Roadmap to DILI research in Europe. A proposal from COST action ProEuroDILINet

In the current article the aims for a constructive way forward in Drug-Induced Liver Injury (DILI) are to highlight the most important priorities in research and clinical science, therefore supporting a more informed, focused, and better funded future for European DILI research. This Roadmap aims to identify key challenges, define a shared vision across all stakeholders for the opportunities to overcome these challenges and propose a high-quality research program to achieve progress on the prediction, prevention, diagnosis and management of this condition and impact on healthcare practice in the field of DILI. This will involve 1. Creation of a database encompassing optimised case report form for prospectively identified DILI cases with well-characterised controls with competing diagnoses, biological samples, and imaging data; 2. Establishing of preclinical models to improve the assessment and prediction of hepatotoxicity in humans to guide future drug safety testing; 3. Emphasis on implementation science and 4. Enhanced collaboration between drug-developers, clinicians and regulatory scientists. This proposed operational framework will advance DILI research and may bring together basic, applied, translational and clinical research in DILI.

Assessing cognitive decline in the aging brain: lessons from rodent and human studies

As life expectancy continues to increase worldwide, age-related dysfunction will largely impact our societies in the future. Aging is well established to promote the deterioration of cognitive function and is the primary risk factor for the development of prevalent neurological disorders. Even in the absence of dementia, age-related cognitive decline impacts specific types of memories and brain structures in humans and animal models. Despite this, preclinical and clinical studies that investigate age-related changes in brain physiology often use largely different methods, which hinders the translational potential of findings. This review seeks to integrate what is known about age-related changes in the brain with analogue cognitive tests used in humans and rodent studies, ranging from "pen and paper" tests to virtual-reality-based paradigms. Finally, we draw parallels between the behavior paradigms used in research compared to the enrollment into clinical trials that aim to study age-related cognitive decline.

Validity and reliability of the WHOQOL-BREF in a pregnant population

BACKGROUND

Physical end emotional changes during pregnancy may not only affect pregnant womens' quality of life, but also how instruments assessing quality of life perform in such populations. To date, there is insufficient evidence on psychometric properties for both generic and condition-specific instruments measuring quality of life during pregnancy. The aim of this study was thus to examine the structural validity, internal consistency, and construct validity of the WHOQOL-BREF in a sample of pregnant women.

METHODS

A convenience sample of 1015 pregnant women in Sweden completed the WHOQOL-BREF online. We examined the psychometric properties of the instrument using principal component analysis (PCA), confirmatory factor analysis (CFA), Cronbach's alpha, item-domain correlations, correlations with overall QOL and general health, and multiple linear regression with items on overall QOL and general health as outcomes.

RESULTS

Principal Component Analysis in a random subsample (n = 502) supported a four-factor model, encompassing the domains physical, psychological, social and environmental quality of life, but with four of the items originally in the environmental domain relocated to the other domains. The proposed domain structure showed good fit in confirmatory factor analysis in the other random subsample (n = 513). The physical and psychological domains showed good internal consistency (Cronbach's alpha = 0.885 and 0.826 respectively), while the social and environmental domains were weaker in this regard. All domains showed significant positive correlations with items on overall QOL and general health. The physical and psychological domains were the most evident predictors in the regression models.

CONCLUSIONS

We find the Swedish version of the WHOQOL-BREF to have good psychometric properties to be used in samples of pregnant women, and propose an alternative domain structure that might be even more useful for assessing quality of life during pregnancy. The physical and psychological domains showed good internal consistency and construct validity.

Single Mutations in Cytochrome P450 Oxidoreductase Can Alter the Specificity of Human Cytochrome P450 1A2-Mediated Caffeine Metabolism

A unique cytochrome P450 (CYP) oxidoreductase (CPR) sustains activities of human microsomal CYPs. Its function requires toggling between a closed conformation enabling electron transfers from NADPH to FAD and then FMN cofactors and open conformations forming complexes and transferring electrons to CYPs. We previously demonstrated that distinct features of the hinge region linking the FAD and FMN domain (FD) modulate conformer poses and their interactions with CYPs. Specific FD residues contribute in a CYP isoform-dependent manner to the recognition and electron transfer mechanisms that are additionally modulated by the structure of CYP-bound substrate. To obtain insights into the underlying mechanisms, we analyzed how hinge region and FD mutations influence CYP1A2-mediated caffeine metabolism. Activities, metabolite profiles, regiospecificity and coupling efficiencies were evaluated in regard to the structural features and molecular dynamics of complexes bearing alternate substrate poses at the CYP active site. Studies reveal that FD variants not only modulate CYP activities but surprisingly the regiospecificity of reactions. Computational approaches evidenced that the considered mutations are generally in close contact with residues at the FD-CYP interface, exhibiting induced fits during complexation and modified dynamics depending on caffeine presence and orientation. It was concluded that dynamic coupling between FD mutations, the complex interface and CYP active site exist consistently with the observed regiospecific alterations.

Coproducing leadership: a reason to resist destructive leaders

Purpose

Follower's individual differences have been receiving increased attention in studying destructive leadership because followers may enable or disable it. One of these yet under-researched features is the role of followers' leadership coproduction beliefs (a role construal) in explaining their resistance to destructive leaders. Departing from the proactive motivation theory, this paper explores the robustness of coproduction beliefs by testing its ability to predict followers' resistance to destructive leaders across four situations – abusive supervision, exploitative leadership, organization directed behaviors and laissez-faire.

Design/methodology/approach

With a sample of 359 participants that answered a scenario-based survey, the present study tests the relationship between coproduction beliefs and resistance behaviors in the four mentioned groups, while controlling for alternative explanations. A multigroup analysis was conducted with PLS-SEM.

Findings

Constructive resistance is always favored by coproduction beliefs independently of the leader's type of destructive behavior. Dysfunctional resistance, however, is sensitive to the leader's type of destructive behavior.

Originality/value

This paper extends knowledge on the role of coproduction beliefs as an individual-based resource against destructive leaders.

The Complex Dynamic of Phase I Drug Metabolism in the Early Stages of Doxorubicin Resistance in Breast Cancer Cells

The altered activity of drug metabolism enzymes (DMEs) is a hallmark of chemotherapy resistance. Cytochrome P450s (CYPs), mainly CYP3A4, and several oxidoreductases are responsible for Phase I metabolism of doxorubicin (DOX), an anthracycline widely used in breast cancer (BC) treatment. This study aimed to investigate the role of Phase I DMEs involved in the first stages of acquisition of DOX-resistance in BC cells. For this purpose, the expression of 92 DME genes and specific CYP-complex enzymes activities were assessed in either sensitive (MCF-7 parental cells; MCF-7/DOX^S) or DOX-resistant (MCF-7/DOX^R) cells. The DMEs genes detected to be significantly differentially expressed in MCF-7/DOX^R cells (12 CYPs and eight oxidoreductases) were indicated previously to be involved in tumor progression and/or chemotherapy response. The analysis of CYP-mediated activities suggests a putative enhanced CYP3A4-dependent metabolism in MCF-7/DOX^R cells. A discrepancy was observed between CYP-enzyme activities and their corresponding levels of mRNA transcripts. This is indicative that the phenotype of DMEs is not linearly correlated with transcription induction responses, confirming the multifactorial complexity of this mechanism. Our results pinpoint the potential role of specific CYPs and oxidoreductases involved in the metabolism of drugs, retinoic and arachidonic acids, in the mechanisms of chemo-resistance to DOX and carcinogenesis of BC.

Empathy development from adolescence to adulthood and its consistency across targets

This research was conducted with two main goals-to contribute to knowledge on the development of empathy from early adolescence to adulthood, including its contribution to decoding emotion expression, and to improve the understanding of the nature of empathy by simultaneously assessing empathy toward two different targets-humans and animals. It unfolded into two cross-sectional studies: One (S1) obtaining measures of empathy toward humans and animals as targets across five age groups (from pre-adolescents to adults); and another (S2) where a subset of the adolescents who participated in S1 were assessed in emotion expression decoding and subjective and physiological responses to emotional video clips. The results of S1 showed that empathy toward animals and most dimensions of empathy toward humans increase toward adulthood, with important gender differences in empathy to animals and humans, and empathy levels in girls starting off in the age trajectory at higher levels, A moderate correlation between empathy toward human and toward animal targets was also found. S2 showed that the expression of positive emotion is better recognized than that of negative emotion, surprise, or neutral expression, and that the measure of human-directed empathy predicts successful decoding of negative emotion, whereas skin conductance responses (SCRs) and subjective valence ratings predicted successful identification of positive emotion. Gender differences emerged but not across all age groups nor all subscales. Results yield keys to the developmental "pace" and trajectory of the various dimensions of empathy and to how empathy relates to emotion decoding.

The Effect of Nudging in Promoting the Consumption of Organic Fruits and Vegetables

A field study collecting behavioral data was conducted to investigate effects of behavioral interventions, commonly known as nudges, in promoting the consumption of organic fruits and vegetables. Consumption, both organically and conventionally produced fruits and vegetables, was measured in a grocery store during 4 days (1 day every other week) where consumers were exposed to informational messages in combination with either emotional images or social norm messages. Measurements of daily consumption without exposure to nudges were carried out during four other days (1 day every other week, alternated with the nudging days). The results showed no effect of the nudging strategy; instead, it pointed to the importance of the price as a determinant of buying decisions. Buying ecological alternatives was associated with lower price differences between the ecological and non-ecological alternatives. We conclude that combined nudges and collected psychological data from participants may contribute to more successful nudging interventions. Some political measures in balancing the price difference between organically and conventionally produced products might also be interesting strategies in order to promote the consumption of organic fruits and vegetables.

Children's Attitudes and Behaviors about Oral Health and Dental Practices

The present study sought to contribute to a better understanding of children's attitudes and behaviors regarding oral health and dental practices. The sample was composed of 101 children (8-10 years), collected from several schools in the Lisbon metropolitan area. Our main goals were to collect a survey of information about the beliefs, attitudes, habits and knowledge of children about oral and dental issues in order to not only have an overview of them but also to serve as a basis and a starting point for the development of intervention programs to increase positive attitudes and behaviors related to oral health and promote greater knowledge about these subjects. In general, children reported positive behaviors regarding dental habits and oral hygiene practices. Children's opinions and beliefs about dentists were also globally positive; however, the results suggested that younger children reported more positive attitudes, emotions and previous experiences. Regarding children's knowledge about these dental issues, the results were quite negative and worrying, ruled by ignorance and incorrect beliefs and behaviors. In sum, all the results and conclusions of this study may contribute to the development of educational programs within the scope of the promotion of oral health and hygiene practices-"An Adventure about Oral Health."

Empirical investigation of the relationship between bilingualism and social flexibility

Recently, a relationship between bilingualism and enhanced social flexibility has been suggested. However, research on the subject is scarce and what little exists is limited by several conceptual and methodological concerns. In the current study, we attempted to (a) replicate the findings from a study by Ikizer and Ramírez-Esparza (Bilingualism: Language and Cognition 21:957–969, 2018) by using the scales that the authors developed, and (b) test the concept of social flexibility experimentally with a switch-task using socially relevant stimuli. In the first part, participants (n = 194) filled out the scales developed by Ikizer and Ramírez-Esparza. We could not find that bilingualism leads to enhanced social flexibility. We did, however, find that higher level of education led to higher scores on the social flexibility scale. In the second part, a subsample (n = 74) from Part 1 completed a task where they were asked to identify the congruency between a face and a voice based on either gender or emotion, and to switch between these two tasks. The experimental task did not show an advantage for the bilingual participants. On the contrary, higher proficiency in a second language led to lower accuracy in the congruent emotion condition, while level of education led to higher accuracy in that same condition. We suggest that factors other than bilingualism, such as level of education and biculturalism, most likely drove the effect found both in the current study and originally by Ikizer and Ramírez-Esparza.

Can you be a follower even when you do not follow the leader? Yes, you can

In the ongoing debate in the area of critical leadership studies, the nature of leader–follower relationships is a thorny issue. The nature of followership has been questioned, especially whether followers can display resistance behaviours while maintaining their follower position. Addressing this issue requires a dialectical approach in which followers and leaders alike are primary elements in leadership co-production. Followers who face destructive leaders are of special interest when leadership is studied as a co-creational process. This context favours the emergence of a full range of behavioural profiles in which passives and colluders will illustrate the destructive leadership co-production process, and those who resist demonstrate that followers may not follow the leader and still keep a followership purpose. A two-step data analysis procedure was conducted based on the behaviour descriptions of 123 followers having a destructive leader. A qualitative analysis (i.e. content analysis) showed a set of behaviours and their antecedents that suggest three main groups of followers: resisters, obedient and mixed behaviour. Treating these data quantitatively (i.e. latent class analysis), six followers’ profiles emerged: active resistance, passive resistance, passive obedience, conflict avoidance, support and mixed. Our findings provide evidence that followers who resist may do it for the sake of the organisation. We discuss our findings in light of followership theory, whereby joining role-based and constructionist approaches allows us to argue that followers may still be followers even when they do not invariably follow their leader.

Interaction Modes of Microsomal Cytochrome P450s with Its Reductase and the Role of Substrate Binding

The activity of microsomal cytochromes P450 (CYP) is strictly dependent on the supply of electrons provided by NADPH cytochrome P450 oxidoreductase (CPR). The variant nature of the isoform-specific proximal interface of microsomal CYPs implies that the interacting interface between the two proteins is degenerated. Recently, we demonstrated that specific CPR mutations in the FMN-domain (FD) may induce a gain in activity for a specific CYP isoform. In the current report, we confirm the CYP isoform dependence of CPR's degenerated binding by demonstrating that the effect of four of the formerly studied FD mutants are indeed exclusive of a specific CYP isoform, as verified by cytochrome c inhibition studies. Moreover, the nature of CYP's substrate seems to have a modulating role in the CPR:CYP interaction. In silico molecular dynamics simulations of the FD evidence that mutations induces very subtle structural alterations, influencing the characteristics of residues formerly implicated in the CPR:CYP interaction or in positioning of the FMN moiety. CPR seems therefore to be able to form effective interaction complexes with its structural diverse partners via a combination of specific structural features of the FD, which are functional in a CYP isoform dependent manner, and dependent on the substrate bound.

The Role of the FMN-Domain of Human Cytochrome P450 Oxidoreductase in Its Promiscuous Interactions With Structurally Diverse Redox Partners

NADPH cytochrome P450 oxidoreductase (CPR) is the obligatory electron supplier that sustains the activity of microsomal cytochrome P450 (CYP) enzymes. The variant nature of the isoform-specific proximal interface of microsomal CYPs indicates that CPR is capable of multiple degenerated interactions with CYPs for electron transfer, through different binding mechanisms, and which are still not well-understood. Recently, we showed that CPR dynamics allows formation of open conformations that can be sampled by its structurally diverse redox partners in a CYP-isoform dependent manner. To further investigate the role of the CPR FMN-domain in effective binding of CPR to its diverse acceptors and to clarify the underlying molecular mechanisms, five different CPR-FMN-domain random mutant libraries were created. These libraries were screened for mutants with increased activity when combined with specific CYP-isoforms. Seven CPR-FMN-domain mutants were identified, supporting a gain in activity for CYP1A2 (P117H, G144C, A229T), 2A6 (P117L/L125V, G175D, H183Y), or 3A4 (N151D). Effects were evaluated using extended enzyme kinetic analysis, cytochrome b₅ competition, ionic strength effect on CYP activity, and structural analysis. Mutated residues were located either in or adjacent to several acidic amino acid stretches – formerly indicated to be involved in CPR:CYP interactions – or close to two tyrosine residues suggested to be involved in FMN binding. Several of the identified positions co-localize with mutations found in naturally occurring CPR variants that were previously shown to cause CYP-isoform-dependent effects. The mutations do not seem to significantly alter the geometry of the FMN-domain but are likely to cause very subtle alterations leading to improved interaction with a specific CYP. Overall, these data suggest that CYPs interact with CPR using an isoform specific combination of several binding motifs of the FMN-domain.

PL3.6 Targeting GSK-3 activity promotes mitotic catastrophe via centrosome destabilisation and enhances the effect of radiotherapy in glioma models

BACKGROUND

Targeting kinases as regulators of cellular processes that drive cancer progression is a promising approach to improve patient outcome in GBM management. The glycogen synthase kinase 3 (GSK-3) plays a role in cancer progression and is known for its pro-proliferative activity in gliomas. The anti-proliferative and cytotoxic effects of the GSK-3 inhibitor AZD2858 were assessed in relevant in vitro and in vivo glioma models to confirm GSK-3 as a suitable target for improved single agent or combination treatments.

MATERIAL AND METHODS

The immortalised cell line U251 and the patient derived cell lines GBM1 and GBM4 were used in in vitro studies including MTT, clonogenic survival, live cell imaging, immunofluorescence microscopy and flow cytometry to assess the cytotoxic and anti-proliferative effects of AZD2858. Observed anti-proliferative effects were investigated by microarray technology for the identification of target genes with known roles in cell proliferation. Clinical relevance of targeting GSK-3 with the inhibitor either for single agent or combination treatment strategies was determined by subcutaneous and orthotopic in vivo modelling. Whole mount mass spectroscopy was used to confirm drug penetration in orthotopic tumour models.

RESULTS

AZD2858 was cytotoxic at low micromolar concentrations and at sub-micromolar concentrations (0.01 - 1.0 μM) induced mitotic defects in all cell lines examined. Prolonged mitosis, centrosome disruption/duplication and cytokinetic failure leading to cell death featured prominently among the cell lines concomitant with an observed S-phase arrest. No cytotoxic or anti-proliferative effect was observed in normal human astrocytes. Analysis of the RNA microarray screen of AZD2858 treated glioma cells revealed the dysregulation of mitosis-associated genes including ASPM and PRC1, encoding proteins with known roles in cytokinesis. The anti-proliferative and cytotoxic effect of AZD2858 was also confirmed in both subcutaneous and orthotopic in vivo models. In addition, combination treatment with AZD2858 enhanced clinically relevant radiation doses leading to reduced tumour volume and improved survival in orthotopic in vivo models.

CONCLUSION

GSK-3 inhibition with the small molecule inhibitor AZD2858 led to cell death in glioma stem cells preventing normal centrosome function and promoting mitotic failure. Normal human astrocytes were not affected by treatment with the inhibitor at submicromolar concentrations. Drug penetration was observed alongside an enhanced effect of clinical radiotherapy doses in vivo. The reported aberrant centrosomal duplication may be a direct consequence of failed cytokinesis suggesting a role of GSK-3 in regulation of mitosis in glioma. GSK-3 is a promising target for combination treatment with radiation in GBM management and plays a role in mitosis-associated events in glioma biology.

Acting on observed social exclusion and pro-social behaviour in autism spectrum disorder

Humans are commonly motivated towards cooperation and prosociality. In this study, we examined this motivational predisposition in autistic individuals. Using an adaptation of the Cyberball paradigm, we investigated subsequent pro-social behaviour after witnessing social exclusion. Participants witnessed and played a series of Cyberball games, rated their affective state and valued emotional faces with respect to their approachability. Results showed that participants from both groups were aware of the social exclusion. However, while neurotypically developing participants engaged in pro-social behaviour in reaction to the exclusion, autistic participants showed less alterations, in terms of either behaviour or affective state. The current findings suggest a distinct motivational drive and processing of social reward stimuli in autism, which may result in behavioural responses divergent from typical development when engaging in the social world.

Probing the Role of the Hinge Segment of Cytochrome P450 Oxidoreductase in the Interaction with Cytochrome P450

NADPH-cytochrome P450 reductase (CPR) is the unique redox partner of microsomal cytochrome P450s (CYPs). CPR exists in a conformational equilibrium between open and closed conformations throughout its electron transfer (ET) function. Previously, we have shown that electrostatic and flexibility properties of the hinge segment of CPR are critical for ET. Three mutants of human CPR were studied (S243P, I245P and R246A) and combined with representative human drug-metabolizing CYPs (isoforms 1A2, 2A6 and 3A4). To probe the effect of these hinge mutations different experimental approaches were employed: CYP bioactivation capacity of pre-carcinogens, enzyme kinetic analysis, and effect of the ionic strength and cytochrome b₅ (CYB5) on CYP activity. The hinge mutations influenced the bioactivation of pre-carcinogens, which seemed CYP isoform and substrate dependent. The deviations of Michaelis-Menten kinetic parameters uncovered tend to confirm this discrepancy, which was confirmed by CYP and hinge mutant specific salt/activity profiles. CPR/CYB5 competition experiments indicated a less important role of affinity in CPR/CYP interaction. Overall, our data suggest that the highly flexible hinge of CPR is responsible for the existence of a conformational aggregate of different open CPR conformers enabling ET-interaction with structural varied redox partners.

Human cytochrome P450 expression in bacteria: Whole-cell high-throughput activity assay for CYP1A2, 2A6 and 3A4

Cytochrome P450s (CYPs) are key enzymes involved in drug and xenobiotic metabolism. A wide array of in vitro methodologies, including recombinant sources, are currently been used to assess CYP catalysis, to identify the metabolic profile of compounds, potential drug-drug interactions, protein-protein interactions in the CYP enzyme complex and the role of polymorphic enzymes. We report here on a bacterial whole-cells high-throughput method for the activity evaluation of human CYP1A2, 2A6, and 3A4, when sustained by NADPH cytochrome P450 oxidoreductase (CPR), in the absence or presence of cytochrome b₅ (CYB5). This new assay consists of a microplate real-time fluorometric method, with direct measurement of metabolite formation, in a suspension of Escherichia coli BTC-CYP bacteria, a human CYP competent tester strain when incubated with specific fluorogenic substrates. Overall, the maximum turnover (k_cat) velocities of the three human CYPs resulting from the whole-BTC cells assays were similar to those obtained when applying the corresponding standard reference membrane fractions assays. CYP activity screening with co-expression of CYB5 suggests an enhancing effect of CYB5 on the k_cat of specific isoforms, when using the whole-BTC cells assay. Our results demonstrate that this new approach can offer an efficient high-throughput method for screening of CYP1A2, 2A6 and 3A4 activity and can be potentially applicable for other human CYPs. This can be of particular use for timely and efficient screening of chemical libraries or mutant libraries of CYP enzyme complex proteins, without the necessity for labor intensive isolation of subcellular fractions.

A biocompatible decellularized pulp scaffold for regenerative endodontics

AIM

To investigate the feasibility of decellularizing the entire dental pulp using a mild treatment protocol to develop a decellularized biological extracellular matrix scaffold for use in regenerative endodontic procedures.

METHODOLOGY

Decellularized human dental pulps were assessed using histological and immunohistochemical methods, scanning electron microscope and DNA quantification assay. Cytotoxicity assays to determine decellularized scaffold biocompatibility were also performed. Decellularized scaffolds were seeded with human dental pulp stem cells and cell viability assessed using Live/Dead^® stain. Quantitative data were analysed statistically using Student's t-test and one-way analysis of variance to compare mean values between groups depending on group numbers.

RESULTS

Assessment of decellularized tissues revealed an acellular matrix with preservation of native tissue histoarchitecture and composition. Decellularized tissues showed no evidence of cytotoxicity, with cell growth in direct contact with the scaffold and no reduction in cellular activity following extract incubation. Furthermore, the scaffold was able to support human dental pulp stem cell viability and attachment following recellularization.

CONCLUSIONS

Promising results were observed in developing a decellularized biological scaffold derived from the dental pulp with the perseveration of extracellular structural components which are required for tissue-specific regeneration.

The Hinge Segment of Human NADPH-Cytochrome P450 Reductase in Conformational Switching: The Critical Role of Ionic Strength

NADPH-cytochrome P450 reductase (CPR) is a redox partner of microsomal cytochromes P450 and is a prototype of the diflavin reductase family. CPR contains 3 distinct functional domains: a FMN-binding domain (acceptor reduction), a linker (hinge), and a connecting/FAD domain (NADPH oxidation). It has been demonstrated that the mechanism of CPR exhibits an important step in which it switches from a compact, closed conformation (locked state) to an ensemble of open conformations (unlocked state), the latter enabling electron transfer to redox partners. The conformational equilibrium between the locked and unlocked states has been shown to be highly dependent on ionic strength, reinforcing the hypothesis of the presence of critical salt interactions at the interface between the FMN and connecting FAD domains. Here we show that specific residues of the hinge segment are important in the control of the conformational equilibrium of CPR. We constructed six single mutants and two double mutants of the human CPR, targeting residues G240, S243, I245 and R246 of the hinge segment, with the aim of modifying the flexibility or the potential ionic interactions of the hinge segment. We measured the reduction of cytochrome c at various salt concentrations of these 8 mutants, either in the soluble or membrane-bound form of human CPR. All mutants were found capable of reducing cytochrome c yet with different efficiency and their maximal rates of cytochrome c reduction were shifted to lower salt concentration. In particular, residue R246 seems to play a key role in a salt bridge network present at the interface of the hinge and the connecting domain. Interestingly, the effects of mutations, although similar, demonstrated specific differences when present in the soluble or membrane-bound context. Our results demonstrate that the electrostatic and flexibility properties of the hinge segment are critical for electron transfer from CPR to its redox partners.

Psychometric Assessment of the Child Surgery Worries Questionnaire Among Portuguese Children

Worries are common in surgical patients, especially in children. The present study analyzed the factor structure and the psychometric properties of a Portuguese version of the Child Surgery Worries Questionnaire (CSWQ-P) in a Portuguese sample of 490 children. Exploratory factor analysis, conducted via principal axis factoring with oblimin rotation, provided evidence for a four-factor structure of the 21 item questionnaire. A confirmatory factor analysis was also conducted, showing the good fit of this solution. The CSWQ-P proved to have one more subscale than the original Spanish version CSWQ. Correlations with the children's trait anxiety provided evidence of convergent validity for the CSWQ-P. Females also scored higher on worries than males on all subscales. Psychometric properties of this revised version of the CSWQ provided support for use with young children, and indicate the CSWQ-P has value for use in healthcare practice and in clinical research.

Must We Suffer to Succeed?

Abstract. Why do some people work best under pressure? In two studies, we examined whether and how people use anxiety to motivate themselves. As predicted, clarity of feelings moderated the relationship between trait anxiety and the tendency to use this emotion as a source of motivation (i.e., anxiety motivation). Furthermore, anxiety motivation mediated the relationship between trait anxiety and outcomes – including academic achievement (Study 1) as well as persistence and job satisfaction (Study 2). These findings suggest that individuals who are clear about their feelings are more likely to thrive on anxiety and eustress and possibly use these to achieve their goals and find satisfaction at work.

Serological diagnosis of pneumocystosis: production of a synthetic recombinant antigen for immunodetection of Pneumocystis jirovecii

Diagnosis of Pneumocystis pneumonia (PcP) relies on the detection of P. jirovecii in respiratory specimens obtained by invasive techniques. Thus, the development of a serological test is urgently needed as it will allow the diagnosis of PcP using blood, an inexpensive and non-invasive specimen. This study aims to combine the production of a multi-epitope synthetic recombinant antigen (RSA) and an ELISA test for detection of anti-P. jirovecii antibodies, in order to develop a new approach for PcP diagnosis. The RSA was selected and designed based on the study of the immunogenicity of the carboxyl-terminal domain of the major surface glycoprotein. This antigen was purified and used as an antigenic tool in an ELISA technique for detection of Ig, IgG and IgM antibodies anti-P. jirovecii (patent-pending no. PT109078). Serum specimens from 88 patients previously categorized in distinct clinical subgroups and 17 blood donors, were analysed. The IgM anti-P. jirovecii levels were statistically increased in patients with PcP (p = 0.001) and the ELISA IgM anti-P. jirovecii test presented a sensitivity of 100% and a specificity of 80.8%, when associated with the clinical diagnosis criteria. This innovative approach, provides good insights about what can be done in the future serum testing for PcP diagnosis.

Toward an understanding of the quality of life construct: Validity and reliability of the WHOQOL-Bref in a psychiatric sample

This study tested the psychometric properties of the WHOQOL-Bref by examining its construct validity, predictive validity and reliability in a psychiatric sample. The sample consisted of 403 participants recruited from mental health care facilities. Construct validity was assessed through confirmatory factor analysis (CFA) and item-domains correlations. Predictive validity was evaluated via multiple regressions. Internal consistency was analyzed by using Cronbach's alpha. Results from CFA second-order hierarchical model and item-domain correlational analyses supported the construct validity of the WHOQOL-Bref. A 5-domain model (psychological, physical, social relationships, environment and level of independence) demonstrated good-fit and adequate internal consistency. Multiple regression analyses of the domains with overall quality of life (QOL), general health and general QOL were supportive of predictive validity. This study found support for the multidimensionality of the WHOQOL-Bref which demonstrated appropriate properties for the assessment of QOL in psychiatric inpatients and outpatients. Thus, a valuable tool to be incorporated as part of the routine clinical evaluation, monitoring and an important indicator of treatment outcome and research. Our findings suggest a conceptual distinction between the physical domain and level of independence domain in this short version of the WHOQOL, as proposed by the WHOQOL-100.

Cross-Cultural Comparison of Personality Traits, Attachment Security, and Satisfaction With Relationships as Predictors of Subjective Well-Being in India, Sweden, and the United States

Personality traits like Neuroticism and Extroversion, Satisfaction With Relationships, and Attachment Security are among the most important predictors of subjective well-being (SWB). However, the relative contribution of these predictors to SWB is seldom tested, and even more rarely tested cross-culturally. In this study, we replicate and extend Galinha, Oishi, Pereira, Wirtz, and Esteves, aiming to identify the strongest predictors of SWB, and in what way that contribution is universal or culture-specific, across such collectivist-individualist countries as India, Sweden, and the United States ( N = 1,622). Structural equation modeling showed that Satisfaction With Relationships is a stronger predictor of SWB in India, while Neuroticism is a stronger predictor of SWB in Sweden and the United States, results consistent with prior Portuguese and Mozambican samples. These findings suggest that Satisfaction With Relationships is probably a stronger predictor of SWB in more collectivistic and less developed countries, while low Neuroticism is a stronger predictor of SWB in more individualistic and highly developed countries. Across all samples, Attachment Security and Extroversion showed very weak or nonsignificant effects on SWB above the contribution of Neuroticism and Satisfaction With Relationships, consistent with prior results. Neuroticism significantly mediated the relationship between Attachment Security, SWB, and Satisfaction With Relationships.

[Children's attitudes regarding health care and perception of pain: the mediating role of medical fears]

This study sought to contribute to a better understanding of children's attitudes and opinions regarding health care, mainly in terms of medical procedures, institutions and the efficacy of health professionals. The sample included 381 children, recruited from different schools in Lisbon. The more negative attitudes were attributed to institutions, while positive attitudes were related to the efficacy of health professionals. Medical procedures were considered less painful compared to potential day-to-day accidents. Higher levels of pain were reported by children of the female sex and by children during the primary education phase. Medical fears mediated the relationship between the perception of pain and children's attitudes with respect to health care. Higher levels of pain perception were seen to be related to more negative attitudes regarding health care. However, this relationship was diminished when children's fears about medical issues were contemplated. In conclusion, a translated instrument to assess children's attitudes regarding health care is needed, as it may even contribute to the development of intervention programs within the scope of the promotion of attitudes towards health care.

Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department

INTRODUCTION

Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes.

MATERIAL AND METHODS

We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012.

RESULTS

In the study, period septic shock was diagnosed in 100 patients (56.2%) and severe sepsis in 78 patients (43.8%). Compliance with the sepsis bundle was: (1) 62.9% for lactate measurement; (2) 62.9% for blood cultures before antibiotics; (3) 41.6% for antibiotics in the first 3 hours; (4) 76.4% for fluid administration; (5) 25% for vasopressor administration; (6) 37% for central venous pressure measurement and (7) 39% for central venous oxygen saturation measurement. Full compliance was observed in 22% of the patients. The individual bundle measure - Blood cultures before antibiotics - was significantly associated with a decreased risk of both intensive care unit mortality and 28-day mortality. There was also a trend for an inverse correlation between increased compliance with the full bundle and the intensive care unit and 28-days hospital mortality.

DISCUSSION

There was a low compliance with the Surviving Sepsis Campaign 6-hour bundle, a result that replicates the findings in similar international studies. The explanation is complex but it may include the lack of institutional quality monitoring in the emergency department.

CONCLUSIONS

The compliance with a sepsis resuscitation bundle starting in the emergency department was positively associated with the outcomes of the septic patients. Nonetheless the bundle was unreliably performed.

Emotions Under the Skin

Abstract. The present study examined physiological reactivity to emotional stimuli as a function of attachment style. Skin conductance responses (SCRs) and heart rate (HR) changes were simultaneously recorded while participants engaged in a visual attentional task. The task included positive, neutral, and negative emotional pictures, and required the identification of a target (neutral picture rotated 90° to the left or right), among a stream of pictures in which an emotional distracter (positive or negative) was presented. Participants additionally rated each of the emotional distracters for valence and arousal. Behavioral results on the attentional task showed that positive pictures facilitated overall target detection for all participants, compared to negative and neutral pictures, and that anxiously attached participants had significantly lower accuracy scores, relative to the other groups. Affective ratings indicated that positive pictures were rated as being more pleasant than negative ones, although no differences were found in HR changes to picture valence. In contrast, negative pictures were evaluated as being highly arousing. Consistent with this, negative pictures elicited larger SCRs in both insecure anxious and avoidant groups, especially for the anxious while the secure group showed SCRs unaffected by stimuli’s arousal. Present results show that individuals with different attachment styles reveal distinct patterns of attentional bias, appraisal, and physiological reactivity toward emotionally arousing stimuli. These findings further highlight the regulatory function of the attachment system.

Attachment style impacts behavior and early oculomotor response to positive, but not negative, pictures

The present study investigated whether oculomotor behavior is influenced by attachment styles. The Relationship Scales Questionnaire was used to assess attachment styles of forty-eight voluntary university students and to classify them into attachment groups (secure, preoccupied, fearful, and dismissing). Eye-tracking was recorded while participants engaged in a 3-seconds free visual exploration of stimuli presenting either a positive or a negative picture together with a neutral picture, all depicting social interactions. The task consisted in identifying whether the two pictures depicted the same emotion. Results showed that the processing of negative pictures was impermeable to attachment style, while the processing of positive pictures was significantly influenced by individual differences in insecure attachment. The groups highly avoidant regarding to attachment (dismissing and fearful) showed reduced accuracy, suggesting a higher threshold for recognizing positive emotions compared to the secure group. The groups with higher attachment anxiety (preoccupied and fearful) showed differences in automatic capture of attention, in particular an increased delay preceding the first fixation to a picture of positive emotional valence. Despite lenient statistical thresholds induced by the limited sample size of some groups (p < 0.05 uncorrected for multiple comparisons), the current findings suggest that the processing of positive emotions is affected by attachment styles. These results are discussed within a broader evolutionary framework.

The Hidden Snake in the Grass: Superior Detection of Snakes in Challenging Attentional Conditions

Snakes have provided a serious threat to primates throughout evolution. Furthermore, bites by venomous snakes still cause significant morbidity and mortality in tropical regions of the world. According to the Snake Detection Theory (SDT Isbell, 2006; 2009), the vital need to detect camouflaged snakes provided strong evolutionary pressure to develop astute perceptual capacity in animals that were potential targets for snake attacks. We performed a series of behavioral tests that assessed snake detection under conditions that may have been critical for survival. We used spiders as the control stimulus because they are also a common object of phobias and rated negatively by the general population, thus commonly lumped together with snakes as “evolutionary fear-relevant”. Across four experiments (N = 205) we demonstrate an advantage in snake detection, which was particularly obvious under visual conditions known to impede detection of a wide array of common stimuli, for example brief stimulus exposures, stimuli presentation in the visual periphery, and stimuli camouflaged in a cluttered environment. Our results demonstrate a striking independence of snake detection from ecological factors that impede the detection of other stimuli, which suggests that, consistent with the SDT, they reflect a specific biological adaptation. Nonetheless, the empirical tests we report are limited to only one aspect of this rich theory, which integrates findings across a wide array of scientific disciplines.

Providing preoperative information for children undergoing surgery: a randomized study testing different types of educational material to reduce children's preoperative worries

This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The participants were randomly assigned to one of the seven independent conditions that were combined into the following three main groups: an experimental group, which received educational materials with information about surgery and hospitalization (a board game, a video or a booklet); a comparison group, which received entertaining material with the same format type; and a control group, which did not receive any material. Children's preoperative worries and parental anxiety were evaluated after the experimental manipulation. Children who received educational materials were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups, although no statistically differences were found between the type of materials within the experimental group, and no significant effect occurred on parental state anxiety. These results do however support the hypothesis that providing preoperative materials with educational information reduce children's preoperative worries.

In the grip of fear: dissociations in attentional processing of animal fearful individuals

Using a modified attention paradigm we investigated specific attentional mechanisms in processing animal feared stimuli. In this paradigm arrays of four pictures were displayed and after its disappearance from view a probe (a letter, X or P) then followed unpredictably in the location of one of the four pictures. The results showed that discriminations of probes tended to be impeded by spider stimuli, compared to snake stimuli. This effect was potentiated by high anxiety but only for those individuals fearful of spiders, since no such effect was observed for snake fearful individuals. Moreover, the discrimination of the probes was not facilitated when presented after the feared stimuli. The implications of these findings are discussed as a function of the cognitive bias involved in specific fear.

Using an Educational Multimedia Application to Prepare Children for Outpatient Surgeries

Surgery is a highly stressful event for children and caregivers. Extensive effort has been made to improve preoperative care in order to alleviate worry about the surgical procedure itself. This study tested the impact of an educational multimedia intervention on the cognitive, emotional, and physiological responses of children undergoing surgery, as well as on parental state anxiety. Children (n = 90) were assigned to three different groups: an educational multimedia intervention (experimental group), an entertainment video game intervention (comparison group), and a control group (no intervention). Children who received the educational multimedia intervention reported lower level of worries about hospitalization, medical procedures, illness, and negative consequences than those in the control and in the comparison groups. Parental state anxiety was also lower in the both the educational and the entertainment video game interventions compared to the control group. These findings suggest that providing information to children regarding medical procedures and hospital rules and routines is important to reduce their preoperative worries, and also relevant for parental anxiety.

Exams? Why worry? Interpreting anxiety as facilitative and stress appraisals

BACKGROUND AND OBJECTIVES

The present study examined why people differ in how they appraise the same stressful situation (an approaching exam).

DESIGN

We explored whether interpreting anxiety as a facilitative emotion can affect the type of stress appraisal people make.

METHOD

One hundred and three undergraduate students took part in this study, which lasted for 10 days (leading up to an exam). The students completed a daily self-reported evaluation of anxiety, emotional exhaustion, and stress experienced.

RESULTS

The findings suggest a process by which a stressful time can be experienced as motivating rather than threatening or emotionally exhausting. For example, interpreting anxiety as facilitative moderated the relationship between anxiety and stress appraisals. When interpreting their anxiety as facilitative, individuals showed a higher tendency to make challenge stress appraisals and a lower tendency to appraising the stressor as a threat. These differences were especially visible with high levels of anxiety. Furthermore, interpreting anxiety as facilitative was negatively associated with emotional exhaustion, but positively associated with the academic performance.

CONCLUSIONS

These findings suggest an explanation why people differ in how they appraise the same stressor: how people interpret their anxiety may to a large part affect how they appraise difficult events and situations.

Will you thrive under pressure or burn out? Linking anxiety motivation and emotional exhaustion

Can individual differences in the tendency to use anxiety as a source of motivation explain emotional exhaustion? We examined the effects of using anxiety as a source of energy or as a source of information (viewed here as two forms of anxiety motivation) on emotional exhaustion. In Study 1, the use of anxiety as a source of energy predicted decreased emotional exhaustion one year later. Moreover, both forms of anxiety motivation buffered people from the detrimental effects of trait anxiety on later emotional exhaustion. In Study 2, an experiment, participants who were instructed to use anxiety as a source of energy reported lower emotional exhaustion following a stressful task, compared to those instructed to focus on the task or to simply do their best. These findings suggest that using anxiety as a source of motivation may protect people against emotional exhaustion.