Assessment of Different Feature Extraction Methods for Discriminating Expressed Emotions during Music Performance towards BCMI Application.

A Brain-Computer Music Interface (BCMI) system may be designed to harness electroencephalography (EEG) signals for control over musical outputs in the context of emotionally expressive performance. To develop a real-time BCMI system, accurate and computationally efficient emotional biomarkers should first be identified. In the current study, we evaluated the ability of various features to discriminate between emotions expressed during music performance with the aim of developing a BCMI system. EEG data was recorded while subjects performed simple piano music with contrasting emotional cues and rated their success in communicating the intended emotion. Power spectra and connectivity features (Magnitude Square Coherence (MSC) and Granger Causality (GC)) were extracted from the signals. Two different approaches of feature selection were used to assess the contribution of neutral baselines in detection accuracies; 1- utilizing the baselines to normalize the features, 2- not taking them into account (non-normalized features). Finally, the Support Vector Machine (SVM) has been used to evaluate and compare the capability of various features for emotion detection. Best detection accuracies were obtained from the non-normalized MSC-based features equal to 85.57 ± 2.34, 84.93 ± 1.67, and 87.16 ± 0.55 for arousal, valence, and emotional conditions respectively, while the power-based features had the lowest accuracies. Both connectivity features show acceptable accuracy while requiring short processing time and thus are potential candidates for the development of a real-time BCMI system.

Objective multi-night sleep monitoring at home: variability of sleep parameters between nights and implications for the reliability of sleep assessment in clinical trials.

STUDY OBJECTIVES: In-laboratory polysomnography is the current gold standard for objective sleep measurements in clinical trials, but this does not capture night-to-night variability in sleep parameters. This study analyzed variability in sleep parameters recorded over multiple nights of sleep in an ecological setting using a portable sleep monitor and then estimated the minimum sample sizes required to reliably account for inter- and intra-individual variability in sleep parameters. METHODS: Participants were males who self-reported the absence of sleep disorders, and used a sleep monitoring device (Dreem Headband, Dreem, France) over multiple nights of sleep. Night-to-night variability of sleep parameters was determined over five consecutive weeknights using coefficients of variation (CV), and the minimal number of individuals and nights needed to reliably determine each sleep parameter was assessed. RESULTS: Night-to-night variability for the whole group (n = 94; 470 nights) was high (CV 0.44-0.58) for N2, N3, sleep onset and persistent sleep latencies, and wake after sleep onset (WASO), medium (CV 0.22-0.28) for N1 and N3 percentage, awakenings and REM latency, and low (CV 0.04-0.19) for sleep efficiency, N2 and REM percentages, total sleep time (TST) and micro-arousal index. Minimum sample sizes for reliable assessment of TST and WASO were 2 nights with 10 participants and 4 nights with 50 participants, respectively. CONCLUSIONS: Night-to-night variability of sleep parameters is underestimated and under-recognized. These data on variability in commonly used sleep parameters will facilitate better estimation of sample sizes and number of nights required in clinical trials based on the outcomes of interest.

Assessment of emotional states in EEG signals using multi-frequency power spectrum and functional connectivity patterns.

In this work, an attempt has been made to characterize arousal and valence emotional states using Electroencephalogram (EEG) signals and Phase lag index (PLI) based functional connectivity features. For this, EEG signals are considered from a publicly available DEAP database. Signals are decomposed into four frequency bands, namely theta (θ, 4-7 Hz), alpha (a, 8-12 Hz), beta (ß, 13-30 Hz), and gamma (γ, 30-45 Hz). Two features, namely relative PSD and PLI, are calculated from each band of signals with Welch's periodogram. Four classifiers, namely Random Forest (RF), Support Vector Machines (SVM), Linear Discriminant Analysis (LDA), and K-Nearest Neighbor (KNN), are employed to discriminate the emotional states. Results show that the proposed approach can differentiate emotional states using EEG signals. It is observed that there is strong functional connectivity in Fp1-02 and Fp2-Pz in all emotional states for different frequency bands. SVM classifier yields the highest classification performance for arousal, and RF yields the highest performance for valence in the y band. The combination of all features performs the best for the valence dimension. Thus, the proposed approach could be extended for classifying various emotional states in clinical settings. Clinical Relevance- This establishes PLI based approach for improved classification (fl = 74.77% for Arousal fl = 74.94 for valence) of emotional states.

Real-time Pilot Crew's Mental Workload and Arousal Assessment During Simulated Flights for Training Evaluation: a Case Study.

Training assessment is usually done by evaluating information derived from instructor's supervision related to the pilot's operational performance and behavior. However, this approach lacks objective measures, especially regarding the pilots' mental states while accomplishing the flight training tasks. The study therefore aimed at developing and testing a method for gathering and analyzing in real-time pilots' brain activity and skin conductance to improve the training evaluation. In this regard, Novice pilots' neurophysiological signals were acquired throughout multi-crew training sessions. The results demonstrated how the methodology proposed was able to endow real-time pilots' mental workload and arousal assessment for i) better evaluating training progress and operational behavior during the training session, and ii) for objectively comparing different training sessions.

I want it small or, rather, give me a bunch: the role of evaluative morphology on the assessment of the emotional properties of words.

ABSTRACTEvaluative markers of diminution and augmentation typically express quantity or intensity. Prior evidence suggests that they also convey emotions, although it remains unexplored as to whether this function is mediated by their role in expressing quantification/intensification. Here we investigated the effects of evaluative suffixes on the assessment of word affective properties by asking participants (N = 300) to score valence and arousal features for augmentatives, diminutives and base words with negative, positive or neutral valence. Diminutives and, to a lesser extent, augmentatives were assessed more positively than base forms in negative words and more negatively than bases in positive words. The capacity of diminution to express attenuated emotions is in line with its function in conveying quantity. By contrast, valence effects for augmentatives suggests a role in expressing pejoration and amelioration that is not mediated by quantification. With regard to arousal, negative, neutral and positive augmentatives showed higher scores than base words, which, in addition, were also rated higher than diminutives. These incremental effects suggest that suffixes which convey larger quantity are also associated with increased arousal. Thus, with the exception of valence effects in augmentatives, it seems that evaluative suffixes encode both valence and arousal through quantification.

Event rate effects on children with attention-deficit/hyperactive disorder: Test predictions from the moderate brain arousal model and the neuro-energetics theory using the diffusion decision model.

BACKGROUND: Converging evidence has found that the inhibitory control of children with attention-deficit/hyperactive disorder (ADHD) is context-dependent and particularly susceptible to the event rate. The Moderate Brain Arousal (MBA) model predicts a U-shaped curve between event rate and performance as a modulation of brain arousal. The neuroenergetics theory (NeT) proposes that a smaller event rate results in neuronal fatigue and subsequent descent performance. However, previous work applied the traditional one-dimensional index of performance, such as accuracy rate and response time, which might limit the exploration of the event rate effect on the specific underlying process. AIMS: We used a diffusion decision model (DDM) to study the influence of event rate on inhibition control in children with ADHD and verified the explanation of the MBA model and the NeT. METHODS AND PROCEDURES: The Stop Signal Task manipulated by four event rate conditions was conducted with 24 children with ADHD (mean age=8.5, males=16) and 29 typical developmental children (TDC) (mean age=9.0, males=12). DDM was applied to compare the differences in the DDM parameters across different event rates. OUTCOMES AND RESULTS: Compared with TDC, children with ADHD had a smaller drift rate, longer non-decision time, and smaller boundary separation. Although the event rate had little influence on ADHD, the drift rate of the TDC was approximately linear with an increased event rate, and the Ter had a quadratic function relationship with the event rate. CONCLUSIONS AND IMPLICATIONS: The event rate effect may influence children's performance through dual mechanisms. Neuronal energy supply could regulate information processing and brain arousal to regulate the activation of primary stimuli encoding and motor control. Insight into the multi-mechanism of ADHD cognition deficits would be helpful for clinicians in making objective diagnoses and effective targeted treatments.

Combining cardiac monitoring with actigraphy aids nocturnal arousal detection during ambulatory sleep assessment in insomnia.

STUDY OBJECTIVES: The objective assessment of insomnia has remained difficult. Multisensory devices collecting heart rate (HR) and motion are regarded as the future of ambulatory sleep monitoring. Unfortunately, reports on altered average HR or heart rate variability (HRV) during sleep in insomnia are equivocal. Here, we evaluated whether the objective quantification of insomnia improves by assessing state-related changes in cardiac measures. METHODS: We recorded electrocardiography, posture, and actigraphy in 33 people without sleep complaints and 158 patients with mild to severe insomnia over 4 d in their home environment. At the microscale, we investigated whether HR changed with proximity to gross (body) and small (wrist) movements at nighttime. At the macroscale, we calculated day-night differences in HR and HRV measures. For both timescales, we tested whether outcome measures were related to insomnia diagnosis and severity. RESULTS: At the microscale, an increase in HR was often detectable already 60 s prior to as well as following a nocturnal chest, but not wrist, movement. This increase was slightly steeper in insomnia and was associated with insomnia severity, but future EEG recordings are necessary to elucidate whether these changes occur prior to or simultaneously with PSG-indicators of wakefulness. At the macroscale, we found an attenuated cardiac response to sleep in insomnia: patients consistently showed smaller day-night differences in HR and HRV. CONCLUSIONS: Incorporating state-related changes in cardiac features in the ambulatory monitoring of sleep might provide a more sensitive biomarker of insomnia than the use of cardiac activity averages or actigraphy alone.

Heart-Focused Anxiety Among Trauma-Exposed Latinx Young Adults: Relations to General Depression, Suicidality, Anxious Arousal, and Social Anxiety.

Rates of traumatic event exposure, posttraumatic stress (PTS), and co-occurring mental health symptoms and disorders are conditionally higher among Latinx individuals compared to other racial/ethnic populations. Importantly, Latinx persons are a heterogeneous population, and certain subgroups endorse higher rates of negative mental health outcomes than others, including Latinx young adults born in the USA. Yet, there is little understanding of individual difference factors among trauma-exposed US born Latinx young adults that may be involved in mental health burden among this group. The present investigation sought to evaluate the potential explanatory relevance of heart-focused anxiety as an individual difference factor regarding some of the most common co-occurring mental health problems among trauma-exposed populations. Specifically, we tested whether heart-focused anxiety was related to increased co-occurring anxious arousal symptoms, depression, social anxiety, and suicidality among 169 (84% female, Mage=23.15 years, SD=6.07) trauma-exposed Latinx young adults. Results indicated that heart-focused anxiety was a statistically significant predictor of general depression (ΔR2 = .02, F(1, 161) = 4.25, p = .041), suicidality (ΔR2 = .10, F(1, 161) = 21.49, p < .001), anxious arousal (ΔR2 = .11, F(1, 161) = 27.31, p < .001), and social anxiety (ΔR2 = .03, F(1, 161) = 7.93, p = .005). Overall, this work offers empirical evidence that individual differences in heart-focused anxiety are related to more severe co-occurring anxiety and depressive symptomatology among a particularly at risk Latinx segment of the Latinx population (non-immigrant Latinx young adults s with previous trauma history).

The costs of anticipating and perseverating about racism: Mechanisms of the associations between racial discrimination, anxious arousal, and low positive affect.

Although numerous studies have documented an association between racial discrimination and internalizing psychopathology symptoms, there is a lack of empirical work that establishes cognitive and emotional mechanisms through which racial discrimination is associated with specific transdiagnostic mental health outcomes (i.e., anxious arousal and low positive affect) among Black Americans. OBJECTIVE: The goal of this study was to test a new etiological model of how racial discrimination is associated with anxious arousal and low positive affect. The overarching model posits that racial discrimination will be associated with anxious arousal and low positive affect through prolonged activation of race-related stress processes (i.e., anticipatory race-related fear and race-related rumination), the effects of which are conditioned on attention bias to threat. METHOD: A total of 326 Black participants (72.4% women) completed the study. RESULTS: For anxious arousal, the indirect effect of racial discrimination through anticipatory race-related fear depended on degree of attention bias, with the effect only reaching statistical significance at mean and relatively higher levels of attention bias to threat. For low positive affect, the indirect effect of racial discrimination through race-related rumination only reached a statistical significance at mean and relatively lower levels of attention bias to threat. CONCLUSIONS: Racial discrimination is indirectly associated with anxious arousal and low positive affect through the effects of anticipatory race-related fear and race-related rumination, respectively. Implications for etiology and treatment of anxious arousal and low positive affect are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Implicit Sexual Risk Assessment: A Pilot Study of a Novel Behavioral Task.

Risky sexual behaviors are a significant public health concern. Laboratory experiments are necessary to identify causal determinants of risky sexual behavior. However, experiments often rely on analogue sexual risk behavior, assessed by self-reported intentions in response to a sexual scenario. Using behavioral tasks to assess risk taking may be a valuable addition to self-reported intention outcome measures. The Balloon Analogue Risk Task (BART) is a commonly used measure of general risk-taking. However, BART's associations with sexual risk-taking have been mixed. In this pilot study, we developed a task akin to the BART, the Implicit Sexual Risk Assessment (ISRA), which incorporates sexual stimuli. We hypothesized sexual arousal would increase risk taking on ISRA relative to BART. Using a within-persons experimental design, 79 participants (52% women, mean age = 19.5 (SD = 1.42)) were randomized to condition (i.e., arousal versus neutral) and completed the BART and ISRA tasks. As expected, sexual arousal was associated with increased risk-taking (i.e., adjusted pumps) on ISRA relative to BART. However, this was unexpectedly the result of decreased pumps on BART instead of increased pumps on ISRA. Neither BART nor ISRA were significantly associated with sexual risk behavior or intentions. Null findings are qualified by the fact that sexual arousal was not significantly associated with sexual risk intentions.

Automatic detection of respiratory events during sleep from Polysomnography data using Layered Hidden Markov Model.

Objective. Sleep apnea is a serious respiratory disorder, which is associated with increased risk factors for cardiovascular disease. Many studies in recent years have been focused on automatic detection of sleep apnea from polysomnography (PSG) recordings, however, detection of subtle respiratory events named Respiratory Event Related Arousals (RERAs) that do not meet the criteria for apnea or hypopnea is still challenging. The objective of this study was to develop automatic detection of sleep apnea based on Hidden Markov Models (HMMs) which are probabilistic models with the ability to learn different dynamics of the real time-series such as clinical recordings.Approach. In this study, a hierarchy of HMMs named Layered HMM was presented to detect respiratory events from PSG recordings. The recordings of 210 PSGs from Massachusetts General Hospital's database were used for this study. To develop detection algorithms, extracted feature signals from airflow, movements over the chest and abdomen, and oxygen saturation in blood (SaO2) were chosen as observations. The respiratory disturbance index (RDI) was estimated as the number of apneas, hypopneas, and RERAs per hour of sleep.Main results. The best F1 score of the event by event detection algorithm was between 0.22 ± 0.16 and 0.70 ± 0.08 for different groups of sleep apnea severity. There was a strong correlation between the estimated and the PSG-derived RDI (R2 = 0.91,p< 0.0001). The best recall of RERA detection was achieved 0.45 ± 0.27.Significance. The results showed that the layered structure can improve the performance of the detection of respiratory events during sleep.

Cold arousal - A mechanism used by hibernating bats to reduce the energetic costs of disturbance.

During the season of hibernation, temperate bats alternate between prolonged bouts of torpor with reduced body temperature and short arousals with a return to normothermy. Hibernating bats are sensitive to non-tactile stimuli and arouse following changes in microclimatic conditions or disturbance from other bats, potential predators, or humans. Here, we used temperature data loggers to register the skin temperature of 38 Myotis myotis bats over two winters (between January and March), during which regular visits were made to the hibernaculum. Two kinds of arousal were observed, normothermic (Tsk > 25 °C) and cold (Tsk < 15 °C). Although bats responded to the presence of a researcher by arousals of both kinds, cold arousals were more frequent (63.8%). We found that mass loss was not affected by the number of disturbances, however it was in positive relationship with the mass at the beginning of the observation and differed between sex and age categories. Furthermore normothermic bats crawling among cluster-mates initiated arousal cascades, which mainly consisted of cold arousals. We failed to detect any effect of age or sex on the number of arousals initiated by normothermic individuals. Warming by only a few degrees requires less energy than a normothermic arousal and we propose it is sufficient to activate the sensory system in order to assess the relevance of external stimuli. Our results indicate that cold arousals reflect a physiological and behavioural adaptation aimed at avoiding the energetic costs of disturbance that can lead to depletion of fat reserves.

Failure to detect ward hypoxaemia and hypotension: contributions of insufficient assessment frequency and patient arousal during nursing assessments.

BACKGROUND: Postoperative hypotension and hypoxaemia are common and often unrecognised. With intermittent nursing vital signs, hypotensive or hypoxaemic episodes might be missed because they occur between scheduled measurements, or because the process of taking vital signs arouses patients and temporarily improves arterial blood pressure and ventilation. We therefore estimated the fraction of desaturation and hypotension episodes that did not overlap nursing assessments and would therefore usually be missed. We also evaluated the effect of taking vital signs on blood pressure and oxygen saturation. METHODS: We estimated the fraction of desaturated episodes (arterial oxygen saturation <90% for at least 90% of the time within 30 continuous minutes) and hypotensive episodes (MAP <70 mm Hg for 15 continuous minutes) that did not overlap nursing assessments in patients recovering from noncardiac surgery. We also evaluated changes over time before and after nursing visits. RESULTS: Among 782 patients, we identified 878 hypotensive episodes and 2893 desaturation episodes, of which 79% of the hypotensive episodes and 82% of the desaturation episodes did not occur within 10 min of a nursing assessment and would therefore usually be missed. Mean BP and oxygen saturation did not improve by clinically meaningful amounts during nursing vital sign assessments. CONCLUSIONS: Hypotensive and desaturation episodes are mostly missed because vital sign assessments on surgical wards are sparse, rather than being falsely negative because the assessment process itself increases blood pressure and oxygen saturation. Continuous vital sign monitoring will detect more disturbances, potentially giving clinicians time to intervene before critical events occur.

Heart rate variability analysis for the assessment of immersive emotional arousal using virtual reality: Comparing real and virtual scenarios.

Many affective computing studies have developed automatic emotion recognition models, mostly using emotional images, audio and videos. In recent years, virtual reality (VR) has been also used as a method to elicit emotions in laboratory environments. However, there is still a need to analyse the validity of VR in order to extrapolate the results it produces and to assess the similarities and differences in physiological responses provoked by real and virtual environments. We investigated the cardiovascular oscillations of 60 participants during a free exploration of a real museum and its virtualisation viewed through a head-mounted display. The differences between the heart rate variability features in the high and low arousal stimuli conditions were analysed through statistical hypothesis testing; and automatic arousal recognition models were developed across the real and the virtual conditions using a support vector machine algorithm with recursive feature selection. The subjects' self-assessments suggested that both museums elicited low and high arousal levels. In addition, the real museum showed differences in terms of cardiovascular responses, differences in vagal activity, while arousal recognition reached 72.92% accuracy. However, we did not find the same arousal-based autonomic nervous system change pattern during the virtual museum exploration. The results showed that, while the direct virtualisation of a real environment might be self-reported as evoking psychological arousal, it does not necessarily evoke the same cardiovascular changes as a real arousing elicitation. These contribute to the understanding of the use of VR in emotion recognition research; future research is needed to study arousal and emotion elicitation in immersive VR.

Neuroergonomic Stress Assessment with Two Different Methodologies, in a Manual Repetitive Task-Product Assembly.

Emotions are a fundamental part of mental health and human behavior. In the workplace, optimal performance of employees is necessary for productivity enhancements and its relation to the quality of a manufacturing product, therefore leading a company to advantages and competitiveness. This means that the workplace staff must remain in a neutral or a calm emotional state, for an adequate job performance. When an operation is not pleasant or the same task is carried out for a long period of time (repetitive), it can cause negative emotions such as stress, and this will have repercussions in poor work performance. The purpose of this research is, by means of an electroencephalogram (EEG), to identify the stress in the repetitive assembly of a manufacturing product. To measure brain waves, the Emotiv Epoc equipment was used and a manufacturing line was designed, divided into three workstations, where the assembly of product comprising a LEGO car was carried out within a manual repetitive approach. The appearance of stress was determined by employing two different methodologies, the prefrontal relative gamma marker (RG) and the valence, arousal, and dominance (VAD) emotional categories. The results obtained from the first methodology, corresponding to the RG marker, displayed a significant more change between the relaxation state and the product assembly carried out at 70% of the standard time (ST). A less significant change was observed between the relaxation state and the product assembly carried out at 100% ST, thus signaling the presence of stress. Additionally, the results from the VAD methodology resulted in moderate and low levels of stress, when the product assembly was carried out at 70% and 100% standard time, respectively.

Psychophysiological assessment of stress reactivity and recovery in anxiety disorders.

The present study aimed to examine changes in psychophysiological arousal from baseline to a stressor phase (reactivity) and from the stressor phase to a second resting phase (recovery) in patients with anxiety disorders. Fifty adult patients with DSM-5 anxiety disorders (panic disorder, generalized anxiety disorder, or social anxiety disorder) and 28 healthy control (HC) participants underwent psychophysiological monitoring including electrocardiogram, respiration rate, electrodermal activity, gastrocnemius electromyograph, and end-tidal CO2 for a 3-min resting phase, a 6-min mild stressor phase, and a 3-min recovery phase. Anxious patients then went on to receive naturalistic cognitive-behavioral therapy (CBT) in a specialty outpatient clinic. Results for the reactivity phase indicated that compared to HCs, patients with social anxiety disorder exhibited heightened psychophysiological reactivity while patients with panic disorder and generalized anxiety disorder exhibited attenuated reactivity. Results for physiological recovery (return to baseline after the stressor was withdrawn) were mixed, but provided some support for slower autonomic recovery in patients with generalized anxiety disorder and panic disorder compared to HCs. Participants with all anxiety disorders exhibited diminished change in high frequency heart rate variability compared to HCs. Generally, psychophysiological reactivity and recovery were not associated with CBT outcome, though exploratory analyses indicated that greater respiration rate reactivity and stronger respiration rate recovery were associated with better CBT outcomes in patients with panic disorder.

A psychoacoustic test for misophonia assessment.

Misophonia is a condition where a strong arousal response is triggered when hearing specific human generated sounds, like chewing, and/or repetitive tapping noises, like pen clicking. It is diagnosed with clinical interviews and questionnaires since no psychoacoustic tools exist to assess its presence. The present study was aimed at developing and testing a new assessment tool for misophonia. The method was inspired by an approach we have recently developed for hyperacusis. It consisted of presenting subjects (n = 253) with misophonic, pleasant, and unpleasant sounds in an online experiment. The task was to rate them on a pleasant to unpleasant visual analog scale. Subjects were labeled as misophonics (n = 78) or controls (n = 55) by using self-report questions and a misophonia questionnaire, the MisoQuest. There was a significant difference between controls and misophonics in the median global rating of misophonic sounds. On the other hand, median global rating of unpleasant, and pleasant sounds did not differ significantly. We selected a subset of the misophonic sounds to form the core discriminant sounds of misophonia (CDSMiso). A metric: the CDS score, was used to quantitatively measure misophonia, both with a global score and with subscores. The latter could specifically quantify aversion towards different sound sources/events, i.e., mouth, breathing/nose, throat, and repetitive sounds. A receiver operating characteristic analysis showed that the method accurately classified subjects with and without misophonia (accuracy = 91%). The present study suggests that the psychoacoustic test we have developed can be used to assess misophonia reliably and quickly.

International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD).

BACKGROUND: Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. AIM: To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. METHODS: A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. OUTCOMES: The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. RESULTS: The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients' symptoms and the associated bother and distress. CLINICAL IMPLICATIONS: The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. STRENGTHS AND LIMITATIONS: Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion. CONCLUSION: We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women's Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665-697.

Do trait psychological characteristics moderate sympathetic arousal to racial discrimination exposure in a natural setting?

Personality and psychological traits are known to influence how individuals react to and cope with stress, and thus, have downstream health and aging consequences. However, research considering psychological health traits as individual-level difference factors moderating the links been racism-related stress and health for racial and ethnic minorities in the United States is rare. Using intensive daily diaries and a wearable sensor that continuously recorded sympathetic nervous system arousal in a sample of racial and ethnic minority college students (80% African American, first-generation Black, or African; 20% Latinx), we linked arousal to racism-related experiences dynamically throughout the day as participants naturally went about their lives. Findings suggest that multiple traits are associated with increased arousal in real time when interpersonal discrimination is perceived, but that only anger and anxiety also predicted increased arousal during moments of rumination and reflection on race-related inequities. Vicarious discrimination exposure moments were also linked to suppressed arousal in general, but particularly for more anxious individuals. We use a stress appraisal and coping framework to elucidate the ways in which individual psychological differences may inform physiological responses to race-related stress. The biopsychosocial pathways by which cognitive appraisal and interpersonal race-related stress contribute to racial health disparities are also discussed.

Rumination and Sleep Quality Among Older Adults: Examining the Role of Social Support.

OBJECTIVES: Although the adverse link between rumination and sleep quality is well established, much of the literature neglects the role of social factors. This study examined the role of older adults' perceived social support from spouses and from family/friends in modifying the association between trait rumination and sleep quality. Existing hypotheses suggest that social support may play 3 unique roles, each tested within the current study: (H1) support may act as a protective factor that buffers negative effects of rumination on sleep quality, (H2) support may curtail rumination and, in turn, promote sleep quality, and (H3) rumination may erode support and, in turn, undermine sleep quality. METHOD: Data came from 86 partnered older adults in independent-living or retirement communities (Mage = 75.70 years). We utilized 3 waves of interview data collected annually between 2017 and 2019. The first hypothesis was tested using moderation in multilevel models; the second 2 hypotheses were evaluated with prospective associations using multilevel mediation. RESULTS: Negative effects of high-trait rumination on time-varying sleep quality were attenuated among those who reported high, stable levels of support from their spouses. Perceived family/friend support did not yield the same protective effect. There was no evidence that support preempted, or was eroded by, rumination. DISCUSSION: Perceived spousal support may act as a psychosocial resource that mitigates negative effects of trait rumination on older adults' sleep quality. Interventions aimed at mitigating maladaptive outcomes of rumination on sleep quality for older adults should consider spousal support as a key target.