at stake.

CONCLUSION

Findings suggest that HVul might be at increased risk of developing anhedonic symptoms due to weaker encoding of reward value, higher difficulty to engage in goal-oriented behaviors and increased sensitivity to negative feedback, particularly in stressful contexts. These findings open new avenues for a better understanding of the mechanisms underlying how the complex interaction between the systems of stress and reward responsiveness contribute to the vulnerability to MDD, and how cognitive resources might modulate this interaction.

Constitutive differences in glucocorticoid responsiveness are related to divergent spatial information processing abilities

The stress response facilitates survival through adaptation and is intimately related to cognitive processes. The Morris water maze task probes spatial learning and memory in rodents and glucocorticoids (i.e. corticosterone (CORT) in rats) have been suggested to elicit a facilitating action on memory formation. Moreover, the early aging period (around 16-18 months of age) is susceptible to stress- and glucocorticoid-mediated acceleration of cognitive decline. In this study, we tested three lines of rats selectively bred according to their individual differences in CORT responsiveness to repeated stress exposure during juvenility. We investigated whether endogenous differences in glucocorticoid responses influenced spatial learning, long-term memory, and reversal learning abilities in a Morris water maze task at early aging. Additionally, we assessed the quality of the different swimming strategies of the rats. Our results indicate that rats with differential CORT responsiveness exhibit similar spatial learning abilities but different long-term memory retention and reversal learning. Specifically, the high CORT responding line had a better long-term spatial memory, while the low CORT responding line was impaired for both long-term retention and reversal learning. Our modeling analysis of performance strategies revealed further important line-related differences. Therefore, our findings support the view that individuals with high CORT responsiveness would form stronger long-term memories to navigate in stressful environments. Conversely, individuals with low CORT responsiveness would be impaired at different phases of spatial learning and memory.

Does acute stress influence the Pavlovian-to-instrumental transfer effect? Implications for substance use disorders

RATIONAL

The ability of conditioned stimuli to affect instrumental responding is a robust finding from animal as well as human research and is assumed as a key factor regarding the development and maintenance of addictive behaviour.

OBJECTIVES

While it is well known that stress is an important factor for relapse after treatment, little is known about the impact of stress on conditioned substance-associated stimuli and their influence on instrumental responding.

METHODS

We administered in the present study a Pavlovian-to-instrumental transfer (PIT) paradigm with stimuli associated with smoking- and chocolate-related rewards using points in a token economy to light to moderate smokers who also indicated to like eating chocolate. After completion of the first two phases of the PIT paradigm (i.e. Pavlovian training and instrumental trainings), participants were randomly allocated to the socially evaluated cold pressor test or a control condition before the final phase of the PIT paradigm, the transfer phase, was administered.

RESULTS

The presentation of a smoking-related stimulus enhanced instrumental responding for a smoking-related reward (i.e. 'smoking-PIT' effect) and presentation of a chocolate-related stimulus for a chocolate-related reward (i.e. 'chocolate-PIT' effect) in participants aware of the experimental contingencies as indicated by expectancy ratings. However, acute stress did not change (i.e. neither enhanced nor attenuated) the 'smoking-PIT' effect or the 'chocolate-PIT' effect, and no overall effect of acute stress on tobacco choice was observed in aware participants.

CONCLUSIONS

The established role of stress in addiction appears not to be driven by an augmenting effect on the ability of drug stimuli to promote drug-seeking.

What Do Women Want? Looking Beyond Patient Satisfaction

OBJECTIVE

To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization.

DESIGN

Focus groups using semistructured interview questions.

SETTING

A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast.

PARTICIPANTS

Women who planned to or had given birth, their partners, and the maternity nurses who cared for them.

MEASUREMENTS

Qualitative thematic analysis of focus group transcripts.

RESULTS

Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period.

CONCLUSION

Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs.

Stress impacts the fidelity but not strength of emotional memories

Psychological stress during memory encoding influences resulting memory representations. However, open questions remain regarding how stress interacts with emotional memory. This interaction has mainly been studied by characterizing the correct identification of previously observed material (memory "hits"), with few studies investigating how stress influences the endorsement of unobserved material as remembered (memory "false alarms"). While hits can provide information about the presence or strength of a memory representation, false alarms provide insight into memory fidelity, indicating to what extent stored memories are confused with similar information presented at retrieval. This study examined the effects of stress on long-term memory for negative and neutral images, considering the separate contributions of hits and false alarms. Participants viewed images after repeated exposure to either a stress or a control manipulation. Stress impaired memory performance for negative pictures and enhanced memory performance for neutral pictures. These effects were driven by false alarms rather than hits: stressed participants false alarmed more often for negative and less often for neutral images. These data suggest that stress undermines the benefits of emotion on memory by changing individuals' susceptibility towards false alarms, and highlight the need to consider both memory strength and fidelity to characterize differences in memory performance.

Enhancing memory with stress: Progress, challenges, and opportunities

Stress can strongly influence what we learn and remember, including by making memories stronger. Experiments probing stress effects on hippocampus-dependent memory in rodents have revealed modulatory factors and physiological mechanisms by which acute stress can enhance long-term memory. However, extending these findings and mechanisms to understand when stress will enhance declarative memory in humans faces important challenges. This review synthesizes human and rodent studies of stress and memory, examining translational gaps related to measurements of declarative memory and stress responses in humans. Human studies diverge from rodent research by assessing declarative memories that may not depend on the hippocampus and by measuring peripheral rather than central stress responses. This highlights opportunities for future research across species, including assessing stress effects on hippocampal-dependent memory processes in humans and relating peripheral stress responses to stress effects on the function of memory-related brain regions in rodents. Together, these investigations will facilitate the translation of stress effects on memory function from rodents to humans and inform interventions that can harness the positive effects of stress on long-term memory.

Negative Mental States and Their Association to the Cognitive Function of Nurses

Abstract. Nurses’ inherently stressful occupation leaves them at a higher risk of developing negative mental states (stress, anxiety, and depression). However, research examining the effect of negative mental states on these health professionals’ cognitive performance is sparse. Thus, the present study aimed to assess the link between negative mental states and cognitive performance in nurses ( n = 53). Negative mental state data was obtained using the Depression Anxiety Stress Scale, brain activity was measured using electroencephalography, and finally, cognitive performance was assessed using the Cognistat and the Mini-Mental State Examination. Significant negative correlations ( p < .05) were observed between anxiety and attention, and all three negative mental states and memory performance. Electroencephalographic changes indicated that increases in anxiety were significantly associated ( p < .05) with decreases in gamma reactivity at fronto-central sites. The current study suggests that higher levels of negative mental states are associated with domain-specific cognitive impairments, and variations in gamma reactivity; possibly reflecting less optimal cortical functioning.

Acute stress improves long-term reward maximization in decision-making under uncertainty

Acute stress influences reward-seeking tendencies and risky decision-making. However, it is unclear how acute stress influences decision-making in situations in which individuals must learn to either maximize long-term or immediate rewards from experience. Consequently, this study sought to investigate whether acute stress enhances salience of small, immediate or large, delayed rewards on decision-making under uncertainty. The Socially Evaluated Cold Pressor Task (SECPT) was used to induce acute stress. Participants in Experiment 1 (N = 50) were exposed to either the SECPT or a warm-water control condition and then completed a decision-making task in which participants needed to learn to forego immediate rewards in favor of larger delayed rewards. The results demonstrated that acute stress enhanced decisions that maximized long-term, large rewards over immediate, small rewards. Experiment 2 (N = 50) included an assessment of salivary cortisol. Results replicated the behavioral findings in Experiment 1 and demonstrated that the acute stress manipulation increased salivary cortisol, thus providing a potential physiological mechanism for these results. This work suggests that moderate acute stress can improve decision-making under uncertainty that depends on learning to maximize long-term rewards from experience.

Workplace Bullying and Occupational Stress Among University Teachers: Mediating and Moderating Factors

In the study, it is explored whether exposure to workplace bullying predicts symptoms of occupational stress, and whether this association is mediated by interpersonal relationships, and moderated by sex and nationality. A sample of 610 university teachers from Pakistan (196 males, 133 females) and Finland (152 males, 129 females) completed an online questionnaire. A conditional process model was applied using the PROCESS programme. Workplace bullying served as predictor, stress symptoms as predicted variable, relationships with (a) colleagues and (b) family as mediators, and sex and country as moderators. As expected, workplace bullying had a significant effect on stress symptoms, which was mediated by family relationships but not by relationships with colleagues. Neither sex nor country had a moderating effect. Positive family relationships thus mediate the stressful impact of workplace bullying, and this was the case for both sexes and both nationalities.

Effective Information Provision About the Side Effects of Treatment for Malignant Lymphoma: Protocol of a Randomized Controlled Trial Using Video Vignettes

BACKGROUND

Informing patients with cancer about the possible implications of prospective treatment is a crucial yet challenging task. Unfortunately, patients' recall of medical information is generally poor and their information needs are not met. Effective information giving entails that oncologists help patients understand and recall the implications of their treatment, meanwhile fostering a trusting physician-patient relationship. Communication strategies that are often suggested to be effective are structuring and tailoring (cognition-oriented) but also are oncologists' expressions of caring or empathy (affect-oriented).

OBJECTIVE

The aim of this study is to provide evidence concerning the pathways linking physician communication to (improved) consultation outcomes for patients. More specifically, the aim is to determine the effects of information structuring and information tailoring, combined with physician caring, on information recall, satisfaction with information, and trust in the physician (primary objective) and on symptom distress (secondary objective).

METHODS

A randomized controlled trial, systematically testing the effects of information structuring and information tailoring, each combined with caring, in 2 video-vignette experiments (2×2 and 2×2×2 design). Using an online survey platform, participants will be randomly allocated (blinded) to 1 of 12 conditions in which they are asked to view a video vignette (intervention) in which an oncologist discusses a treatment plan for malignant lymphoma with a patient. The independent variables of interest are systematically varied across conditions. The outcome measures are assessed in a survey, using validated instruments. Study participants are (former) patients with cancer and their relatives recruited via online panels and patient organizations. This protocol discusses the trial design, including the video-vignette design, intervention pretesting, and a pilot study.

RESULTS

Data collection has now been completed, and preliminary analyses will be available in Spring 2019. A total of 470 participants completed the first part of the survey and were randomized to receive the intervention.

CONCLUSIONS

The results of the proposed trial will provide evidence concerning the pathways linking physician information, giving skills to (improved) consultation outcomes for patients.

TRIAL REGISTRATION

Netherlands Trial Register NTR6153; https://www.trialregister.nl/trial/6022 (Archived by Webcite at http://www.webcitation.org/76xVV9xC8).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/12453.

Feasibility and acceptance of the CaringGuidance web-based, distress self-management, psychoeducational program initiated within 12 weeks of breast cancer diagnosis

OBJECTIVE

Limited clinical resources create barriers to quality management of cancer-related distress. CaringGuidance After Breast Cancer Diagnosis is a web-based, patient-controlled, psychoeducational program of cognitive-behavioral, coping and problem-solving strategies aimed at early post-diagnosis distress reduction without clinical resources. This study evaluated the feasibility of recruiting and retaining newly diagnosed women to 12 weeks of CaringGuidance and program acceptance.

METHODS

Women with stage 0 to II breast cancer diagnosed within the prior 3 months were recruited from clinics and communities in four states, from 2013 to 2015 and randomized to 12 weeks of CaringGuidance plus usual care (n = 57) or usual care alone (n = 43). Recruitment, retention, and program use were tracked. Using standard and study-derived measures, demographic and psychological variables were assessed at baseline and monthly and program satisfaction at 12 weeks.

RESULTS

Of 139 women screened, 100 enrolled, five withdrew, and 12 were lost to follow-up (83% retention rate). Total program engagement was positively associated with greater baseline intrusive/avoidant thoughts. Intervention participants (92%) believed CaringGuidance would benefit future women and was easy to use. Sixty-six percent believed CaringGuidance helped them cope. Women used program content to change thoughts (49%) or behaviors (40%). Stress in the previous year was positively associated with reports that CaringGuidance was reassuring and helpful.

CONCLUSIONS

Feasibility and acceptance of CaringGuidance was demonstrated pointing to the program's potential as a cancer-distress self-management intervention. Future research will explore program feasibility and acceptability in other regions of the United States, leading to clinical implementation trials.

Unpacking the Literature on Stress and Resiliency: A Narrative Review Focused on Learners in the Operating Room

PURPOSE

The operating room is a high pressure environment for surgical trainees as they attempt to reach a high level of performance in the midst of a multitude of stressors. The purpose of this work was to examine the relationships between stress, coping, and psychological resilience and their effects on performance and learning in surgical training.

METHODS

A narrative review was carried out of the existing literature on stress, coping, and resilience in surgeons and surgical trainees. Multiple fields of study were examined including medical education, surgery, surgical safety, anesthesia, workplace ergonomics, and psychology.

RESULTS

Sources of intraoperative stress include fatigue, disruptions, interpersonal conflicts, time pressure, a complex case or high risk patient, surgical errors, and surgeon temperament. These stressors can negatively impact the performance of surgeons and trainees and may inhibit learning. How a learner responds to stress in the operating room is highly variable and influenced by the context of the stress, the coping mechanisms available, and individual psychological resilience. Stress management techniques, such as mental rehearsal, are beneficial for reducing stress. Resilience is protective against stress and burnout, and resilience training is useful for reducing stress and improving mental health in physicians and medical students.

CONCLUSIONS

Surgical trainees experience significant stress in the operating room and their experience of stress is modulated by cognitive and behavioral factors. Further research is required on the development of effective interventions to help trainees manage intraoperative stress, with the potential to improve surgical performance, learning, and patient safety.

Using a Standardized Client Encounter to Practice Death Notification after the Unexpected Death of a Feline Patient Following Routine Ovariohysterectomy

Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what not to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.

The opioid system in stress-induced memory disorders: From basic mechanisms to clinical implications in post-traumatic stress disorder and Alzheimer's disease

Cognitive and emotional impairment are a serious consequence of stress exposure and are core features of neurological and psychiatric conditions that involve memory disorders. Indeed, acute and chronic stress are high-risk factors for the onset of post-traumatic stress disorder (PTSD) and Alzheimer's disease (AD), two devastating brain disorders associated with memory dysfunction. Besides the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, stress response also involves the activation of the opioid system in brain regions associated with stress regulation and memory processing. In this context, it is possible that stress-induced memory disorders may be attributed to alterations in the interaction between the neuroendocrine stress system and the opioid system. In this review, we: (1) describe the effects of acute and chronic stress on memory, and the modulatory role of the opioid system, (2) discuss the contribution of the opioid system to the pathophysiology of PTSD and AD, and (3) present evidence of current and potential therapies that target the opioid receptors to treat PTSD- and AD-associated symptoms.

Effects of acute stress on social behavior in women

Acute stress is known to increase prosocial behavior in men via a "tend-and-befriend" pattern originally proposed as a specifically female stress response alongside the fight-or-flight response. However, the direct effects of acute stress on women's social behavior have not been investigated. Applying the Trier Social Stress Test for groups (TSST-G), 94 women were confronted with either a stress or control condition. We repeatedly measured their subjective stress responses, salivary cortisol, and heart rate, and investigated their level of trust, trustworthiness, sharing, punishment and non-social risk using social decision paradigms. We detected significant increases in all stress parameters, as well as the wish for closeness during the stress condition. Acute stress exposure elevated prosocial trustworthiness and sharing without affecting non-social risk behavior. These results are in line with findings on the effects of stress in men, and further validate the tend-and-befriend pattern as one possible behavioral response during stress in humans.

Does silence speak louder than words? The impact of oncologists' emotion-oriented communication on analogue patients' information recall and emotional stress

OBJECTIVE

The impact of two types of oncologists' emotion-oriented communication on participants' recall of medical information was investigated, and the potential mediation by a reduction in emotional stress. Additionally, moderation effects by personal characteristics were explored.

METHODS

An oncologist's communication in response to a patient's emotional expressions was manipulated during a videotaped, scripted bad-news consultation. Three conditions were created: 1) standard communication, 2) emotion-oriented silence, and 3) emotion-oriented speech. Participants (N = 217) were randomly allocated to one of the three conditions. Measurements included information recall (free recall and recognition), emotional stress (self-reported and physiological), and personal characteristics.

RESULTS

Emotion-oriented silence (p = .002) and speech (p = .019) enhanced information recognition compared to standard communication. No differences in free recall were found. Emotional stress did not mediate these relations. Poorer functional health literacy predicted poorer recognition, but this was counteracted by emotion-oriented communication.

CONCLUSIONS

By means of acknowledging, exploring, empathic and supportive statements, and attentive silence, the oncologist's communication resulted in better information recognition. How oncologists' communication impacts patients' information recall warrants further investigation, as this could not be explained by reducing emotional stress.

PRACTICE IMPLICATIONS

These insights will help educators to validate the relevance of emotion-oriented strategies, and encourage oncologists to adopt them.

Behavioral and neural mechanisms underlying habitual and compulsive drug seeking

Addiction is characterized by compulsive drug use despite negative consequences. Here we review studies that indicate that compulsive drug use, and in particular punishment resistance in animal models of addiction, is related to impaired cortical control over habitual behavior. In humans and animals, instrumental behavior is supported by goal-directed and habitual systems that rely on distinct corticostriatal networks. Chronic exposure to addictive drugs or stress has been shown to bias instrumental response strategies toward habit learning, and impair prefrontal cortical (PFC) control over responding. Moreover, recent work has implicated prelimbic PFC hypofunction in the punishment resistance that has been observed in a subset of animals with an extended history of cocaine self-administration. This may be related to a broader role for prelimbic PFC in mediating adaptive responding and behavioral flexibility, including exerting goal-directed control over behavior. We hypothesize that impaired cortical control and reduced flexibility between habitual and goal-directed systems may be critically involved in the development of maladaptive, compulsive drug use.

Psychosocial stress reactivity is associated with decreased whole-brain network efficiency and increased amygdala centrality

Cognitive and emotional functions are supported by the coordinated activity of a distributed network of brain regions. This coordinated activity may be disrupted by psychosocial stress, resulting in the dysfunction of cognitive and emotional processes. Graph theory is a mathematical approach to assess coordinated brain activity that can estimate the efficiency of information flow and determine the centrality of brain regions within a larger distributed neural network. However, limited research has applied graph-theory techniques to the study of stress. Advancing our understanding of the impact stress has on global brain networks may provide new insight into factors that influence individual differences in stress susceptibility. Therefore, the present study examined the brain connectivity of participants that completed the Montreal Imaging Stress Task (Goodman et al., 2016; Wheelock et al., 2016). Salivary cortisol, heart rate, skin conductance response, and self-reported stress served as indices of stress, and trait anxiety served as an index of participant's disposition toward negative affectivity. Psychosocial stress was associated with a decrease in the efficiency of the flow of information within the brain. Further, the centrality of brain regions that mediate emotion regulation processes (i.e., hippocampus, ventral prefrontal cortex, and cingulate cortex) decreased during stress exposure. Interestingly, individual differences in cortisol reactivity were negatively correlated with the efficiency of information flow within this network, whereas cortisol reactivity was positively correlated with the centrality of the amygdala within the network. These findings suggest that stress reduces the efficiency of information transfer and leaves the function of brain regions that regulate the stress response vulnerable to disruption. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The influence of information structuring and health literacy on recall and satisfaction in a simulated discharge communication

OBJECTIVE

We investigated the effects of information structuring and its potential interaction with pre-existing medical knowledge on recall in a simulated discharge communication.

METHODS

127 proxy-patients (i.e. students) were randomly assigned to one of four conditions. Video vignettes provided identical information, differing in means of information structuring only: The natural conversation (NC) condition was not explicitly structured whereas the structure (S) condition presented information organised by chapter headings. The book metaphor (BM) and the post organizer (PO) conditions also presented structured information but in addition included a synopsis, either at the beginning or at the end of discharge communication, respectively. Proxy-patients' recall, perception of quality and pre-existing medical knowledge were assessed.

RESULTS

Information structuring (conditions: S, BM, PO) did not increase recall in comparison to NC, but pre-existing medical knowledge improved recall (p < .01). An interaction between medical knowledge and recall in the BM condition was found (p = .02). In comparison to the NC, proxy-patients in all information structuring conditions more strongly recommended the physician (p < .001).

CONCLUSIONS

Structured discharge communication complemented by the BM is beneficial in individuals with lower pre-existing medical knowledge.

PRACTICE IMPLICATIONS

The lower pre-existing medical knowledge, the more recipients will profit from information structuring with the BM.

Feasibility of using auditory event-related potentials to investigate learning and memory in nonverbal individuals with Angelman syndrome

The combination of intellectual, communicative, and motor deficits limit the use of standardized behavioral assessments of cognition in individuals with Angelman syndrome (AS). The current study is the first to objectively evaluate learning and memory in AS using auditory event-related potentials (ERP) during passive exposure to spoken stimuli. Fifteen nonverbal individuals with the deletion subtype of AS (age 4-45 years) completed the auditory incidental memory paradigm. Auditory ERPs were recorded in response to a sequence of unfamiliar nonwords, in which one randomly selected stimulus was repeated multiple times and the rest were presented once. Larger parietal responses within 200-500 ms for the repeated nonword compared to novel distracters were associated with caregiver reports of more adaptive communication skills. These findings demonstrate good tolerability of ERP procedures (94% success rate) and indicate that persons with AS can acquire new information following repeated auditory exposure, even in the absence of explicit memorization instructions. Strong associations between the caregiver reports of adaptive functioning and neural indices of auditory learning and memory support the utility of brain-based measures for objectively evaluating higher-order information processing in nonverbal persons with neurodevelopmental disorders.

Stereotypic horses (Equus caballus) are not cognitively impaired

Stereotypies in animals are thought to arise from an interaction between genetic predisposition and sub-optimal housing conditions. In domestic horses, a well-studied stereotypy is crib-biting, an abnormal behaviour that appears to help individuals to cope with stressful situations. One prominent hypothesis states that animals affected by stereotypies are cognitively less flexible compared to healthy controls, due to sensitization of a specific brain area, the basal ganglia. The aim of this study was to test this hypothesis in crib-biting and healthy controls, using a cognitive task, reversal learning, which has been used as a diagnostic for basal ganglia dysfunction. The procedure consisted of exposing subjects to four learning tasks; first and second acquisition, and their reversals. For each task, we measured the number of trials to reach criterion and heart rate and heart-rate variability. Importantly, we did not try to prevent crib-biters from executing their stereotypic behaviour. We found that the first reversal learning task required the largest number of trials, confirming its challenging nature. Interestingly, the second reversal learning task required significantly fewer trials to reach criterion, suggesting generalisation learning. However, we did not find any performance differences across groups; both stereotypic and control animals required a similar numbers of trials and did not differ in their physiological responses. Our results thus challenge the widely held belief that crib-biting horses, and stereotypic animals more generally, are cognitively impaired. We conclude that cognitive underperformance may occur in stereotypic horses if they are prevented from crib-biting to cope with experienced stress.

Cerebellar Learning Properties Are Modulated by the CRF Receptor

Corticotropin-releasing factor (CRF) and its type 1 receptor (CRFR₁) play an important role in the responses to stressful challenges. Despite the well established expression of CRFR₁ in granular cells (GrCs), its role in procedural motor performance and memory formation remains elusive. To investigate the role of CRFR₁ expression in cerebellar GrCs, we used a mouse model depleted of CRFR₁ in these cells. We detected changes in the cellular learning mechanisms in GrCs depleted of CRFR₁ in that they showed changes in intrinsic excitability and long-term synaptic plasticity. Analysis of cerebella transcriptome obtained from KO and control mice detected prominent alterations in the expression of calcium signaling pathways components. Moreover, male mice depleted of CRFR₁ specifically in GrCs showed accelerated Pavlovian associative eye-blink conditioning, but no differences in baseline motor performance, locomotion, or fear and anxiety-related behaviors. Our findings shed light on the interplay between stress-related central mechanisms and cerebellar motor conditioning, highlighting the role of the CRF system in regulating particular forms of cerebellar learning.SIGNIFICANCE STATEMENT Although it is known that the corticotropin-releasing factor type 1 receptor (CRFR₁) is highly expressed in the cerebellum, little attention has been given to its role in cerebellar functions in the behaving animal. Moreover, most of the attention was directed at the effect of CRF on Purkinje cells at the cellular level and, to this date, almost no data exist on the role of this stress-related receptor in other cerebellar structures. Here, we explored the behavioral and cellular effect of granular cell-specific ablation of CRFR₁ We found a profound effect on learning both at the cellular and behavioral levels without an effect on baseline motor skills.

The effects of chronic stress on the human brain: From neurotoxicity, to vulnerability, to opportunity

For the last five decades, science has managed to delineate the mechanisms by which stress hormones can impact on the human brain. Receptors for glucocorticoids are found in the hippocampus, amygdala and frontal cortex, three brain regions involved in memory processing and emotional regulation. Studies have shown that chronic exposure to stress is associated with reduced volume of the hippocampus and that chronic stress can modulate volumes of both the amygdala and frontal cortex, suggesting neurotoxic effects of stress hormones on the brain. Yet, other studies report that exposure to early adversity and/or familial/social stressors can increase vulnerability to stress in adulthood. Models have been recently developed to describe the roles that neurotoxic and vulnerability effects can have on the developing brain. These models suggest that developing early stress interventions could potentially counteract the effects of chronic stress on the brain and results going along with this hypothesis are summarized.

Teaching parasitology in a modular veterinary curriculum - The Vienna experience

In a changing world with rapidly evolving new technologies, even in the "sheltered world" of teachers and lecturers at universities, we are challenged by new developments. As diversification is increasing in many aspects of our professional life, there is also a need to employ new ways of teaching, learning and assessments in veterinary curricula, taking into account the increasing numbers of students and limited teaching resources. The "classical" Austrian veterinary curriculum, with a series of consecutive lectures followed by practical courses in the different disciplines, separated from each other in the curricular time table and by annual examinations, has been a long-standing concept for teaching in the past. However, when veterinary practitioners and graduates where asked to judge the adequacy of undergraduate training for their professional skills and knowledge, several major shortcomings were revealed. The most commonly mentioned point was a lack of first-day competencies. As a consequence, the Vetmeduni Vienna developed a new veterinary curriculum implemented in 2014-2015. This curriculum covers 12 semesters and includes a "Diploma" (degree) thesis and several externships; graduates are eligible to practice in all branches of veterinary medicine. We abandoned the classical discipline-based teaching, established a modular, mostly organ-based system, and focus on student-centred and competency-based learning and teaching with defined learning outcomes and first-day skills. We also include training of scientific, managerial and communication skills in the curriculum. What does this mean for parasitology? We do not teach this subject in a closed lecture, but rather in a modular style, starting in the first year with the taxonomy and basic morphology of the animal kingdom, proceeding to parasite biology of the major groups in the second year, to the diagnostic and clinical training in practicals in the third year as well as joint lectures, seminars and conversatories in the organ- and species-based clinical training in years 3-6. Examinations are organised in different test formats, aligned to a list of skills and diseases. Quality assurance is a formal process and implemented at different levels. The ultimate aim of undergraduate teaching is to provide students with defined professional competencies and promoting life-long learning.

Older Patients' Recall of Online Cancer Information: Do Ability and Motivation Matter More than Chronological Age?

This study proposes and tests a model to provide a more comprehensive understanding of the contribution of chronological age versus age-related ability and motivation factors in explaining recall of online cancer information among older patients (n = 197). Results revealed that recall is not a matter of chronological age per se, but rather a matter of ability and motivation. Age-related ability and motivation factors explained 37.9% of the variance in recall. Health literacy, involvement with the webpage, and satisfaction with the emotional support were positively associated with recall. Furthermore, recall was negatively related to frailty, anger, future time perspective, and perceived cognitive load. The findings pose relevant opportunities for tailoring interventions to improve online information provision for older cancer patients.

Recent life stress exposure is associated with poorer long-term memory, working memory, and self-reported memory

Although substantial research has examined the effects of stress on cognition, much of this research has focused on acute stress (e.g. manipulated in the laboratory) or chronic stress (e.g. persistent interpersonal or financial difficulties). In contrast, the effects of recent life stress on cognition have been relatively understudied. To address this issue, we examined how recent life stress is associated with long-term, working memory, and self-reported memory in a sample of 142 healthy young adults who were assessed at two time points over a two-week period. Recent life stress was measured using the newly-developed Stress and Adversity Inventory for Daily Stress (Daily STRAIN), which assesses the frequency of relatively common stressful life events and difficulties over the preceding two weeks. To assess memory performance, participants completed both long-term and working memory tasks. Participants also provided self-reports of memory problems. As hypothesized, greater recent life stress exposure was associated with worse performance on measures of long-term and working memory, as well as more self-reported memory problems. These associations were largely robust while controlling for possible confounds, including participants' age, sex, and negative affect. The findings indicate that recent life stress exposure is broadly associated with worse memory. Future studies should thus consider assessing recent life stress as a potential predictor, moderator, or covariate of memory performance.

The Influences of Emotion on Learning and Memory

Emotion has a substantial influence on the cognitive processes in humans, including perception, attention, learning, memory, reasoning, and problem solving. Emotion has a particularly strong influence on attention, especially modulating the selectivity of attention as well as motivating action and behavior. This attentional and executive control is intimately linked to learning processes, as intrinsically limited attentional capacities are better focused on relevant information. Emotion also facilitates encoding and helps retrieval of information efficiently. However, the effects of emotion on learning and memory are not always univalent, as studies have reported that emotion either enhances or impairs learning and long-term memory (LTM) retention, depending on a range of factors. Recent neuroimaging findings have indicated that the amygdala and prefrontal cortex cooperate with the medial temporal lobe in an integrated manner that affords (i) the amygdala modulating memory consolidation; (ii) the prefrontal cortex mediating memory encoding and formation; and (iii) the hippocampus for successful learning and LTM retention. We also review the nested hierarchies of circular emotional control and cognitive regulation (bottom-up and top-down influences) within the brain to achieve optimal integration of emotional and cognitive processing. This review highlights a basic evolutionary approach to emotion to understand the effects of emotion on learning and memory and the functional roles played by various brain regions and their mutual interactions in relation to emotional processing. We also summarize the current state of knowledge on the impact of emotion on memory and map implications for educational settings. In addition to elucidating the memory-enhancing effects of emotion, neuroimaging findings extend our understanding of emotional influences on learning and memory processes; this knowledge may be useful for the design of effective educational curricula to provide a conducive learning environment for both traditional "live" learning in classrooms and "virtual" learning through online-based educational technologies.

The effect of mild acute stress during memory consolidation on emotional recognition memory

Stress during consolidation improves recognition memory performance. Generally, this memory benefit is greater for emotionally arousing stimuli than neutral stimuli. The strength of the stressor also plays a role in memory performance, with memory performance improving up to a moderate level of stress and thereafter worsening. As our daily stressors are generally minimal in strength, we chose to induce mild acute stress to determine its effect on memory performance. In the current study, we investigated if mild acute stress during consolidation improves memory performance for emotionally arousing images. To investigate this, we had participants encode highly arousing negative, minimally arousing negative, and neutral images. We induced stress using the Montreal Imaging Stress Task (MIST) in half of the participants and a control task to the other half of the participants directly after encoding (i.e. during consolidation) and tested recognition 48h later. We found no difference in memory performance between the stress and control group. We found a graded pattern among confidence, with responders in the stress group having the least amount of confidence in their hits and controls having the most. Across groups, we found highly arousing negative images were better remembered than minimally arousing negative or neutral images. Although stress did not affect memory accuracy, responders, as defined by cortisol reactivity, were less confident in their decisions. Our results suggest that the daily stressors humans experience, regardless of their emotional affect, do not have adverse effects on memory.

The Influences of Emotion on Learning and Memory

Emotion has a substantial influence on the cognitive processes in humans, including perception, attention, learning, memory, reasoning, and problem solving. Emotion has a particularly strong influence on attention, especially modulating the selectivity of attention as well as motivating action and behavior. This attentional and executive control is intimately linked to learning processes, as intrinsically limited attentional capacities are better focused on relevant information. Emotion also facilitates encoding and helps retrieval of information efficiently. However, the effects of emotion on learning and memory are not always univalent, as studies have reported that emotion either enhances or impairs learning and long-term memory (LTM) retention, depending on a range of factors. Recent neuroimaging findings have indicated that the amygdala and prefrontal cortex cooperate with the medial temporal lobe in an integrated manner that affords (i) the amygdala modulating memory consolidation; (ii) the prefrontal cortex mediating memory encoding and formation; and (iii) the hippocampus for successful learning and LTM retention. We also review the nested hierarchies of circular emotional control and cognitive regulation (bottom-up and top-down influences) within the brain to achieve optimal integration of emotional and cognitive processing. This review highlights a basic evolutionary approach to emotion to understand the effects of emotion on learning and memory and the functional roles played by various brain regions and their mutual interactions in relation to emotional processing. We also summarize the current state of knowledge on the impact of emotion on memory and map implications for educational settings. In addition to elucidating the memory-enhancing effects of emotion, neuroimaging findings extend our understanding of emotional influences on learning and memory processes; this knowledge may be useful for the design of effective educational curricula to provide a conducive learning environment for both traditional "live" learning in classrooms and "virtual" learning through online-based educational technologies.

Exposure to a contextually neutral stressor potentiates fear conditioning in juvenile rainbow trout, Oncorhynchus mykiss

Organisms faced with stressors deploy a suite of adaptive responses in the form of behavioral, physiological and cognitive modifications to overcome the challenge. Interactive effects of these responses are known to influence learning and memory processes and facilitation is thought to be dependent, in part, upon contextual relevance of the stressor to the learning task. Predation is one such stressor for prey animals, and their ability to manage reliable information about predators is essential for adaptive antipredator strategies. Here, we investigated (i) the influence cortisol has on the ability of juvenile rainbow trout to learn and retain conditioned antipredator responses to predatory cues, and (ii) whether conditioned behavioral and physiological responses to predator cues are fixed or deployed in a threat-sensitive manner. Trout were fed cortisol-coated pellets minutes prior to a conditioning event where they were exposed to novel predator odor paired with chemical alarm cues (unconditioned stimulus). We tested for conditioned responses by exposing trout to predator cues after 2, 4 or 10days and subsequently documented physiological and behavioral responses. Both control and cortisol-fed trout learned the predator odor and responded 2 and 4days post conditioning. However, at 10days only cortisol-fed trout maintained strong behavioral responses to predator cues. Interestingly, we failed to find conditioned physiological responses to predator odor despite the presence of threat-sensitive cortisol responses to the unconditioned stimulus. Our findings suggest cortisol exposure prior to predator-learning may enhance retention of conditioned responses, even without a contextual link between stressor source and learning task.

How oncologists' communication improves (analogue) patients' recall of information. A randomized video-vignettes study

OBJECTIVE

Cancer patients need information provision to cope with their disease. However, only 20-60% of information provided during consultations is remembered. This study aimed to investigate whether oncologists' use of trust-conveying communication, characterized by communicating competence, honesty and caring, enhances patients' memory. Moreover, we aimed to investigate if this hypothetical relationship is mediated by a reduction in psychophysiological arousal during the consultation.

METHODS

An experimental design was used, allowing for conclusion about causality. Two versions of a scripted video-taped consultation were used in which the oncologist adopted either a standard or a trust-conveying communication style. 97 cancer-naive individuals acted as analogue patients and were randomly assigned to watch one of the consultations.

RESULTS

Free recall, assessed 24-28h after viewing, was higher (p=0.039) in the trust-conveying condition (65.3% versus 59.5%). Recognition did not differ (p=0.502). Psychophysiological assessment during watching showed a smaller heart rate response in the trust-conveying condition (p=0.037). No mediation effect nor an effect on electrodermal activity was found.

CONCLUSION

These results suggest that oncologists' use of trust-conveying communication could increase patients' free recall of information and diminish their cardiovascular response.

PRACTICE IMPLICATIONS

The underlying mechanisms by which oncologists' communication influences information recall warrants further investigation.

The effects of acute stress on episodic memory: A meta-analysis and integrative review

A growing body of research has indicated that acute stress can critically impact memory. However, there are a number of inconsistencies in the literature, and important questions remain regarding the conditions under which stress effects emerge as well as basic questions about how stress impacts different phases of memory. In this meta-analysis, we examined 113 independent studies in humans with 6,216 participants that explored effects of stress on encoding, postencoding, retrieval, or postreactivation phases of episodic memory. The results indicated that when stress occurred prior to or during encoding it impaired memory, unless both the delay between the stressor and encoding was very short and the study materials were directly related to the stressor, in which case stress improved encoding. In contrast, postencoding stress improved memory unless the stressor occurred in a different physical context than the study materials. When stress occurred just prior to or during retrieval, memory was impaired, and these effects were larger for emotionally valenced materials than neutral materials. Although stress consistently increased cortisol, the magnitude of the cortisol response was not related to the effects of stress on memory. Nonetheless, the effects of stress on memory were generally reduced in magnitude for women taking hormonal contraceptives. These analyses indicate that stress disrupts some episodic memory processes while enhancing others, and that the effects of stress are modulated by a number of critical factors. These results provide important constraints on current theories of stress and memory, and point to new questions for future research. (PsycINFO Database Record

Glucocorticoid administration into the dorsolateral but not dorsomedial striatum accelerates the shift from a spatial toward procedural memory

Glucocorticoid stress hormones are known to enhance the consolidation of hippocampus-dependent spatial and contextual memory. Recent findings indicate that glucocorticoids also enhance the consolidation of procedural memory that relies on the dorsal striatum. The dorsal striatum can be functionally subdivided into the dorsolateral striatum (DLS), which is primarily implicated in shaping procedural memories, and the dorsomedial striatum (DMS), which is engaged in spatial memory. Here, we investigated the hypothesis that posttraining glucocorticoid administration into the DLS promotes the formation of a procedural memory that will normally take place only with extensive training. Male Wistar rats were trained to find a reward in a cross maze that can be solved through either place or response learning. Rats received four trials per day for 5days, a probe trial on Day 6, further training on Days 7-13, and an additional probe trial on Day 14. On Days 2-4 of training, they received posttraining infusions of corticosterone (10 or 30ng) or vehicle into either the DLS or DMS. Rats treated with vehicle into either the DLS or DMS displayed place learning on Day 6 and response learning on Day 14, indicating a shift in control of learned behavior toward a habit-like procedural strategy with extended training. Rats administered corticosterone (10ng) into the DLS displayed response learning on both Days 6 and 14, indicating an accelerated shift to response learning. In contrast, corticosterone administered posttraining into the DMS did not significantly alter the shift from place to response learning. These findings indicate that glucocorticoid administration into the DLS enhances memory consolidation of procedural learning and thereby influences the timing of the switch from the use of spatial/contextual memory to habit-like procedural memory to guide behavior.

Light and water are not simple conditions: fine tuning of animal housing in male C57BL/6 mice

While animal housing conditions are highly controlled and standardized between different laboratories, there are still many subtle differences that unavoidably influence the host organisms and, consequently, interlaboratory reproducibility. Here, we investigated the physiological and immunological consequences between two light/dark cycle (LDC) lengths (14-h/10-h vs. 12-h/12-h LDC) and two commonly used forms of drinking water (acidified drinking water (AW) versus normal tap water (NW)) in single-housed (SH) mice. Our results indicate that SH mice bred under a 12-h/12-h LDC and NW at the supplier's facility showed increased basal morning plasma corticosterone (CORT) levels even 4 weeks after arrival at our animal facility employing a 14-h/10-h LDC and AW. This effect was even more pronounced two weeks after arrival and had abated after 8 weeks. In agreement, increased plasma adrenocorticotropic hormone (ACTH), adrenal in vitro ACTH sensitivity, as well as relative and absolute adrenal weight normalized during this 8-week exposure to the novel and unfamiliar 14-h/10-h LDC and AW. Employment of a 12-h/12-h LDC in our facility completely abrogated the CORT-elevating effects of the 14-h/10-h LDC, despite these animals drinking AW. When both the water and light conditions were matched to those at the supplier's facility, we observed a further reduction in adrenal weight, increased thymus weight, and decreased pro-inflammatory cytokine secretion of isolated and anti-CD3/28-stimulated mesenteric lymph node cells. In summary, our results indicate that prolonged alteration of both the light phase and drinking water represent severe and long-lasting stressors for laboratory rodents. These findings are of general interest for all scientists obtaining their experimental animals from conventional suppliers.

Are psychophysiological arousal and self-reported emotional stress during an oncological consultation related to memory of medical information? An experimental study

Patients forget 20-80% of information provided during medical consultations. The emotional stress often experienced by patients during consultations could be one of the mechanisms that lead to limited recall. The current experimental study therefore investigated the associations between (analog) patients' psychophysiological arousal, self-reported emotional stress and their (long term) memory of information provided by the physician. One hundred and eighty one cancer-naïve individuals acted as so-called analog patients (APs), i.e. they were instructed to watch a scripted video-recoding of an oncological bad news consultation while imagining themselves being in the patient's situation. Electrodermal and cardiovascular activity (e.g. skin conductance level and heart rate) were recorded during watching. Self-reported emotional stress was assessed before and after watching, using the STAI-State and seven Visual Analog Scales. Memory, both free recall and recognition, was assessed after 24-28 h. Watching the consultation evoked significant psychophysiological and self-reported stress responses. However, investigating the associations between 24 psychophysiological arousal measures, eight self-reported stress measures and free recall and recognition of information resulted in one significant, small (partial) correlation (r = 0.19). Considering multiple testing, this significant result was probably due to chance. Alternative analytical methods yielded identical results, strengthening our conclusion that no evidence was found for relationships between variables of interest. These null-findings are highly relevant, as they may be considered to refute the long-standing, but yet untested assumption that a relationship between stress and memory exists within this context. Moreover, these findings suggest that lowering patients' stress levels during the consultation would probably not be sufficient to raise memory of information to an optimal level. Alternative explanations for these findings are discussed.

Memory under stress: from single systems to network changes

Stressful events have profound effects on learning and memory. These effects are mainly mediated by catecholamines and glucocorticoid hormones released from the adrenals during stressful encounters. It has been known for long that both catecholamines and glucocorticoids influence the functioning of the hippocampus, a critical hub for episodic memory. However, areas implicated in other forms of memory, such as the insula or the dorsal striatum, can be affected by stress as well. Beyond changes in single memory systems, acute stress triggers the reconfiguration of large scale neural networks which sets the stage for a shift from thoughtful, 'cognitive' control of learning and memory toward more reflexive, 'habitual' processes. Stress-related alterations in amygdala connectivity with the hippocampus, dorsal striatum, and prefrontal cortex seem to play a key role in this shift. The bias toward systems proficient in threat processing and the implementation of well-established routines may facilitate coping with an acute stressor. Overreliance on these reflexive systems or the inability to shift flexibly between them, however, may represent a risk factor for psychopathology in the long-run.

Effects of natural enrichment materials on stress, memory and exploratory behavior in mice

Environmental enrichment is an essential component of laboratory animal housing that allows animals to engage in natural behaviors in an otherwise artificial setting. Previous research by the authors suggested that, compared with synthetic enrichment materials, natural materials were associated with lower stress levels in mice. Here, the authors compare the effects of different enrichment materials on stress, memory and exploratory behavior in Swiss Webster mice. Mice that were provided with natural enrichment materials had lower stress levels, better memory and greater exploratory behavior than did mice provided with synthetic enrichment materials or with no enrichment materials. These findings suggest that provision of natural enrichment materials can improve well-being of laboratory mice.

Stress, stress-induced cortisol responses, and eyewitness identification performance

In the eyewitness identification literature, stress and arousal at the time of encoding are considered to adversely influence identification performance. This assumption is in contrast with findings from the neurobiology field of learning and memory, showing that stress and stress hormones are critically involved in forming enduring memories. This discrepancy may be related to methodological differences between the two fields of research, such as the tendency for immediate testing or the use of very short (1-2 hours) retention intervals in eyewitness research, while neurobiology studies insert at least 24 hours. Other differences refer to the extent to which stress-responsive systems (i.e., the hypothalamic-pituitary-adrenal axis) are stimulated effectively under laboratory conditions. The aim of the current study was to conduct an experiment that accounts for the contemporary state of knowledge in both fields. In all, 123 participants witnessed a live staged theft while being exposed to a laboratory stressor that reliably elicits autonomic and glucocorticoid stress responses or while performing a control task. Salivary cortisol levels were measured to control for the effectiveness of the stress induction. One week later, participants attempted to identify the thief from target-present and target-absent line-ups. According to regression and receiver operating characteristic analyses, stress did not have robust detrimental effects on identification performance. Copyright © 2016 John Wiley & Sons, Ltd. © 2016 The Authors Behavioral Sciences & the Law Published by John Wiley & Sons Ltd.

Learning and memory under stress: implications for the classroom

Exams, tight deadlines and interpersonal conflicts are just a few examples of the many events that may result in high levels of stress in both students and teachers. Research over the past two decades identified stress and the hormones and neurotransmitters released during and after a stressful event as major modulators of human learning and memory processes, with critical implications for educational contexts. While stress around the time of learning is thought to enhance memory formation, thus leading to robust memories, stress markedly impairs memory retrieval, bearing, for instance, the risk of underachieving at exams. Recent evidence further indicates that stress may hamper the updating of memories in the light of new information and induce a shift from a flexible, 'cognitive' form of learning towards rather rigid, 'habit'-like behaviour. Together, these stress-induced changes may explain some of the difficulties of learning and remembering under stress in the classroom. Taking these insights from psychology and neuroscience into account could bear the potential to facilitate processes of education for both students and teachers.

Student Perceptions of the Use of a Laser Pointer for Intra-Operative Guidance in Feline Castration

In veterinary clinical education, students perform surgery under guided supervision. This study aimed to determine if students' perception of how well they understood verbal guidance could be improved by using a laser pointer during feline castration. It was assumed that a teacher's use of a laser pointer could help students identify structures of importance during surgery. The hypothesis was that use of a laser pointer would improve student understanding of verbal guidance during surgery. Eighteen privately owned male cats were electively neutered by fourth- and fifth-year veterinary students at the Swedish University of Agricultural Sciences, Uppsala, Sweden. Each student performed orchiectomy on one cat. One testis was removed while the student received verbal guidance combined with a laser pointer, and the other testis was removed while the student received only verbal guidance. The use of a laser pointer alternated between first and second testis. After surgery, students rated how well they understood verbal guidance on a visual-analog scale (100 mm) for each instructional method. The two ratings were compared in a student's two-sided t-test. The median score with or without guidance with a laser pointer was 81 (59-96) and 54 (25-86), respectively (p<.001). This study showed that laser pointers enhanced verbal guidance given to students during surgery. The suggested mechanism of explanation is that the technology enabled a more precise guidance of location and identification of anatomic structures.