A stress-is-enhancing mindset is associated with lower traumatic stress symptoms during the COVID-19 pandemic

BACKGROUND

A stress-is-enhancing mindset is associated with lower perceived stress and better coping. However, work examining the prospective associations of stress mindset on perceived traumatic stress symptoms during a stressful real-world life event is limited. The present prospective study explored whether stress-is-enhancing mindset measured before the onset of the COVID-19 global pandemic was associated with later traumatic stress symptoms in response to the COVID-19 global pandemic.

METHODS

University students (N = 179; 68% female; Mage = 19.31, SD = 0.79 years) completed the Stress Mindset Measure (SMM) prior to COVID-19 pandemic onset as part of a larger study. The Impact of Event Scale-Revised (IES-R) with respect to the COVID-19 pandemic was completed 1 year into the pandemic.

RESULTS

SMM negatively predicted the IES-R subscales intrusion, avoidance, and hyperarousal such that a more stress-is-enhancing mindset was associated with lower intrusion, avoidance, and hyperarousal following the onset of COVID-19.

CONCLUSIONS

Results suggest a more positive stress mindset is associated with fewer traumatic stress symptoms following a traumatic life event. Altering stress mindset may be an avenue for future interventions to cope with stress.

Mastery imagery ability moderates the relationship between heart rate reactivity to acute psychological stress and perceptions of stress and physiological arousal

Imagery has been associated with cardiovascular and psychological responses to stress; however, the mechanisms underlying this association are not fully understood. The present study examined if the ability to image mastering challenging or difficult situations moderated the relationship between heart rate reactivity and perceptions of stress and physiological arousal experienced during acute stress. Four hundred and fifty-eight participants completed a standardized laboratory stress protocol with heart rate being measured throughout. After completing an acute psychological stress task, participants rated how stressed and physiologically aroused they felt (i.e., intensity) and whether they perceived the stress and physiological arousal as being helpful/unhelpful to performance (i.e., interpretation). Mastery imagery ability was assessed by questionnaire. Moderation analyses controlling for gender demonstrated that imagery ability moderated the relationship between heart rate reactivity and interpretation of stress (β = 0.015, p = .003) and perceived physiological arousal (β = 0.013, p = .004). Simple slope analysis indicated that in those with higher imagery ability, heart rate reactivity was associated with stress and arousal being perceived as more positive toward performance. Imagery ability did not moderate the relationship between heart rate reactivity and perceived stress intensity or physiological arousal intensity (p's > .05), but imagery ability did predict lower perceived stress intensity (β = -0.217, p < .001) and perceived physiological arousal intensity (β = -0.172, p < .001). Higher mastery imagery ability may possibly help individuals perceive responses to stress as more beneficial for performance and thus be an effective coping technique.

Improving stress mindset through education and imagery

BACKGROUND

Research suggests interventions such as education and imagery can elicit a greater stress-is-enhancing mindset. The present study examined the individual and combined effect of stress-is-enhancing education and/or imagery delivered virtually in altering stress mindset. Three 3-minute online video interventions: (1) education, (2) imagery, (3) education with imagery were compared to each other and a control comparison.

DESIGN AND METHODS

Participants (N = 164; 103 = female; Mage = 20.03, SD = 1.39 years) completed the Stress Mindset Measure (SMM) before being randomly assigned to a group to watch a three-minute video and completing the SMM again.

RESULTS

The 2-time × 4-group ANOVA showed a significant time effect, F(1, 158) = 50.45, p < .001, ηp2 = .242, no group effect, F(3, 158) = 0.89, p = .449, ηp2 = .017, and a significant time × group interaction, F(3, 158) = 4.48, p = .005, ηp2 = .078. All three experimental groups reported greater stress-is-enhancing mindset post-intervention compared to pre-intervention. At post-intervention the education with imagery group had a significantly more stress-is-enhancing mindset compared to the control group.

CONCLUSIONS

Results suggest that online stress mindset videos may be effective with a combined stress education and imagery intervention being most effective.

Examining the associations between physical activity, self-esteem, perceived stress, and internalizing symptoms among older adolescents

INTRODUCTION

In older adolescence, stress has been found to be prevalent. It has been seen that higher physical activity (PA) relates to lower stress levels, which, in turn, relates to fewer anxiety and depressive symptoms (internalizing symptoms). However, how these associations function is not fully understood. PA is strongly associated with greater self-esteem in adolescents. As greater self-esteem is thought to aid better coping with stress and has been seen as beneficial for mental health in adolescents, PA may be associated with lower stress and better mental health through self-esteem and more adaptive stress appraisals. Therefore, the aim of the study was to examine the relationships between PA, self-esteem, stress, and mental health.

METHODS

A cross-sectional design was employed, and path analysis was implemented. PA, self-esteem, stress appraisals, distress tolerance, perceived stress, anxiety, and depression were assessed using online questionnaires from 244 adolescent participants from the United Kingdom (aged 15-19, M = 16.75 [SD = 0.82], 145 female).

RESULTS

Path analysis revealed that PA was associated with lower perceived stress through increased self-esteem, adaptive appraisals, and higher distress tolerance (total standardized indirect effect; p = .007 (-0.25 to -0.11). Moreover, lower perceived stress was associated with lower anxiety (standardized direct effect; p < .001 [2.65-4.0] and depressive symptoms (standardized direct effect; p < .001 [0.33-0.63]).

CONCLUSIONS

Findings suggest that higher PA could be effective in improving mental health among older adolescents, due to its association with perceived stress through higher self-esteem and more adaptive appraisals of stress.

Factors Associated With Parental COVID-19 Vaccination Acceptance

As the coronavirus pandemic continues to impact families and children, understanding parental attitudes and likely acceptance of the COVID-19 vaccine is essential. We conducted a statewide survey with a representative sample of parents in Tennessee focused on COVID-19 and influenza vaccine acceptance and perspectives. Data from 1066 parents were analyzed using weighted survey methods to generalize results to the state of Tennessee. About 53% of parents reported a likelihood to vaccinate their children against COVID-19, and 45% were likely to vaccinate their child against COVID-19 and influenza. Female parents were less likely to vaccinate their children against COVID-19, but the strongest predictor of likely COVID-19 vaccine acceptance was influenza vaccine acceptance (adjusted odds ratio = 5.46; 95% confidence interval: 3.20-9.30). Parental acceptance of COVID-19 vaccines for children is closely tied to influenza vaccine acceptance. Public health approaches to maximize vaccine uptake could focus on children who have not been receiving influenza vaccines.

Mapping cis-regulatory elements in human neurons links psychiatric disease heritability and activity-regulated transcriptional programs

Genome-wide association studies (GWASs) have identified hundreds of loci associated with psychiatric diseases, yet there is a lack of understanding of disease pathophysiology. Common risk variants can shed light on the underlying molecular mechanisms; however, identifying causal variants remains challenging. We map cis-regulatory elements in human neurons derived from pluripotent stem cells. This system allows us to determine enhancers that activate the transcription of neuronal activity-regulated gene programs, which are thought to be critical for synaptic plasticity and are not possible to identify from postmortem tissues. Using the activity-by-contact model, we create variant-to-gene maps to interpret the function of GWAS variants. Our work nominates a subset of variants to elucidate the molecular mechanisms involving GWAS-significant loci. It also highlights that in vitro human cellular models are a powerful platform for identifying and mechanistic studies of human trait-associated genetic variants in cell states that are inaccessible from other types of human samples.

Atrial tissue characterisation using electroanatomic voltage mapping and cardiac magnetic resonance imaging

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Atrial voltage mapping and atrial cardiac magnetic resonance imaging are two contemporary methods for quantification of atrial fibrosis. However, the absence of a gold standard for measuring atrial fibrosis has precluded their direct comparison. Nevertheless, understanding the relative performance of voltage mapping and atrial late gadolinium enhancement for identification of atrial cardiomyopathy remains critical to correctly targeting clinical application of these techniques.

Purpose

To assess the relative performance of electroanatomic voltage mapping and atrial late gadolinium enhancement imaging using three surrogate markers chosen to distinguish pre-procedural utility (progression to recurrent atrial fibrillation following ablation) from potential utility for providing atrial fibrillation mechanistic insights (paroxysmal vs. persistent status of atrial fibrillation and relationship with co-morbidities associated with atrial fibrillation).

Methods

123 patients underwent atrial late gadolinium enhancement imaging and electroanatomic voltage mapping prior to atrial fibrillation ablation. Atrial late gadolinium enhancement imaging was assessed with CEMRG software and electroanatomic voltage mapping processed with OpenEP software using previously published thresholds. Low voltage tissue was defined at (1) &lt;0.5mV, (2) &lt;1.17mV, and (3) &lt;1.3mV. Atrial fibrosis using late gadolinium enhancement was defined using four thresholds (1) signal intensity &gt;3.3 standard deviations above the blood pool mean; (2) image intensity ratio (IIR) 1.2x blood pool mean; (3) IIR 1.32x blood pool mean; and (4) IIR 0.97x blood pool mean.

Results

Patients with persistent atrial fibrillation and those with CHA2DS2VaSc &gt;2 had increased low voltage area for each of the thresholds tested, but there was no increase in atrial late gadolinium enhancement area at any of the imaging thresholds tested.

Increased atrial fibrosis using IIR&gt;0.97 was independently associated with recurrence of atrial fibrillation (OR 1.05 (CI 1.01-1.09), p=0.009) in both univariate and multivariate analysis. Low voltage area &lt;1.13mV and low voltage area &lt;1.17mV were associated with increased risk of recurrence (OR 1.02 (CI 1.01-1.04), p=0.01, and OR 1.03 (CI 1.01-1.04), p=0.009) in univariate analysis but neither voltage threshold remained statistically significant in multivariate analysis controlling for clinical variables.

Conclusion

Increased fibrosis burden measured with atrial magnetic resonance imaging, but not with low voltage area, is independently associated with recurrence of atrial fibrillation following catheter ablation. However, increased low voltage area measured with electroanatomic mapping is associated with persistent atrial fibrillation status and CHADS2VaSc score. These findings support the use of magnetic resonance imaging for pre-procedure assessment and the use of electroanatomic mapping for intraprocedural mechanism-based assessment of atrial cardiomyopathy.

Cardiovascular reactions to acute psychological stress and academic achievement

Cardiovascular reactions to acute psychological stress have been associated with cognitive function. However, previous work has assessed cardiovascular reactions and cognitive function in the laboratory at the same time. The present study examined the association between cardiovascular reactions to acute psychological stress in the laboratory and academic performance in final year high school students. Heart rate, blood pressure, stroke volume, and cardiac output reactions to an acute psychological stress task were measured in 131 participants during their final year of high school. Performance on high school A‐levels were obtained the following year. Higher heart rate and cardiac output reactivity were associated with better A‐level performance. These associations were still statistically significant after adjusting for a wide range of potentially confounding variables. The present results are consistent with a body of literature suggesting that higher heart rate reactions to acute psychological stress are associated with better cognitive performance across a variety of domains.

The present study is the first to examine the associations between cardiovascular reactions to stress in the laboratory and academic achievement. Additionally, it is the first to examine a more comprehensive hemodynamic profile of cardiovascular reactivity (e.g., cardiac output) with cognitive function. The present results are consistent with a body of literature suggesting that higher heart rate reactions to acute psychological stress are associated with better cognitive performance across a variety of domains.

The schizophrenia-associated variant in SLC39A8 alters protein glycosylation in the mouse brain

A missense mutation (A391T) in SLC39A8 is strongly associated with schizophrenia in genomic studies, though the molecular connection to the brain is unknown. Human carriers of A391T have reduced serum manganese, altered plasma glycosylation, and brain MRI changes consistent with altered metal transport. Here, using a knock-in mouse model homozygous for A391T, we show that the schizophrenia-associated variant changes protein glycosylation in the brain. Glycosylation of Asn residues in glycoproteins (N-glycosylation) was most significantly impaired, with effects differing between regions. RNAseq analysis showed negligible regional variation, consistent with changes in the activity of glycosylation enzymes rather than gene expression. Finally, nearly one-third of detected glycoproteins were differentially N-glycosylated in the cortex, including members of several pathways previously implicated in schizophrenia, such as cell adhesion molecules and neurotransmitter receptors that are expressed across all cell types. These findings provide a mechanistic link between a risk allele and potentially reversible biochemical changes in the brain, furthering our molecular understanding of the pathophysiology of schizophrenia and a novel opportunity for therapeutic development.

Mammalian brain glycoproteins exhibit diminished glycan complexity compared to other tissues

Glycosylation is essential to brain development and function, but prior studies have often been limited to a single analytical technique and excluded region- and sex-specific analyses. Here, using several methodologies, we analyze Asn-linked and Ser/Thr/Tyr-linked protein glycosylation between brain regions and sexes in mice. Brain N-glycans are less complex in sequence and variety compared to other tissues, consisting predominantly of high-mannose and fucosylated/bisected structures. Most brain O-glycans are unbranched, sialylated O-GalNAc and O-mannose structures. A consistent pattern is observed between regions, and sex differences are minimal compared to those in plasma. Brain glycans correlate with RNA expression of their synthetic enzymes, and analysis of glycosylation genes in humans show a global downregulation in the brain compared to other tissues. We hypothesize that this restricted repertoire of protein glycans arises from their tight regulation in the brain. These results provide a roadmap for future studies of glycosylation in neurodevelopment and disease.

Effects of arousal reappraisal on the anxiety responses to stress: Breaking the cycle of negative arousal intensity and arousal interpretation

Arousal reappraisal has been shown to be an effective strategy during stress to improve anxiety. However, the exact psychological mechanism through which arousal reappraisal improves anxiety is unknown. In a large, cross-sectional study (Study 1, N = 455) participants engaged in an acute psychological stress task and rated their levels of physiological arousal, cognitive anxiety, and somatic anxiety, and whether they perceived this physiological arousal, cognitive anxiety, and somatic anxiety as helpful or hurtful (i.e., interpretation). Structural equation models supported a previously hypothesized model demonstrating that higher levels of physiological arousal were interpreted more negatively and this negative interpretation was associated with higher levels of anxiety intensity and more negative interpretations of anxiety. In an independent sample (Study 2, N = 155), participants were randomly assigned to an arousal reappraisal intervention or control condition prior to engaging in the psychological stress task. Results indicated that arousal reappraisal resulted in more positive interpretations of physiological arousal and anxiety. Results also supported a previously hypothesized model demonstrating that arousal reappraisal 'broke' the connection between physiological arousal intensity and physiological arousal interpretation. The present studies suggest that arousal reappraisal could possibly be acting through improving interpretations of physiological arousal symptoms.

Heart Rate Reactivity to Acute Psychological Stress Predicts Higher Levels of Posttraumatic Stress Disorder Symptoms During the COVID-19 Pandemic

OBJECTIVE

Increased autonomic arousal is a proposed risk factor for posttraumatic stress disorder (PTSD). Few studies have prospectively examined the association between physiological responses to acute psychological stress before a traumatic event and later PTSD symptoms. The present prospective study examined whether cardiovascular responses to an acute psychological stress task before the COVID-19 global pandemic predicted PTSD symptoms related to the ongoing pandemic.

METHODS

Participants (n = 120) were a subsample of an ongoing research study. Phase 1 consisted of a 10-minute baseline and 4-minute acute psychological stress task with blood pressure and heart rate recorded throughout. Phase 2 was initiated 2 weeks after the COVID-19 pandemic declaration. Participants completed the Impact of Event Scale-Revised (IES-R) with respect to the ongoing pandemic. Hierarchical linear regression analyses were used to examine whether cardiovascular stress reactivity predicted COVID-19 PTSD symptoms.

RESULTS

Heart rate reactivity significantly predicted IES intrusion (β = -0.208, t = -2.28, p = .025, ΔR2 = 0.041, confidence interval = -0.021 to -0.001) and IES hyperarousal (β = -0.224, t = -2.54, p = .012, ΔR2 = 0.047, confidence interval = -0.22 to - 0.003), but not IES avoidance (p = .077). These results remained statistically significant after adjustment for sex, socioeconomic status, baseline cardiovascular activity, neuroticism, race, ethnicity, body mass index, and adverse childhood experiences. There were no statistically significant associations between blood pressure and any of the Impact of Event Scale-Revised subscales (p values > .12).

CONCLUSIONS

Diminished heart rate responses (i.e., lower physiological arousal) to acute psychological stress before the COVID-19 pandemic significantly predicted reported PTSD symptoms during the crisis.

Mastery Imagery Ability Is Associated With Positive Anxiety and Performance During Psychological Stress

Mastery imagery (i.e., images of being in control and coping in difficult situations) is used to regulate anxiety. The ability to image this content is associated with trait confidence and anxiety, but research examining mastery imagery ability's association with confidence and anxiety in response to a stressful event is scant. The present study examined whether trait mastery imagery ability mediated the relationship between confidence and anxiety, and the subsequent associations on performance in response to an acute psychological stress. Participants (N = 130; 55% male; M_age = 19.94 years; SD = 1.07 years) completed assessments of mastery imagery ability and engaged in a standardized acute psychological stress task. Immediately prior to the task, confidence, cognitive and somatic anxiety intensity, and interpretation of anxiety symptoms regarding the task were assessed. Path analyses supported a model whereby mastery imagery ability mediated the relationship between confidence and cognitive and somatic anxiety interpretation. Greater mastery imagery ability and confidence were both directly associated with better performance on the stress task. Mastery imagery ability may help individuals experience more facilitative anxiety and perform better during stressful tasks. Improving mastery imagery ability by enhancing self-confidence may help individuals successfully cope with anxiety elicited during stressful situations.

Physical Activity Protects Against the Negative Impact of Coronavirus Fear on Adolescent Mental Health and Well-Being During the COVID-19 Pandemic

Background: The severity of the Coronavirus pandemic has led to lockdowns in different countries to reduce the spread of the infection. These lockdown restrictions are likely to be detrimental to mental health and well-being in adolescents. Physical activity can be beneficial for mental health and well-being; however, research has yet to examine associations between adolescent physical activity and mental health and well-being during lockdown. Purpose: Examine the effects of adolescent perceived Coronavirus prevalence and fear on mental health and well-being and investigate the extent to which physical activity can be a protective factor against these concerns. Methods: During United Kingdom lockdown restrictions, 165 participants (100 female, aged 13-19) completed an online questionnaire assessing perceived Coronavirus prevalence and fear, physical activity, and indicators of mental health and well-being (stress, anxiety, depression, fatigue, vitality, and perceived health). Separate hierarchical multiple linear regression analyses (with age, gender, perceived Coronavirus prevalence, and fear entered in step 1, and physical activity in step 2) were run to predict each well-being outcome. Results: Regression analyses indicated that in general, while Coronavirus fear was a negative predictor, physical activity was a positive and stronger predictor of enhanced mental health and well-being outcomes. Conclusion: Findings suggest that physical activity during the Coronavirus pandemic can counteract the negative effects of Coronavirus fear on adolescent mental health and well-being. Therefore, physical activity should be promoted during lockdown to support good mental health and well-being.

Glycobiology and schizophrenia: a biological hypothesis emerging from genomic research

Advances in genomics are opening new windows into the biology of schizophrenia. Though common variants individually have small effects on disease risk, GWAS provide a powerful opportunity to explore pathways and mechanisms contributing to pathophysiology. Here, we highlight an underappreciated biological theme emerging from GWAS: the role of glycosylation in schizophrenia. The strongest coding variant in schizophrenia GWAS is a missense mutation in the manganese transporter SLC39A8, which is associated with altered glycosylation patterns in humans. Furthermore, variants near several genes encoding glycosylation enzymes are unambiguously associated with schizophrenia: FUT9, MAN2A1, TMTC1, GALNT10, and B3GAT1. Here, we summarize the known biological functions, target substrates, and expression patterns of these enzymes as a primer for future studies. We also highlight a subset of schizophrenia-associated proteins critically modified by glycosylation including glutamate receptors, voltage-gated calcium channels, the dopamine D2 receptor, and complement glycoproteins. We hypothesize that common genetic variants alter brain glycosylation and play a fundamental role in the development of schizophrenia. Leveraging these findings will advance our mechanistic understanding of disease and may provide novel avenues for treatment development.

The schizophrenia risk locus in SLC39A8 alters brain metal transport and plasma glycosylation

A common missense variant in SLC39A8 is convincingly associated with schizophrenia and several additional phenotypes. Homozygous loss-of-function mutations in SLC39A8 result in undetectable serum manganese (Mn) and a Congenital Disorder of Glycosylation (CDG) due to the exquisite sensitivity of glycosyltransferases to Mn concentration. Here, we identified several Mn-related changes in human carriers of the common SLC39A8 missense allele. Analysis of structural brain MRI scans showed a dose-dependent change in the ratio of T2w to T1w signal in several regions. Comprehensive trace element analysis confirmed a specific reduction of only serum Mn, and plasma protein N-glycome profiling revealed reduced complexity and branching. N-glycome profiling from two individuals with SLC39A8-CDG showed similar but more severe alterations in branching that improved with Mn supplementation, suggesting that the common variant exists on a spectrum of hypofunction with potential for reversibility. Characterizing the functional impact of this variant will enhance our understanding of schizophrenia pathogenesis and identify novel therapeutic targets and biomarkers.

Associations between heart rate, perceived heart rate, and anxiety during acute psychological stress

Background: Acute psychological stress elicits increases in heart rate (HR) and anxiety. Theories propose associations between HR, perceived HR, and anxiety during stress. However, anxiety is often measured as a unidimensional construct which limits a comprehensive understanding of these relationships. Objectives: This research explored whether HR reactivity or perceived HR change was more closely associated with cognitive and somatic anxiety during acute psychological stress. Design: Two laboratory-based studies were conducted. Methods: In a single laboratory session, healthy male (N = 71; study 1) and female (N = 70; study 2) university students completed three laboratory psychological stress tasks (counterbalanced), each with a preceding baseline. Heart rate, perceived HR change, and cognitive and somatic anxiety intensity and interpretation of anxiety symptoms were assessed immediately following each task. Data were aggregated across tasks. Results: Actual HR change was unrelated to anxiety intensity, but was associated with more debilitative interpretations of anxiety (study 2). Perceptions of HR change were consistently associated with greater intensity of cognitive (study 1) and somatic (study 1 and 2) anxiety. Conclusions: Perceived HR rather than actual HR is more closely associated with anxiety intensity during psychological stress. The findings have implications for stress management and the clinical treatment of anxiety symptoms.

The psychological interaction of spam email features

This study explored distinct perceptual and decisional contributions to spam email mental construal. Participants classified spam emails according to pairings of three stimulus features - presence or absence of awkward prose, abnormal message structure, and implausible premise. We examined dimensional interactions within general recognition theory (GRT; a multidimensional extension of signal detection theory). Classification accuracy was highest for categories containing either two non-normal dimension levels (e.g. awkward prose and implausible premise) or two normal dimension levels (e.g. normal prose and plausible premise). Modelling indicated both perceptual and decisional contributions to classification responding. In most cases, perceptual discriminability was higher along one dimension when stimuli contained a non-normal level of the paired dimension (e.g. prose discriminability was higher with abnormal structure). Similarly, decision criteria along one dimension were biased in favour of the non-normal response when stimuli contained a non-normal level of the paired dimension. Potential applications for training are discussed. Practitioner summary: We applied general recognition theory (i.e. multivariate signal detection theory) to spam email classification at low or high levels of three stimulus dimensions: premise plausibility, prose quality, and email structure. Relevant to training, this approach helped identify perceptual and decisional biases that could be leveraged to individualise training.

UK medical students' perspectives on practical prescribing teaching and learning provisions: a cross-sectional survey

PURPOSE

To determine medical students' perspectives on the provision for the teaching and learning of processes that lead to and include the writing of a clear, safe and legal prescription (practical prescribing) in UK medical schools.

METHODS

We designed a cross-sectional survey of UK medical students in years three, four and five. Students were asked about their experiences and views of practical prescribing teaching and learning they had encountered on their medical course.

RESULTS

A total of 1023 medical students responded (7% response rate), from 25 UK medical schools: 22%, 37% and 41% in the third, fourth and final years, respectively. Teaching of practical prescribing was widespread, with 94.3% of final year (n = 396, 95% confidence interval [CI] = 92-97%), 86.8% of fourth year (n = 328, CI = 83-90%) and 73.8% of third year (n = 166, CI = 67-80%) students reporting they had received it. Availability of this teaching appeared to vary by medical school. Self-directed learning was the most frequently reported mode of delivery (90.9%, n = 809). Validated pre-prescribing and simulation were perceived by students in each year group as the most effective methods. Clinical pharmacologists, clinical pharmacists and junior doctors were perceived by the students as being the most effective professional groups at teaching practical prescribing.

CONCLUSIONS

UK medical students reported a variety of methods utilised in the teaching and learning of practical prescribing. However, methods they perceived to be very effective (simulation and pre-prescribing) do not appear to be widely available or are only reserved for the final year of study. Combining such methods with involvement of professional groups perceived to be most effective should be explored.

Increased stressor-evoked cardiovascular reactivity is associated with reduced amygdala and hippocampus volume

Exaggerated cardiovascular reactivity to acute psychological stress is associated with an increased risk of developing cardiovascular disease. The amygdala and hippocampus have been implicated in centrally mediating stressor-evoked cardiovascular reactivity. However, little is known about the associations of amygdala and hippocampus morphology with stressor-evoked cardiovascular reactivity. Forty (M_age = 19.05, SD = 0.22 years) healthy young women completed two separate testing sessions. Session 1 assessed multiple parameters of cardiovascular physiology at rest and during a validated psychological stress task (Paced Auditory Serial Addition Test), using electrocardiography, Doppler echocardiography, and blood pressure monitoring. In Session 2, 1 year later, structural MRI was conducted. Brain structural volumes were computed using automated segmentation methods. Regression analyses, following Benjamini-Hochberg correction, showed that greater heart rate and cardiac output reactivity were associated with reduced amygdala and hippocampus gray matter volume. Systolic blood pressure reactivity was associated with reduced hippocampus volume. In contrast, no associations between diastolic blood pressure, mean arterial blood pressure, stroke volume, or total peripheral resistance reactivity with amygdala or hippocampus volumes were apparent. Comparison analyses examining insula volume found no significant associations. Some indicators of greater stressor-evoked cardiovascular reactivity associate with reduced amygdala and hippocampus gray matter volume, but the mechanisms of this association warrant further study.

Exploring Imagery as a Technique for Promoting Physical Activity in Older Adults

Exercise imagery can be beneficial for insufficiently active people as a means to promote physical activity (PA) engagement and positive psychological states. The present study explored imagery use in physically active and insufficiently active older adults. The revised applied model of deliberate imagery use (RAMDIU) was used as a framework to explain When, Where, Why, What, and How older adults image and explored whether the Who component of the model (older adults/PA status) interacts with these different components; 37 ( Mage = 64, SD = 5.2; 17 females) participants representing a range of PA levels took part in one of seven focus groups. Thematic analysis provided support for RAMDIU, with motivation, memory, and planning identified as the most common imagery functions, and scenery and reward images as the most commonly reported imagery content. Although some similarities exist, older adults tend to use imagery for unique functions compared with younger counterparts (e.g., to improve memory). Understanding the use of imagery in older adults will help to tailor PA interventions for promoting healthy aging in this population.

Closing the Gap: Mouse Models to Study Adhesion in Secondary Palatogenesis

Secondary palatogenesis occurs when the bilateral palatal shelves (PS), arising from maxillary prominences, fuse at the midline, forming the hard and soft palate. This embryonic phenomenon involves a complex array of morphogenetic events that require coordinated proliferation, apoptosis, migration, and adhesion in the PS epithelia and underlying mesenchyme. When the delicate process of craniofacial morphogenesis is disrupted, the result is orofacial clefting, including cleft lip and cleft palate (CL/P). Through human genetic and animal studies, there are now hundreds of known genetic alternations associated with orofacial clefts; so, it is not surprising that CL/P is among the most common of all birth defects. In recent years, in vitro cell-based assays, ex vivo palate cultures, and genetically engineered animal models have advanced our understanding of the developmental and cell biological pathways that contribute to palate closure. This is particularly true for the areas of PS patterning and growth as well as medial epithelial seam dissolution during palatal fusion. Here, we focus on epithelial cell-cell adhesion, a critical but understudied process in secondary palatogenesis, and provide a review of the available tools and mouse models to better understand this phenomenon.

Barriers and enablers of physical activity engagement for patients with COPD in primary care

Background

Given that physical activity (PA) has a positive impact on COPD symptoms and prognosis, this study examined the factors that both encourage and limit participation in PA for individuals with COPD in a primary care setting from the perspective of social cognitive theory.

Methods

A purposive sample of 26 individuals with a range of COPD severity (age range: 50–89 years; males =15) were recruited from primary care to participate in one of four focus groups. Thematic analysis was undertaken to identify key concepts related to their self-efficacy beliefs.

Results

Several barriers and enablers closely related to self-efficacy beliefs and symptom severity were identified. The main barriers were health related (fatigue, mobility problems, breathing issues caused by the weather), psychological (embarrassment, fear, frustration/disappointment), attitudinal (feeling in control of their condition, PA perception, older age perception), and motivational. The main enabling factors were related to motivation (autonomous or controlled), attitudes, self-regulation, and performance accomplishments.

Clinical implications

When designing interventions for individuals with COPD, it is important to understand the patient-specific social cognitive influences on PA participation. This information can then inform individually tailored management planning.

Partial sleep deprivation impacts impulsive action but not impulsive decision-making

Sleep deprivation may lead to increased impulsivity, however, previous literature has focused on examining effects of total sleep deprivation (TSD) rather than the more common condition, partial sleep deprivation (PSD) or 'short sleep'. Moreover, it has been unclear whether PSD impacts impulse-related cognitive processes, and specifically if it differentially affects impulsive action versus impulsive decision-making. We sought to determine if short compared to long sleep (6 vs. 9h/night) impacts impulsive action via behavioral inhibition (Go/No-Go), and/or impulsive decision-making processes of risk taking (Balloon Analogue Risk Task [BART]) and preferences for immediate over delayed rewards (Delay Discounting). In a within-subject design, 34 participants (71% female, mean age=37.0years, SD=10.54) were assigned to four consecutive nights of 6h/night (short sleep) and 9h/night (long sleep) in their own home in random counterbalanced order. Sleep was measured via wrist-worn actigraphs to confirm adherence to the sleep schedules (mean short sleep=5.9h, SD=0.3; mean long sleep=8.6h, SD=0.3, p<0.001). The Go/No-Go, BART, and Delay Discounting tasks were completed following both sleep conditions. Participants had more inhibition errors on the Go/No-Go task after short (mean false alarms=19.79%, SD=14.51) versus long sleep (mean=15.97%, SD=9.51, p=0.039). This effect was strongest in participants reporting longer habitual time in bed (p=0.04). There were no differences in performance following long- versus short-sleep for either delay discounting or the BART (p's>0.4). Overall, these results indicate that four days of PSD diminishes behavioral inhibition abilities, but may not alter impulsive decision-making. These findings contribute to the emerging understanding of how partial sleep deprivation, currently an epidemic, impacts cognitive ability. Future research should continue to explore the connection between PSD and cognitive functions, and ways to minimize the occurrence and negative consequences of short sleep.

Screening Tool Predicts Future Underimmunization Among a Pediatric Practice in Tennessee

The Parent Attitudes about Childhood Vaccines (PACV) survey for identifying vaccine-hesitant parents was recently validated in Washington State but did not include all recommended childhood vaccines. The current study compares vaccination rates for all recommended childhood vaccines and PACV scores at one pediatric practice in Tennessee. Children were enrolled at the 2-week well visit, and vaccination rates were assessed at 19 months of age. Outcomes at 19 months of age included mean percentage of days underimmunized and up-to-date status (yes/no) compared with PACV scores. The impact of provider on immunization status was assessed. Complete vaccination data were available for 158 children of 183 enrolled (86%). Higher PACV scores were associated with more days underimmunized (P < .001) and being overdue for vaccine doses at 19 months of age (P < .001). No difference was seen between providers and up-to-date status. Our study supports the predictive validity of the PACV for underimmunization.

Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013: its impact in the Northern Rivers, NSW

OBJECTIVE

The objective of the study was to explore the impact of implementation of the Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013 on child-care centres in the Northern Rivers region of New South Wales (NSW), from the perspective of child-care centre directors. Importance of study: Immunisation is an effective public health intervention, but more than 75 000 Australian children are not fully vaccinated. A recent amendment to the NSW Public Health Act 2010 asks child-care facilities to collect evidence of complete vaccination or approved exemption before allowing enrolment.

METHODS

Ten child-care centre directors participated in a semiscripted interview. Interviews were recorded, transcribed and analysed.

RESULTS

Common themes included misinterpretation of the amendment before implementation, the importance of adequate notice for implementation, lack of understanding of assessment of compliance, increased administrative requirements, the importance of other public health efforts, and limited change in vaccination rates. Child-care centres differed in their experience of the resources provided by the government, interactions with Medicare, and ease of integration with existing record-keeping methods.

CONCLUSIONS

Participants felt that the amendment was successfully implemented. The amendment was felt to have fulfilled its aim of prompting parents who had forgotten to vaccinate, but failed to significantly affect conscientious objectors. Overall, the amendment was perceived to be a positive step in improving vaccination rates, but its impact was largely complementary to other components of the multifaceted vaccination policy.

Anxiety symptom interpretation: A potential mechanism explaining the cardiorespiratory fitness-anxiety relationship

BACKGROUND

Higher cardiorespiratory fitness is associated with lower trait anxiety, but research has not examined whether fitness is associated with state anxiety levels and the interpretation of these symptoms. The aim of this paper was to (1) reexamine the association between cardiorespiratory fitness and general anxiety and (2) examine anxiety intensity and perceptions of these symptoms prior to an acute psychological stress task.

METHODS

Participants (N=185; 81% female; Mage=18.04, SD=0.43 years) completed a 10-minute Paced Serial Addition Test. General anxiety was assessed using the anxiety subscale of the Hospital Anxiety Depression Scale. Cognitive and somatic anxiety intensity and perceptions of symptoms was assessed immediately prior to the acute psychological stress task using the Immediate Anxiety Measures Scale. Cardiorespiratory fitness was calculated using a validated standardized formula.

RESULTS

Higher levels of cardiorespiratory fitness were associated with lower levels of general anxiety. Path analysis supported a model whereby perceptions of anxiety symptoms mediated the relationship between cardiorespiratory fitness and levels of anxiety experienced during the stress task; results remained significant after adjusting for general anxiety levels. Specifically, higher levels of cardiorespiratory fitness were positively associated with more positive perceptions of anxiety symptoms and lower levels of state anxiety.

LIMITATIONS

A standard formula rather than maximal testing was used to assess cardiorespiratory fitness, self-report questionnaires were used to assess anxiety, and the study was cross-sectional in design.

CONCLUSIONS

Results suggest a potential mechanism explaining how cardiorespiratory fitness can reduce anxiety levels.

Investigating the psychosocial determinants of physical activity in older adults: A qualitative approach

Objective: Despite the benefits of physical activity (PA), only one-third of older adults meet the recommended levels. The present study focused on psychosocial determinants of PA following retirement. Social cognitive theory (SCT) was used to better understand pre- and post-retirement adults’ thoughts about PA, the reasons why some individuals are more active than others, and how PA is incorporated into daily life after retirement.

Design: Seven focus groups of older adults (N = 37, M = 64, SD = 5.20; males = 20) representing a range of PA levels and retirement length participated in one of seven focus groups.

Results: Aligned with SCT, self-efficacy beliefs along with perceptions about barriers and benefits of PA were among the major determinants of PA. Findings highlighted the importance of social support, positive outcome expectations and self-regulatory strategies as motivators. The lack of structure in retirement was a hindrance to incorporating PA into daily routine but, when incorporated, PA provided a sense of purpose in the lives of retired individuals.

Conclusion: It is important to understand the meaning of retirement as a life transition and how it affects beliefs about PA to inform SCT-based health promotion interventions targeting individuals in retirement age.

Comparing self-report and mental chronometry measures of motor imagery ability

The present study investigated the relationship between two of the most common measures of motor imagery ability, self-report ratings, and chronometric assessment. This was done for three types of imagery modalities: external visual imagery (EVI), internal visual imagery (IVI), and kinesthetic imagery (KI). Measures of imagery ability (i.e. self-report and mental chronometry) were also compared across skill levels. Participants (N = 198) completed the Movement Imagery Questionnaire-3 (MIQ-3) to generate self-report ratings. Chronometric assessment was obtained by recording the duration of each MIQ-3 movement imaged and physically performed and then calculating a discrepancy score. There were no significant correlations between self-report and mental chronometry for any of the three motor imagery types (p > .05). When assessing the different types of motor imagery ability using self-report ratings, elite athletes had significantly higher KI than IVI, which was in turn significantly higher than EVI (p < .05). When assessing motor imagery ability using mental chronometry, there were no significant differences in imagery type (p > .05). Findings suggest both measures address different components of MI quality and should be used together to obtain a more comprehensive assessment of motor imagery ability.

Best-classifier feedback in diagnostic classification training

Diagnostic classification training requires viewing many examples along with category membership feedback. "Objective" feedback based on category membership suggests that perfect accuracy is attainable when it may not be (e.g., with confusable categories). Previous work shows that feedback based on an "optimal" responder (that sometimes makes classification errors) leads to higher long-run reward, especially in unequal category payoff conditions. In the current study, participants learned to classify normal or cancerous mammography images, earning more points for correct "cancer" than "normal" responses. Feedback was either objective or based on performance of an empirically determined "best" classifier. This approach is necessary because theoretically optimal responses cannot be determined with complex real-world stimuli with unknown perceptual distributions. Replicating earlier work that used simple artificial stimuli, we found that best-classifier performance led to decision-criterion values (β) closer to the reward-maximizing criterion, along with higher point totals and a slight reduction (as predicted) in overall accuracy.

What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?

Parental refusal or delay of childhood vaccines is increasing. Barriers to vaccination among this population have been described, yet less is known regarding motivating factors. Researchers are beginning to evaluate various approaches to address the concerns of "vaccine-hesitant" parents, but few studies have evaluated the effect of interventions on timely vaccine uptake. Several models for communicating with vaccine-hesitant parents have been reported for healthcare providers; however, the effectiveness and utility of these strategies has not been quantified. This article reviews the known barriers to vaccination reported by vaccine-hesitant parents and the current evidence on strategies to address parental vaccine hesitancy.

Quantitative effects of inclusion of fat on muscle diffusion tensor MRI measurements

PURPOSE

To determine the minimum water percentage in a muscle region of interest that would allow diffusion tensor (DT-) MRI data to reflect the diffusion properties of pure muscle accurately.

MATERIALS AND METHODS

Proton density-weighted images with and without fat saturation were obtained at the mid-thigh in four subjects. Co-registered DT-MR images were used to calculate the diffusion tensor's eigenvalues and fractional anisotropy.

RESULTS

The eigenvalues transitioned monotonically as a function of water signal percentage from values near to those expected for pure fat to those for pure muscle. Also, the fractional anisotropy transitioned monotonically from 0.50 (fat) to 0.20 (muscle). For water signal percentages >55%, none of the diffusion indices differed significantly from those for regions of >90% muscle.

CONCLUSION

Accounting for the T1 and T2 values of muscle and fat and the pulse sequence properties, it is concluded that, as a conservative estimate, regions must contain at least 76% muscle tissue to reflect the diffusion properties of pure muscle accurately.

Layered stimulus response training improves motor imagery ability and movement execution

This study aimed to test Lang's bioinformational theory by comparing the effects of layered stimulus and response training (LSRT) with imagery practice on improvements in imagery ability and performance of a motor skill (golf putting) in 24 novices (age, M = 20.13 years; SD = 1.65; 12 female) low in imagery ability. Participants were randomly assigned to a LSRT (introducing stimulus and response propositions to an image in a layered approach), motor imagery (MI) practice, or visual imagery (VI) practice group. Following baseline measures of MI ability and golf putting performance, the LSRT and MI practice groups imaged successfully performing the golf putting task 5 times each day for 4 days whereas the VI practice group imaged the ball rolling into the hole. Only the LSRT group experienced an improvement in kinesthetic MI ability, MI ability of more complex skills, and actual golf putting performance. Results support bioinformational theory by demonstrating that LSRT can facilitate visual and kinesthetic MI ability and reiterate the importance of imagery ability to ensure MI is an effective prime for movement execution.

Further validation and development of the movement imagery questionnaire

This research validated and extended the Movement Imagery Questionnaire- Revised (MIQ-R; Hall & Martin, 1997). Study 1 (N = 400) examined the MIQ-R's factor structure via multitrait-multimethod confirmatory factor analysis. The questionnaire was then modified in Study 2 (N = 370) to separately assess the ease of imaging external visual imagery and internal visual imagery, as well as kinesthetic imagery (termed the Movement Imagery Questionnaire-3; MIQ-3). Both Studies 1 and 2 found that a correlated-traits correlated-uniqueness model provided the best fit to the data, while displaying gender invariance and no significant differences in latent mean scores across gender. Study 3 (N = 97) demonstrated the MIQ-3's predictive validity revealing the relationships between imagery ability and observational learning use. Findings highlight the method effects that occur by assessing each type of imagery ability using the same four movements and demonstrate that better imagers report greater use of observational learning.

Dialectical Behavioural Therapy and Borderline Personality Disorder: Effects on Service Utilisation and Self-Reported Symptoms

In a pilot evaluation study, effectiveness of a 20-week dialectical behavioural therapy (DBT) skills training group program was explored for adult clients with borderline personality disorder (BPD;N= 140). Subjective ratings of depression, anxiety and BPD symptomatology were obtained pre and post group therapy. Objective measures of service utilisation levels were obtained for the 6 months prior to group therapy, the duration of therapy, and the 6 months following therapy. Group completers (n= 68) showed reductions in depression, anxiety and BPD symptomatology, as well as in the number of emergency department attendances. Completers with previous high service utilisation had decreases in telephone counselling calls and inpatient days during therapy, and fewer emergency department attendances post therapy. Completers had larger decreases in service utilisation than noncompleters (n= 72). Simultaneous engagement in individual DBT was related to higher group completion than was individual therapy as usual, but it did not impact on level of service utilisation or psychological functioning. This quasi-experimental pilot study suggests that DBT groups may improve psychological functioning and decrease service utilisation for BPD clients, particularly those with high service utilisation. The treatment warrants systematic evaluation.

The functional equivalence between movement imagery, observation, and execution influences imagery ability

Based on literature identifying movement imagery, observation, and execution to elicit similar areas of neural activity, research has demonstrated that movement imagery and observation successfully prime movement execution. To investigate whether movement and observation could prime ease of imaging from an external visual-imagery perspective, an internal visual-imagery perspective, and kinesthetic modality, 36 participants (M age = 20.58; SD = 3.11; 18 women and 18 men) completed an adapted version of the Movement Imagery Questionnaire-Revised under four modes of delivery (movement prime, external observation prime, internal observation prime, and image-only). The results revealed that ease of imaging was significantly greater during the movement and observation prime conditions compared to the image-only condition (p < .05). Specifically when priming external visual imagery and internal visual imagery, observation facilitated ease of imaging only when the perspective was congruent with the imagery perspective. The results support the use of movement and observation to facilitate ease of imaging, but highlight the importance of considering the visual perspective when using observation.