An exploratory study of a hands-on naloxone training for rural clinicians and staff.

INTRODUCTION: Since the COVID-19 pandemic, an increase in fentanyl-combined drugs has led to a surge in opioid overdose deaths in the United States. Higher opioid overdose mortality rates are problematic in rural communities, and there are few prevention, treatment, and recovery resources for individuals experiencing opioid use disorder. METHOD: This exploratory project aimed to investigate a hands-on naloxone training for rural clinicians and staff. Rural clinicians and staff at two behavioral health centers were recruited to participate in a 30-min lecture and 30-min hands-on intranasal naloxone training using a low-fidelity mannequin. A pre-post opioid knowledge questionnaire, rubric based on the Substance Abuse and Mental Health Services Administration toolkit, and investigator-generated survey were used to evaluate opioid knowledge and response, demonstration of intranasal naloxone administration, and participants' perceptions of the training. Enrollment characteristics were summarized using descriptive statistics and paired t-tests were used to assess mean differences. RESULTS: Of the nine participants in the project, seven (87.5%) were female and six (75.0%) were Black. Four participants assumed a therapist role, attained a MS or MA degree, and had 5 or more years of experience working in healthcare. The total mean rubric score for all participants was 96.0 (SD = 8.8). No significant pre-post mean differences among opioid knowledge, overdose risk, and overdose response categories were found, all p > 0.05. However, post-intervention mean scores were slightly higher in all categories except overdose risk. Most participants (77.8%) responded that they felt comfortable handling an opioid situation and teaching the training to community members. Open-ended responses indicated that participants liked the demonstrations, examples used, hands-on nature of the training, and the presentation materials. CONCLUSION: A hands-on naloxone training is beneficial for training rural clinicians and staff to respond to opioid overdose. This training may be a promising solution to reduce response time between recognition of opioid symptoms and administration of the life-saving medication, naloxone. Future studies should examine the efficacy of this training in larger samples with the inclusion of rural interdisciplinary teams, trusted community leaders, and family and friends of those impacted by opioid use disorder. CLINICAL RELEVANCE: This innovative hands-on naloxone training is designed for rural clinicians and residents who are most likely to witness individuals experiencing opioid toxicity. The primary goal is to reduce response time between recognition of signs and symptoms and administration of the life-saving medication, Naloxone.

Substance use and opioid-related stigma among Black communities in the rural South.

PURPOSE: This study examined perceived substance use, opioid knowledge, and barriers to Black people accessing treatment for substance and opioid use disorder (SUD/OUD). METHODS: Thirty-nine participants completed the community survey and The Brief Opioid Overdose Knowledge questionnaire. Qualitative interviews were conducted with 18 stakeholders and 9 people with SUD/OUD. FINDINGS: Out of 39 participants, <50 % knew where to refer someone for treatment and fewer knew where to access naloxone. Majority of the stakeholders and people with SUD/OUD reported stigma as a treatment barrier. CONCLUSION: Studies related to provider anti-stigma trainings and psychoeducation for Black people living in the rural South are warranted.

The Effects of Race and Socioeconomics on the Relationship Between Gestational Diabetes Mellitus and Birth Outcomes: An Analysis of Southern US PRAMS data.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Uncontrolled GDM increases the risk of negative pregnancy outcomes for both the pregnant individual and the infant. African Americans (AAs) have higher maternal morbidity and infant mortality rates than non-Hispanic whites (NHWs). The goal of the current study was to examine racial differences in the effect of GDM on birth outcomes. The data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed with a focus on four states in the southern U.S. (Alabama, Georgia, Louisiana, and Mississippi). The results presented suggest that AAs are at lower risk of GDM than NHW individuals. Even with the lower risk of GDM, AAs are at higher risk of pre-term births. In addition, socioeconomic factors and access to prenatal care play a role in birth outcomes including moderating the effect of GDM on outcomes. A discussion of potential policy interventions that may improve pregnancy outcomes is discussed including increased use of doulas to support pregnant people.

Both activation and deactivation of functional networks support increased sentence processing costs.

The research on the neural correlates underlying the language system has gradually moved away from the traditional Broca-Wernicke framework to a network perspective in the past 15 years. Language processing is found to be supported by the co-activation of both core and peripheral brain regions. However, the dynamic co-activation patterns of these brain regions serving different language functions remain to be fully revealed. The present functional magnetic resonance imaging (fMRI) study focused on sentence processing at different syntactic complexity levels to examine how the co-activation of different brain networks will be modulated by increased processing costs. Chinese relative clauses were used to probe the two dimensions of syntactic complexity: embeddedness (left-branching vs. center-embedded) and gap-filler dependency (subject-gap vs. object-gap) using the general linear model (GLM) approach, independent component analysis (ICA) and graph theoretical analysis. In contrast to localized activation revealed by the GLM approach, ICA identified more extensive networks both positively and negatively correlated with the task. We found that the posterior default mode network was anti-correlated to the gap-filler integration costs with increased deactivation for the left-branching object relative clauses compared to subject relative clauses, suggesting the involvement of this network in leveraging the cognitive resources based on the complexity level of the language task. Concurrent activation and deactivation of networks were found to be associated with the higher costs induced by center-embedding and its interaction with gap-filler integration. The graph theoretical analysis further unveiled that center-embeddedness imposed more attentional demand on the subject relative clause, as characterized by its higher degree and strength in the ventral attention network, and higher processing costs of syntactic reanalysis on the object relative clause, as characterized by increased intermodular connections of the language network with other networks. The results suggest that network activation and deactivation profiles are modulated by different dimensions of syntactic complexity to serve the higher demand of creating a coherent semantic representation.

Embracing diversity and inclusivity in an academic setting: Insights from the Organization for Human Brain Mapping.

Scientific research aims to bring forward innovative ideas and constantly challenges existing knowledge structures and stereotypes. However, women, ethnic and cultural minorities, as well as individuals with disabilities, are systematically discriminated against or even excluded from promotions, publications, and general visibility. A more diverse workforce is more productive, and thus discrimination has a negative impact on science and the wider society, as well as on the education, careers, and well-being of individuals who are discriminated against. Moreover, the lack of diversity at scientific gatherings can lead to micro-aggressions or harassment, making such meetings unpleasant, or even unsafe environments for early career and underrepresented scientists. At the Organization for Human Brain Mapping (OHBM), we recognized the need for promoting underrepresented scientists and creating diverse role models in the field of neuroimaging. To foster this, the OHBM has created a Diversity and Inclusivity Committee (DIC). In this article, we review the composition and activities of the DIC that have promoted diversity within OHBM, in order to inspire other organizations to implement similar initiatives. Activities of the committee over the past four years have included (a) creating a code of conduct, (b) providing diversity and inclusivity education for OHBM members, (c) organizing interviews and symposia on diversity issues, and (d) organizing family-friendly activities and providing childcare grants during the OHBM annual meetings. We strongly believe that these activities have brought positive change within the wider OHBM community, improving inclusivity and fostering diversity while promoting rigorous, ground-breaking science. These positive changes could not have been so rapidly implemented without the enthusiastic support from the leadership, including OHBM Council and Program Committee, and the OHBM Special Interest Groups (SIGs), namely the Open Science, Student and Postdoc, and Brain-Art SIGs. Nevertheless, there remains ample room for improvement, in all areas, and even more so in the area of targeted attempts to increase inclusivity for women, individuals with disabilities, members of the LGBTQ+ community, racial/ethnic minorities, and individuals of lower socioeconomic status or from low and middle-income countries. Here, we present an overview of the DIC's composition, its activities, future directions and challenges. Our goal is to share our experiences with a wider audience to provide information to other organizations and institutions wishing to implement similar comprehensive diversity initiatives. We propose that scientific organizations can push the boundaries of scientific progress only by moving beyond existing power structures and by integrating principles of equity and inclusivity in their core values.

An investigation of glutamate quantification with PRESS and MEGA-PRESS.

Glutamate is an important neurotransmitter. Although many studies have measured glutamate concentration in vivo using magnetic resonance spectroscopy (MRS), researchers have not reached a consensus on the accuracy of glutamate quantification at the field strength of 3 T. Besides, there is not an optimal MRS protocol for glutamate measurement. In this work, both simulation and phantom scans indicate that glutamate can be estimated with reasonable accuracy (<10% error on average) using the standard Point-RESolved Spectroscopy (PRESS) technique with TE 30 ms; glutamine, however, is likely underestimated, which is also suggested by results from human scans using the same protocol. The phantom results show an underestimation of glutamate and glutamine for PRESS with long TE and MEGA-PRESS off-resonance spectra. Despite the underestimation, there is a high correlation between the measured values and the true values (r > 0.8). Our results suggest that the quantification of glutamate and glutamine is reliable but can be off by a scaling factor, depending on the imaging technique. The outputs from all three PRESS sequences (TE = 30, 68 and 80 ms) are also highly correlated with each other (r > 0.7) and moderately correlated (r > 0.5) with the results from the MEGA-PRESS difference spectra with moderate to good shimming (linewidth < 16 Hz).

Differential Cognitive Performance in Females and Males with Regular Cannabis Use.

OBJECTIVES: Preclinical and clinical studies suggest that males and females may be differentially affected by cannabis use. This study evaluated the interaction of cannabis use and biological sex on cognition, and the association between observed cognitive deficits and features of cannabis use. METHODS: Cognitive measures were assessed in those with regular, ongoing, cannabis use (N = 40; 22 female) and non-using peers (N = 40; 23 female). Intelligence, psychomotor speed, and verbal working memory were measured with the Wechsler Abbreviated Scale of Intelligence, Digit Symbol Test, and Digit Span and Hopkins Verbal Learning Test, respectively. Associations between cognitive measures and cannabis use features (e.g., lifetime cannabis use, age of initiation, time since last use of cannabis, recent high-concentration tetrahydrocannabinoid exposure) were also evaluated. RESULTS: No main effects of group were observed across measures. Significant interactions between group and biological sex were observed on measures of intelligence, psychomotor speed, and verbal learning, with greatest group differences observed between males with and without regular cannabis use. Psychomotor performance was negatively correlated with lifetime cannabis exposure. Female and male cannabis use groups did not differ in features of cannabis use. CONCLUSIONS: Findings suggest that biological sex influences the relationship between cannabis and cognition, with males potentially being more vulnerable to the neurocognitive deficits related to cannabis use.

Neural signatures of inhibitory control in intra-sentential code-switching: Evidence from fMRI.

In this study we examined the neural control mechanisms that are at play when habitual code-switchers read code-switches embedded in a sentence context. The goal was also to understand if and to what extent the putative control network that is engaged during the comprehension of code-switched sentences is modulated by the linguistic regularity of those switches. Towards that goal, we tested two different types of code switches (switches at the noun-phrase boundary and switches at the verb-phrase boundary) that despite being both represented in naturalistic corpora of code switching, show different distributional properties. Results show that areas involved in general cognitive control (e.g., pre-SMA, anterior cingulate cortex) are recruited when processing code-switched sentences, relative to non-code-switched sentences. Additionally, significant activation in the cerebellum when processing sentences containing code-switches at the noun-phrase boundary suggests that habitual code-switchers might engage a wider control network to adapt inhibitory control processes according to task demands. Results are discussed in the context of the current literature on neural models of bilingual language control.

Cerebellar-cortical dysconnectivity in resting-state associated with sensorimotor tasks in schizophrenia.

Abnormalities of cerebellar function have been implicated in the pathophysiology of schizophrenia. Since the cerebellum has afferent and efferent projections to diverse brain regions, abnormalities in cerebellar lobules could affect functional connectivity with multiple functional systems in the brain. Prior studies, however, have not examined the relationship of individual cerebellar lobules with motor and nonmotor resting-state functional networks. We evaluated these relationships using resting-state fMRI in 30 patients with a schizophrenia-spectrum disorder and 37 healthy comparison participants. For connectivity analyses, the cerebellum was parcellated into 18 lobular and vermal regions, and functional connectivity of each lobule to 10 major functional networks in the cerebrum was evaluated. The relationship between functional connectivity measures and behavioral performance on sensorimotor tasks (i.e., finger-tapping and postural sway) was also examined. We found cerebellar-cortical hyperconnectivity in schizophrenia, which was predominantly associated with Crus I, Crus II, lobule IX, and lobule X. Specifically, abnormal cerebellar connectivity was found to the cerebral ventral attention, motor, and auditory networks. This cerebellar-cortical connectivity in the resting-state was differentially associated with sensorimotor task-based behavioral measures in schizophrenia and healthy comparison participants-that is, dissociation with motor network and association with nonmotor network in schizophrenia. These findings suggest that functional association between individual cerebellar lobules and the ventral attentional, motor, and auditory networks is particularly affected in schizophrenia. They are also consistent with dysconnectivity models of schizophrenia suggesting cerebellar contributions to a broad range of sensorimotor and cognitive operations.

Association between Muscle Damage and Head Impacts in High School American Football.

Subconcussive head impacts (SHI), defined as impacts to the cranium that do not result in concussion symptoms, are gaining traction as a major public health concern. The contribution of physiological factors such as physical exertion and muscle damage to SHI-dependent changes in neurological measures remains unknown. A prospective longitudinal study examined the association between physiological factors and SHI kinematics in 15 high school American football players over one season. Players wore a sensor-installed mouthguard for all practices and games, recording frequency and magnitude of all head impacts. Serum samples were collected at 12 time points (pre-season, pre- and post-game for five in-season games, and post-season) and were assessed for an isoenzyme of creatine kinase (CK-MM) primarily found in skeletal muscle. Physical exertion was estimated in the form of excess post-exercise oxygen consumption (EPOC) from heart rate data captured during the five games. Mixed-effect regression models indicated that head impact kinematics were significantly and positively associated with change in CK-MM but not EPOC. There was a significant and positive association between CK-MM and EPOC. These data suggest that when examining SHI, effects of skeletal muscle damage should be considered when using outcome measures that may have an interaction with muscle damage.

Aberrant structural-functional coupling in adult cannabis users.

Cellular studies indicate that endocannabinoid type-1 retrograde signaling plays a major role in synaptic plasticity. Disruption of these processes by delta-9-tetrahydrocannabinol (THC) could produce alterations either in structural and functional brain connectivity or in their association in cannabis (CB) users. Graph theoretic structural and functional networks were generated with diffusion tensor imaging and resting-state functional imaging in 37 current CB users and 31 healthy non-users. The primary outcome measures were coupling between structural and functional connectivity, global network characteristics, association between the coupling and network properties, and measures of rich-club organization. Structural-functional (SC-FC) coupling was globally preserved showing a positive association in current CB users. However, the users had disrupted associations between SC-FC coupling and network topological characteristics, most perturbed for shorter connections implying region-specific disruption by CB use. Rich-club analysis revealed impaired SC-FC coupling in the hippocampus and caudate of users. This study provides evidence of the abnormal SC-FC association in CB users. The effect was predominant in shorter connections of the brain network, suggesting that the impact of CB use or predispositional factors may be most apparent in local interconnections. Notably, the hippocampus and caudate specifically showed aberrant structural and functional coupling. These structures have high CB1 receptor density and may also be associated with changes in learning and habit formation that occur with chronic cannabis use.

Alterations in White Matter Microstructure and Connectivity in Young Adults with Alcohol Use Disorder.

BACKGROUND: Magnetic resonance imaging (MRI) studies have shown differences in volume and structure in the brains of individuals with alcohol use disorder (AUD). Most research has focused on neuropathological effects of alcohol that appear after years of chronic alcohol misuse. However, few studies have investigated white matter (WM) microstructure and diffusion MRI-based (DWI) connectivity during early stages of AUD. Therefore, the goal of this work was to investigate WM integrity and structural connectivity in emerging adulthood AUD subjects using both conventional DWI metrics and a novel connectomics approach. METHODS: Twenty-two AUD and 18 controls (CON) underwent anatomic and diffusion MRI. Outcome measures were scalar diffusion metrics and structural network connectomes. Tract-Based Spatial Statistics was used to investigate group differences in diffusion measures. Structural connectomes were used as input into a community structure procedure to obtain a coclassification index matrix (an indicator of community association strength) for each subject. Differences in coclassification and structural connectivity (indexed by streamline density) were assessed via the Network Based Statistics Toolbox. RESULTS: AUD had higher fractional anisotropy (FA) values throughout the major WM tracts, but also had lower FA values in WM tracts in the cerebellum and right insula (pTFCE  < 0.05). Mean diffusivity was generally lower in the AUD group (pTFCE  < 0.05). AUD had lower coclassification of nodes between ventral attention and default mode networks and higher coclassification between nodes of visual, default mode, and somatomotor networks. Additionally, AUD had higher fiber density between an adjacent pair of nodes within the default mode network. CONCLUSIONS: Our results indicate that emerging adulthood AUD subjects may have differential patterns of FA and distinct differences in structural connectomes compared with CON. These data suggest that such alterations in microstructure and structural connectivity may uniquely characterize early stages of AUD and/or a predisposition for development of AUD.

The impact of inverted text on visual word processing: An fMRI study.

Visual word recognition has been studied for decades. One question that has received limited attention is how different text presentation orientations disrupt word recognition. By examining how word recognition processes may be disrupted by different text orientations it is hoped that new insights can be gained concerning the process. Here, we examined the impact of rotating and inverting text on the neural network responsible for visual word recognition focusing primarily on a region of the occipto-temporal cortex referred to as the visual word form area (VWFA). A lexical decision task was employed in which words and pseudowords were presented in one of three orientations (upright, rotated or inverted). The results demonstrate that inversion caused the greatest disruption of visual word recognition processes. Both rotated and inverted text elicited increased activation in spatial attention regions within the right parietal cortex. However, inverted text recruited phonological and articulatory processing regions within the left inferior frontal and left inferior parietal cortices. Finally, the VWFA was found to not behave similarly to the fusiform face area in that unusual text orientations resulted in increased activation and not decreased activation. It is hypothesized here that the VWFA activation is modulated by feedback from linguistic processes.

Effects of Alcohol Cues on MRS Glutamate Levels in the Anterior Cingulate.

Growing evidence suggests that glutamate neurotransmission plays a critical role in alcohol addiction. Cue-induced change of glutamate has been observed in animal studies but never been investigated in humans. This work investigates cue-induced change in forebrain glutamate in individuals with alcohol use disorder (AUD). A total of 35 subjects (17 individuals with AUD and 18 healthy controls) participated in this study. The glutamate concentration was measured with single-voxel 1H-MR spectroscopy at the dorsal anterior cingulate. Two MRS sessions were performed in succession, the first to establish basal glutamate levels and the second to measure the change in response to alcohol cues. The changes in glutamate were quantified for both AUD subjects and controls. A mixed model ANOVA and t-tests were performed for statistical analysis. ANOVA revealed a main effect of cue-induced decrease of glutamate level in the anterior cingulate cortex (ACC). A significant interaction revealed that only AUD subjects showed significant decrease of glutamate in the ACC. There were no significant group differences in the level of basal glutamate. However, a negative correlation was found between the basal glutamate level and the number of drinking days in the past 2 weeks for the AUD subjects. Collectively, our results indicate that glutamate in key areas of the forebrain reward circuit is modulated by alcohol cues in early alcohol dependence.

Spoken Language Activation Alters Subsequent Sign Language Activation in L2 Learners of American Sign Language.

A large body of literature has characterized unimodal monolingual and bilingual lexicons and how neighborhood density affects lexical access; however there have been relatively fewer studies that generalize these findings to bimodal (M2) second language (L2) learners of sign languages. The goal of the current study was to investigate parallel language activation in M2L2 learners of sign language and to characterize the influence of spoken language and sign language neighborhood density on the activation of ASL signs. A priming paradigm was used in which the neighbors of the sign target were activated with a spoken English word and compared the activation of the targets in sparse and dense neighborhoods. Neighborhood density effects in auditory primed lexical decision task were then compared to previous reports of native deaf signers who were only processing sign language. Results indicated reversed neighborhood density effects in M2L2 learners relative to those in deaf signers such that there were inhibitory effects of handshape density and facilitatory effects of location density. Additionally, increased inhibition for signs in dense handshape neighborhoods was greater for high proficiency L2 learners. These findings support recent models of the hearing bimodal bilingual lexicon, which posit lateral links between spoken language and sign language lexical representations.

Operationalization of Sign Language Phonological Similarity and its Effects on Lexical Access.

Cognitive mechanisms for sign language lexical access are fairly unknown. This study investigated whether phonological similarity facilitates lexical retrieval in sign languages using measures from a new lexical database for American Sign Language. Additionally, it aimed to determine which similarity metric best fits the present data in order to inform theories of how phonological similarity is constructed within the lexicon and to aid in the operationalization of phonological similarity in sign language. Sign repetition latencies and accuracy were obtained when native signers were asked to reproduce a sign displayed on a computer screen. Results indicated that, as predicted, phonological similarity facilitated repetition latencies and accuracy as long as there were no strict constraints on the type of sublexical features that overlapped. The data converged to suggest that one similarity measure, MaxD, defined as the overlap of any 4 sublexical features, likely best represents mechanisms of phonological similarity in the mental lexicon. Together, these data suggest that lexical access in sign language is facilitated by phonologically similar lexical representations in memory and the optimal operationalization is defined as liberal constraints on overlap of 4 out of 5 sublexical features-similar to the majority of extant definitions in the literature.

Differences in cognitive ability and apparent sex differences in corpus callosum size.

Gender differences in brain structure and function have long been an interest to neuroscientists. One region where these differences have been reported is in the band of white matter that connects the two cerebral hemisphere, the corpus callosum. The current study explores the possibility that differences in cognitive ability contribute to the observed gender effects. The focus here is on visuo-spatial processing as measured by mental rotation which has also been found to have significant gender differences. The results reported show that two segments of the corpus callosum revealed gender differences, the rostrum and the anterior midbody. Both segments connect cortical regions that have been implicated in mental rotation. Additionally, the gender effect found in the rostrum appears to be due to visuo-spatial processing while the anterior midbody appears to be affected by both visuo-spatial processing and gender. These results suggest that because neural structure and cognition are intimately intertwined, cognition should be accounted for when making group comparisons of neural structure.

Does finger sense predict addition performance?

The impact of fingers on numerical and mathematical cognition has received a great deal of attention recently. However, the precise role that fingers play in numerical cognition is unknown. The current study explores the relationship between finger sense, arithmetic and general cognitive ability. Seventy-six children between the ages of 5 and 12 participated in the study. The results of stepwise multiple regression analyses demonstrated that while general cognitive ability including language processing was a predictor of addition performance, finger sense was not. The impact of age on the relationship between finger sense, and addition was further examined. The participants were separated into two groups based on age. The results showed that finger gnosia score impacted addition performance in the older group but not the younger group. These results appear to support the hypothesis that fingers provide a scaffold for calculation and that if that scaffold is not properly built, it has continued differential consequences to mathematical cognition.

Anatomically ordered tapping interferes more with one-digit addition than two-digit addition: a dual-task fMRI study.

Fingers are used as canonical representations for numbers across cultures. In previous imaging studies, it was shown that arithmetic processing activates neural resources that are known to participate in finger movements. Additionally, in one dual-task study, it was shown that anatomically ordered finger tapping disrupts addition and subtraction more than multiplication, possibly due to a long-lasting effect of early finger counting experiences on the neural correlates and organization of addition and subtraction processes. How arithmetic task difficulty and tapping complexity affect the concurrent performance is still unclear. If early finger counting experiences have bearing on the neural correlates of arithmetic in adults, then one would expect anatomically and non-anatomically ordered tapping to have different interference effects, given that finger counting is usually anatomically ordered. To unravel these issues, we studied how (1) arithmetic task difficulty and (2) the complexity of the finger tapping sequence (anatomical vs. non-anatomical ordering) affect concurrent performance and use of key neural circuits using a mixed block/event-related dual-task fMRI design with adult participants. The results suggest that complexity of the tapping sequence modulates interference on addition, and that one-digit addition (fact retrieval), compared to two-digit addition (calculation), is more affected from anatomically ordered tapping. The region-of-interest analysis showed higher left angular gyrus BOLD response for one-digit compared to two-digit addition, and in no-tapping conditions than dual tapping conditions. The results support a specific association between addition fact retrieval and anatomically ordered finger movements in adults, possibly due to finger counting strategies that deploy anatomically ordered finger movements early in the development.

Impacts of Visual Sonority and Handshape Markedness on Second Language Learning of American Sign Language.

The roles of visual sonority and handshape markedness in sign language acquisition and production were investigated. In Experiment 1, learners were taught sign-nonobject correspondences that varied in sign movement sonority and handshape markedness. Results from a sign-picture matching task revealed that high sonority signs were more accurately matched, especially when the sign contained a marked handshape. In Experiment 2, learners produced these familiar signs in addition to novel signs, which differed based on sonority and markedness. Results from a key-release reaction time reproduction task showed that learners tended to produce high sonority signs much more quickly than low sonority signs, especially when the sign contained an unmarked handshape. This effect was only present in familiar signs. Sign production accuracy rates revealed that high sonority signs were more accurate than low sonority signs. Similarly, signs with unmarked handshapes were produced more accurately than those with marked handshapes. Together, results from Experiments 1 and 2 suggested that signs that contain high sonority movements are more easily processed, both perceptually and productively, and handshape markedness plays a differential role in perception and production.