Climate Anxiety: Current Evidence and Future Directions.

PURPOSE OF REVIEW: Challenging cognitive, somatic, and behavioral responses to climate change are often conceptualized as climate anxiety (CA). Due to the increased recognition of the impacts of climate change on mental health, a growing body of scientific literature is developing. The purpose of this manuscript is to review the current evidence base for CA and propose future research needs for this emerging construct. RECENT FINDINGS: Early evidence supports underlying psychological mechanisms in the development and maintenance of CA, which are similar to other anxiety-related conditions. However, the study of CA poses unique challenges to researchers. The psychological impacts that occur in the context of climate change may be adaptive depending on the imminent threat of natural disasters, forced migration, or other climate-related challenges. Due to the potentially adaptive nature of CA and limited current evidence, a coordinated research program of climate-related distress is necessary. A review of the extant literature identified current gaps in understanding the epidemiology and individual differences that promote CA. Current evidence supports the prominent role of neuroticism, intolerance of uncertainty, and rumination. The development of evidence-based models of climate-related distress may provide a more valid and comprehensive depiction of the impacts of climate change on mental health. Transdiagnostic treatment methods are likely the most appropriate intervention for climate-related distress. As models, measures, and treatments of climate-related distress are developed, it is crucial to incorporate studies of populations most at risk for climate change-related mental health effects.

Outcomes of Common Peroneal Nerve Decompression.

PURPOSE: Common peroneal nerve (CPN) neuropathy is the most common lower extremity mononeuropathy. When delayed or no recovery from CPN neuropathy is suspected, surgical CPN decompression (CPND) is considered to relieve symptoms. This study aimed to evaluate patient outcomes post-CPND performed by a single surgeon at a tertiary medical center. METHODS: Patient outcomes after CPND performed by a single surgeon were reviewed. Motor, sensation, and pain scores post-CPND were assessed in 47 of the 46 patients. Patient demographics, including age, concomitant morbidities, time from injury to surgery, and body mass index (BMI), were also analyzed for correlations with outcomes after CPND by logistic regression. RESULTS: 29/34 patients with impaired motor function improved by at least one motor grade, 19/42 with altered sensation reported restored normal sensation, and 31/37 reported improved pain after CPND. No correlation of patient demographic factors with motor or pain improvement after CPND was observed. However, a BMI greater than 29.15 and a time between injury and surgery exceeding 506 days were associated with lower odds of reporting restored sensation. CONCLUSIONS: Operative decompression of CPN neuropathy improves objective motor scores and subjective sensation and pain scores.

Honey Phytochemicals: Bioactive Agents With Therapeutic Potential for Dermatological Disorders.

Honey has been reported to have a range of biological activities including antimicrobial, immunomodulatory, and wound healing effects. Indeed, medical-grade honey is currently used in hospitals for the clinical management of wound infections. Honey is also of scientific interest for its therapeutic effects on other dermatological disorders such as atopic dermatitis, rosacea, and skin cancer. Recent studies have uncovered that honey contains a range of phytochemicals including flavonoids, dicarboxylic acids, coumarins, and phenolic acids. In this review, PubMed was used to search the scientific literature on the biological properties of honey phytochemicals in relation to dermatological disorders and to evaluate their potential as bioactive agents, drugs, or cosmeceuticals for the treatment of skin disease. The review revealed that phytochemicals found in honey have antimicrobial, anti-inflammatory, antiaging, antioxidant, anticancer, depigmenting, photoprotective, wound healing, and skin barrier enhancing properties. Although further high-quality studies are required to establish clinical efficacy, these findings suggest that honey phytochemicals may have the potential to be used as bioactive agents for the management of a range of dermatological disorders including wounds, psoriasis, atopic dermatitis, vitiligo, rosacea, and skin cancer.

Mapping the Sun's coronal magnetic field using the Zeeman effect.

Regular remote sensing of the magnetic field embedded within the million-degree solar corona is severely lacking. This reality impedes fundamental investigations of the nature of coronal heating, the generation of solar and stellar winds, and the impulsive release of energy into the solar system via flares and other eruptive phenomena. Resulting from advancements in large aperture solar coronagraphy, we report unprecedented maps of polarized spectra emitted at 1074 nm by Fe+12 atoms in the active corona. We detect clear signatures of the Zeeman effect that are produced by the coronal magnetic field along the optically thin path length of its formation. Our comparisons with global magnetohydrodynamic models highlight the valuable constraints that these measurements provide for coronal modeling efforts, which are anticipated to yield subsequent benefits for space weather research and forecasting.

Intolerance of uncertainty as a predictor of anxiety severity and trajectory during the COVID-19 pandemic.

BACKGROUND: Efforts to identify risk and resilience factors for anxiety severity and course during the COVID-19 pandemic have focused primarily on demographic rather than psychological variables. Intolerance of uncertainty (IU), a transdiagnostic risk factor for anxiety, may be a particularly relevant vulnerability factor. METHOD: N = 641 adults with pre-pandemic anxiety data reported their anxiety, IU, and other pandemic and mental health-related variables at least once and up to four times during the COVID-19 pandemic, with assessments beginning in May 2020 through March 2021. RESULTS: In preregistered analyses using latent growth models, higher IU at the first pandemic timepoint predicted more severe anxiety, but also a sharper decline in anxiety, across timepoints. This finding was robust to the addition of pre-pandemic anxiety and demographic predictors as covariates (in the full sample) as well as pre-pandemic depression severity (in participants for whom pre-pandemic depression data were available). Younger age, lower self/parent education, and self-reported history of COVID-19 illness at the first pandemic timepoint predicted more severe anxiety across timepoints with strong model fit, but did not predict anxiety trajectory. CONCLUSIONS: IU prospectively predicted more severe anxiety but a sharper decrease in anxiety over time during the pandemic, including after adjustment for covariates. IU therefore appears to have unique and specific predictive utility with respect to anxiety in the context of the COVID-19 pandemic.

Electromagnetic Enantiomer: Chiral Nanophotonic Cavities for Inducing Chemical Asymmetry.

Chiral molecules, a cornerstone of chemical sciences with applications ranging from pharmaceuticals to molecular electronics, come in mirror-image pairs called enantiomers. However, their synthesis often requires complex control of their molecular geometry. We propose a strategy called "electromagnetic enantiomers" for inducing chirality in molecules located within engineered nanocavities using light, eliminating the need for intricate molecular design. This approach works by exploiting the strong coupling between a nonchiral molecule and a chiral mode within a nanocavity. We provide evidence for this strong coupling through angular emission patterns verified by numerical simulations and with complementary evidence provided by luminescence lifetime measurements. In simpler terms, our hypothesis suggests that chiral properties can be conveyed on to a molecule with a suitable chromophore by placing it within a specially designed chiral nanocavity that is significantly larger (hundreds of nanometers) than the molecule itself. To demonstrate this concept, we showcase an application in display technology, achieving efficient emission of circularly polarized light from a nonchiral molecule. The electromagnetic enantiomer concept offers a simpler approach to chiral control, potentially opening doors for asymmetric synthesis.

Exercise and PTSD.

Evidence indicating that exercise benefits mental health symptoms across a range of mental health diagnoses spans decades of scientific literature; however, fewer studies have examined the impact of exercise on posttraumatic stress disorder (PTSD). Exercise is an accessible, cost-effective, and scalable treatment option that has the potential to improve both physiological and psychological symptoms among individuals with PTSD. The purpose of this chapter is to review empirical literature on the role of exercise in the treatment of PTSD. Researchers have demonstrated that exercise improves PTSD symptoms as both a stand-alone treatment and as an adjunct to cognitive behavioral and trauma-focused therapies. Additional research is needed to clarify mechanisms that account for the impacts of exercise on PTSD and to identify which components of exercise (e.g., type of exercise, dose, intensity, frequency) are the most beneficial.

Wristband Personal Passive Samplers and Suspect Screening Methods Highlight Gender Disparities in Chemical Exposures.

Wristband personal samplers enable human exposure assessments for a diverse range of chemical contaminants and exposure settings with a previously unattainable scale and cost-effectiveness. Paired with nontargeted analyses, wristbands can provide important exposure monitoring data to expand our understanding of the environmental exposome. Here, a custom scripted suspect screening workflow was developed in the R programming language for feature selection and chemical annotations using gas chromatography-high-resolution mass spectrometry data acquired from the analysis of wristband samples collected from five different cohorts. The workflow includes blank subtraction, internal standard normalization, prediction of chemical uses in products, and feature annotation using multiple library search metrics and metadata from PubChem, among other functionalities. The workflow was developed and validated against 104 analytes identified by targeted analytical results in previously published reports of wristbands. A true positive rate of 62 and 48% in a quality control matrix and wristband samples, respectively, was observed for our optimum set of parameters. Feature analysis identified 458 features that were significantly higher on female-worn wristbands and only 21 features that were significantly higher on male-worn wristbands across all cohorts. Tentative identifications suggest that personal care products are a primary driver of the differences observed.

Gait signature changes with walking speed are similar among able-bodied young adults despite persistent individual-specific differences.

Understanding individuals' distinct movement patterns is crucial for health, rehabilitation, and sports. Recently, we developed a machine learning-based framework to show that "gait signatures" describing the neuromechanical dynamics governing able-bodied and post-stroke gait kinematics remain individual-specific across speeds. However, we only evaluated gait signatures within a limited speed range and number of participants, using only sagittal plane (i.e., 2D) joint angles. Here we characterized changes in gait signatures across a wide range of speeds, from very slow (0.3 m/s) to exceptionally fast (above the walk-to-run transition speed) in 17 able-bodied young adults. We further assessed whether 3D kinematic and/or kinetic (ground reaction forces, joint moments, and powers) data would improve the discrimination of gait signatures. Our study showed that gait signatures remained individual-specific across walking speeds: Notably, 3D kinematic signatures achieved exceptional accuracy (99.8%, confidence interval (CI) 99.1-100%) in classifying individuals, surpassing both 2D kinematics and 3D kinetics. Moreover, participants exhibited consistent, predictable linear changes in their gait signatures across the entire speed range. These changes were associated with participants' preferred walking speeds, balance ability, cadence, and step length. These findings support gait signatures as a tool to characterize individual differences in gait and predict speed-induced changes in gait dynamics.

Age-associated contraction of tumor-specific T cells impairs antitumor immunity.

Progressive decline of the adaptive immune system with increasing age coincides with a sharp increase in cancer incidence. In this study, we set out to understand whether deficits in antitumor immunity with advanced age promote tumor progression and/or drive resistance to immunotherapy. We found that multiple syngeneic cancers grew more rapidly in aged versus young adult mice, driven by dysfunctional CD8+ T-cell responses. By systematically mapping immune cell profiles within tumors, we identified loss of tumor antigen-specific CD8+ T cells as a primary feature accelerating the growth of tumors in aged mice and driving resistance to immunotherapy. When antigen-specific T cells from young adult mice were administered to aged mice, tumor outgrowth was delayed and the aged animals became sensitive to PD-1 blockade. These studies reveal how age-associated CD8+ T-cell dysfunction may license tumorigenesis in elderly patients and have important implications for the use of aged mice as pre-clinical models of aging and cancer.

Genomic Discovery and Structure-Activity Exploration of a Novel Family of Enzyme-Activated Covalent Cyclin-Dependent Kinase Inhibitors.

Fungi have historically been the source of numerous important medicinal compounds, but full exploitation of their genetic potential for drug development has been hampered in traditional discovery paradigms. Here we describe a radically different approach, top-down drug discovery (TD3), starting with a massive digital search through a database of over 100,000 fully genomicized fungi to identify loci encoding molecules with a predetermined human target. We exemplify TD3 by the selection of cyclin-dependent kinases (CDKs) as targets and the discovery of two molecules, 1 and 2, which inhibit therapeutically important human CDKs. 1 and 2 exhibit a remarkable mechanism, forming a site-selective covalent bond to the CDK active site Lys. We explored the structure-activity relationship via semi- and total synthesis, generating an analog, 43, with improved kinase selectivity, bioavailability, and efficacy. This work highlights the power of TD3 to identify mechanistically and structurally novel molecules for the development of new medicines.

Sexual victimization among Royal Canadian Mounted Police.

OBJECTIVE: The present study was designed to provide the first in-depth, academically peer-reviewed assessment of sexual victimization among Royal Canadian Mounted Police (RCMP). METHOD: A representative sample of RCMP (n = 1,324; 76.5% men) completed the self-report survey. RESULTS: Participants reported a higher overall lifetime history of sexual assault than would be expected for the general population (p < .05). Women participants reported a higher prevalence of lifetime history of sexual assault (p < .05). Participants reported being sexually assaulted during the RCMP Cadet Training Program (CTP; n = 27), with comparable proportions of men and women. Participants reported being sexually assaulted while on duty (n = 168), with a greater proportion of women reporting being sexually assaulted than men (p < .05). Women more often reported being sexually assaulted while on duty by a superior, coworker or peer, or subordinate, whereas men more often reported being sexually assaulted by a civilian. Participants (n = 94) reported being sexually harassed during the CTP and while on duty (n = 282), with a greater proportion of women reporting being sexually harassed during the CTP and while on duty. CONCLUSIONS: RCMP cadets appear to be sexually assaulted and sexually harassed less frequently than Canadian university and military college students, whereas RCMP appear to be sexually assaulted more often while on duty than Canadian men and women in the general population while at work; however, direct comparisons are problematic because of differing frames for questions and time spans. The current results help quantify sexual victimization among RCMP, which can support ongoing and novel prevention and intervention strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stop Asking How Much Information Your Patient Wants Before Discussing Serious News.

Discussing serious news is a fundamental communication skill, and many clinicians have been taught to ask their patients how much detail they want to hear before sharing difficult information. Over the past decade, we have taught hundreds of medical students how to discuss serious news and reviewed hundreds of their recorded conversations. We've found that asking how much detail a patient wants to hear often results in confusion and is not an effective way to understand their communication preferences. Instead of asking how much detail your patient wants to hear, we propose an alternative way to tailor information to their needs when discussing serious news. By asking permission to share, presenting the news in a succinct, jargon-free headline, and providing emotional support and expert guidance at the right times, you can give the correct amount of detail while avoiding unnecessary confusion resulting in high-quality, patient centered communication every time you discuss serious news.

Prevalence of current chronic pain in Royal Canadian Mounted Police cadets.

Background: Nearly half of active duty Royal Canadian Mounted Police (RCMP) officers report experiencing current chronic pain (43%; i.e. pain lasting longer than 3 months). Most RCMP officers who report chronic pain indicate that the pain started after working as RCMP officers (91%). Baseline data on chronic pain prevalence among RCMP cadets has not been available. Aims: The current study was designed to provide cross-sectional estimates of chronic pain prevalence among RCMP cadets starting the Cadet Training Program and to assess for sociodemographic differences among participants. Methods: The RCMP Study uses a longitudinal prospective sequential experimental cohort design to create a clustered randomized trial that engages individual participants for 5.5 years. The current article provides cross-sectional associations between chronic pain prevalence and sociodemographic characteristics. Participants were RCMP cadets starting the Cadet Training Program (n = 770). Location, intensity (on a 0-10 scale and days per week experienced), and duration (number of months) of chronic pain were reported. Differences across sociodemographic characteristics were examined. Results: Few RCMP cadets reported experiencing chronic pain (10%); lower back pain was rated as the most severe in terms of intensity and duration and second most frequently reported in number of days experienced per week. Prevalence of chronic pain was lower among RCMP cadets than among RCMP officers. Conclusions: Chronic pain prevalence among active duty RCMP officers may result from or be moderated by operational duties, as well as routine aging. Future researchers could examine ways to mitigate chronic pain development during RCMP officer careers.

Contexte: Près de la moitié des agents de la Gendarmerie royale du Canada (GRC) en service actif déclarent souffrir de douleur chronique (43 %; c'est-à-dire une douleur qui dure plus de trois mois). La plupart des agents de la GRC qui déclarent souffrir de douleur chronique indiquent que la douleur a commencé après avoir travaillé comme agents de la GRC (91 %). Il n'existe pas de données de référence sur la prévalence de la douleur chronique chez les cadets de la GRC.Objectifs: La présente étude a été conçue pour fournir des estimations transversales de la prévalence de la douleur chronique chez les cadets de la GRC qui commencent le Programme de formation des cadets et évaluer les différences sociodémographiques entre les participants.Méthodes: L'étude sur la GRC utilise un devis de cohorte expérimental séquentiel prospectif longitudinal pour créer un essai randomisé en grappes impliquant des participants individuels pendant 5,5 ans. Le présent article présente des associations transversales entre la prévalence de la douleur chronique et les caractéristiques sociodémographiques. Les participants étaient des cadets de la GRC qui commençaient le Programme de formation des cadets (n = 770). Le lieu, l'intensité (sur une échelle de 0 à 10 et selon le nombre de jours par semaine où la douleur était ressentie), de même que la durée (nombre de mois) pendant laquelle la douleur chronique était ressentie, ont été déclarés.Résultats: Peu de cadets de la GRC ont déclaré souffrir de douleur chronique (10 %); la douleur lombaire a été évaluée comme la plus sévère en termes d'intensité et de durée, et la deuxième la plus fréquemment rapportée en nombre de jours par semaine. La prévalence de la douleur chronique était plus faible chez les cadets de la GRC que chez les agents de la GRC.Conclusions: La prévalence de la douleur chronique chez les agents de la GRC en service actif peut résulter des tâches opérationnelles ou être modérée par celles-ci, ainsi que par le vieillissement normal. Les futurs chercheurs pourraient examiner les moyens d'atténuer le développement de la douleur chronique au cours de la carrière des agents de la GRC.

Examination of COVID stress syndrome facets and relations to substance misuse using profile analysis via multidimensional scaling (PAMS).

The COVID-19 pandemic has contributed to significant societal challenges, including increased substance misuse. The COVID stress syndrome is a constellation of interrelated processes that occur in response to pandemics, including danger/contamination fears, fears concerning economic consequences, xenophobia, compulsive checking/reassurance-seeking, and pandemic-related traumatic stress symptoms. In the present study, using a sample of 812 adults collected during the early stages of the COVID-19 pandemic in May 2020, we examined the relations between identified profiles of the COVID Stress Scales (CSS) and behavioral and cognitive aspects of substance misuse. Using profile analysis via multidimensional scaling (PAMS), we identified two core profiles of the CSS, which explained 60 % of the variance in participant responding: 1) High compulsive checking & Low xenophobia and 2) High xenophobia & Low danger/contamination. The first profile is consistent with the COVID stress syndrome, while the second profile aligns with the COVID disregard syndrome, which is a constellation of interrelated processes distinguished by a denial or downplaying of the seriousness of the COVID-19 pandemic and lack of perceived vulnerability to disease. Both profiles demonstrated significant positive correlations with drug and alcohol misuse, respectively. However, only the High xenophobia & Low danger/contamination profile demonstrated relations with cognitive aspects of substance misuse via positive and negative correlations with positive and negative expectancies of alcohol use, respectively. These findings provide further support for the relationship between the COVID stress syndrome and substance misuse and offer insight into how unique profiles of this syndrome may impact pandemic-related mental and public health interventions.

Caregiver greeting to infants under 6 months already reflects emerging differences in those later diagnosed with autism.

As infants develop, caregivers adjust their behaviour to scaffold their infant's emerging skills, such that changes in infants' social abilities are expected to elicit changes in caregiver behaviour. We examined whether changes in the probability of infant-directed caregiving behaviour-specifically, greeting, a ubiquitous signal used by caregivers to initiate reciprocal interactions-differ between infant-caregiver dyads with an infant later diagnosed with autism and dyads with a neurotypically developing infant during infants' first 6 months. Using longitudinal data from 163 dyads, we found that caregivers in autism dyads (n = 40) used greeting less and at later infant ages than caregivers with a neurotypically developing infant (neurotypical dyads, n = 83). Caregivers in dyads with infants at elevated familial genetic likelihood for autism who did not receive an autism diagnosis (EL-non-autism dyads, n = 40) showed no differences in greeting compared with neurotypical dyads. Socioeconomic status partially mediated the difference between autism and neurotypical dyads. These findings show that autism and socioeconomic status were associated with the mutually adapted dynamics of dyadic interaction beginning in the first postnatal weeks. Importantly, differences in caregiver greeting observed in autism dyads are not interpreted as suboptimal behaviour from caregivers but rather indicate how early emerging social differences related to autism, years before overt features are present, may alter social learning opportunities elicited by the infant.

Bringing competency-based communication training to scale: A multi-institutional virtual simulation-based mastery learning curriculum for Emergency Medicine residents.

PURPOSE: Serious illness communication skills are essential for physicians, yet competency-based training is lacking. We address scalability barriers to competency-based communication skills training by assessing the feasibility of a multi-center, virtual simulation-based mastery learning (vSBML) curriculum on breaking bad news (BBN). METHODS: First-year emergency medicine residents at three academic medical centers participated in the virtual curriculum. Participants completed a pretest with a standardized patient (SP), a workshop with didactics and small group roleplay with SPs, a posttest with an SP, and additional deliberate practice sessions if needed to achieve the minimum passing standard (MPS). Participants were assessed using a previously published BBN assessment tool that included a checklist and scaled items. Authors compared pre- and posttests to evaluate the impact of the curriculum. RESULTS: Twenty-eight (90%) of 31 eligible residents completed the curriculum. Eighty-nine percent of participants did not meet the MPS at pretest. Post-intervention, there was a statistically significant improvement in checklist performance (Median= 93% vs. 53%, p < 0.001) and on all scaled items assessing quality of communication. All participants ultimately achieved the MPS. CONCLUSIONS: A multi-site vSBML curriculum brought all participants to mastery in the core communication skill of BBN and represents a feasible, scalable model to incorporate competency-based communication skills education in a widespread manner.

Outcomes of a Multisite Mentored Implementation Approach to Promoting Goals of Care Conversations.

CONTEXT: The Preference-Aligned Communication and Treatment (PACT) Project is a multisite quality improvement effort that has been shown to increase the frequency of goals of care (GOC) conversations in hospitalized patients with serious illness. OBJECTIVES: To evaluate the effect of PACT on goal-discordant care and resource utilization. METHODS: Hospitals enrolled in a multiyear mentored implementation quality improvement initiative to facilitate GOC conversations for seriously ill hospitalized patients. The primary outcome was the percentage of patients with care discordant with stated preferences, assessed by comparing documented wishes to Medicare claims data for patients who were admitted to intervention units and died over the study period. Secondary outcomes evaluated end-of-life resource utilization by comparing Medicare claims data for intervention patients with propensity score-matched controls. RESULTS: In the 9 hospitals included in the study, 1347 intervention group patients were compared to 4019 in the control group. Rates of discordance between wishes and care were generally low in the intervention group. Compared to the control group, patients in the intervention group had lower costs (-976.05 dollars, P = 0.010), were less likely to be admitted to the ICU (OR 0.9, P = 0.005), less likely to be on a ventilator or undergo CPR or cardioversion, more likely to enroll in hospice (OR 1.81, P < 0.001) and had a longer hospice stay (3.35 more days, P = 0.041). CONCLUSION: A multisite mentored implementation quality improvement intervention for seriously ill hospitalized patients resulted in care aligned with goals and decreased resource utilization at the end of life.