The Emotional and Behavioral Impact of Delivering Bad News to Virtual versus Real Standardized Patients: A Pilot Study.

Phenomenon: Virtual standardized patients (vSPs) are becoming increasingly common in medical education, though one limitation of vSPs is the artificiality of computer-based simulators. Past research on the use of vSPs has not clearly established whether learners have different emotional responses to real SPs (rSPs) compared with vSPs; however, understanding learners' emotional responses to vSPs is important in providing realistic learning experiences and establishing the validity of this teaching and assessment tool. This study compared the emotional experiences of individuals who interacted with rSPs and vSPs. Approach: Sixty medical students at a medical school in the southeastern United States participated in the study. Participants were randomly assigned to deliver bad news to an rSP or vSP. The vSP for this study used a hybrid intelligence model that allowed a person to "inhabit" the vSP. Salivary cortisol and a self-report measure of mood-the Profile of Mood States, Second Edition (POMS 2)-were gathered before and after delivering the bad news. The SP and 2 independent evaluators rated the behavioral performance of each participant in real and virtual conditions. Participants also rated the performance of the SP. Findings: Participants in both conditions reported increased negative emotionality on the POMS 2 following the SP interaction. There were no significant between-group differences on the POMS 2 or salivary cortisol concentration following the SP interaction. Ratings by the SP and independent evaluators indicated that participants performed similarly on most interpersonal dimensions, except tone of voice. Participants perceived the vSP as less realistic than the rSP. Insights: These results suggest that medical students may have similar emotional and behavioral responses when delivering bad news to a vSP when compared to an rSP. These findings provide support for the continued use of vSPs in training learners to deliver bad news and other communication-based skills and to assess their performance on these tasks.

Alcohol-Related Blackouts, Negative Alcohol-Related Consequences, and Motivations for Drinking Reported by Newly Matriculating Transgender College Students.

BACKGROUND: Many transgender college students struggle with identity formation and other emotional, social, and developmental challenges associated with emerging adulthood. A potential maladaptive coping strategy employed by such students is heavy drinking. Prior literature has suggested greater consumption and negative alcohol-related consequences (ARCs) in transgender students compared with their cisgender peers, but little is known about their differing experiences with alcohol-related blackouts (ARBs). We examined the level of alcohol consumption, the frequency of ARBs and other ARCs, and motivations for drinking reported by the largest sample of transgender college students to date. METHODS: A Web survey from an alcohol-prevention program, AlcoholEdu for College™, assessed student demographics and drinking-related behaviors, experiences, and motivations of newly matriculating first-year college students. A self-reported drinking calendar was used to examine each of the following measures over the previous 14 days: number of drinking days, total number of drinks, and maximum number of drinks on any single day. A 7-point Likert scale was used to measure ARCs, ARBs, and drinking motivations. Transgender students of both sexes were compared with their cisgender peers. RESULTS: A total of 989 of 422,906 students (0.2%) identified as transgender. Over a 14-day period, transgender compared with cisgender students were more likely to consume alcohol over more days, more total drinks, and a greater number of maximum drinks on a single day. Transgender students (36%) were more likely to report an ARB than cisgender students (25%) as well as more negative academic, confrontation-related, social, and sexual ARCs. Transgender respondents more often cited stress reduction, social anxiety, self-esteem issues, and the inherent properties of alcohol as motivations for drinking. For nearly all measures, higher values were yielded by male-to-female than female-to-male transgender students. CONCLUSIONS: Transgender compared with cisgender first-year students engage in higher-risk drinking patterns and experience more ARBs and other negative ARCs. Broad institutional efforts are required to address the unique circumstances of transgender men and women and to reduce negative ARCs in college students, regardless of their sex or gender identity.

Effects of incapacitant spray deployed in the restraint and arrest of detainees in the Metropolitan Police Service area, London, UK: a prospective study.

PURPOSE: In the United Kingdom (UK) police restraint and control of detainees is undertaken by assorted means. Two types of incapacitant spray (IS) are approved by the UK Home Office for use: CS (o-chlorobenzylidine malononitrile, dissolved in an organic solvent--methyl iso-butyl ketone and pelargonic acid vanillyamide (PAVA). The aim of this study was to document the effects of incapacitant sprays, by symptom assessment and medical examination, within a few hours of deployment. METHODS: A detailed proforma was produced to explore the nature of the arrest, the nature of exposure to the incapacitant spray, the type of incapacitant spray, the symptoms experienced and the medical findings. RESULTS: 99 proformas were completed. 74 % were completed by detainees and 26 % were completed by police officers. 88 % were exposed to CS spray, the remainder to PAVA spray. The mean time of assessment after exposure was 2.8 ± 2.33 h (mean ± SD). The most frequent sites of IS contact were the face and scalp (n = 78), and exposure to the left and right eyes (n = 32). The most common symptoms were: painful eyes (n = 68); red eyes (n = 58); runny nose (n = 59); lacrimation (n = 55); nasal discomfort (n = 52); skin irritation (n = 49); and skin burning (n = 45). The most common medical findings were: conjunctival erythema (n = 34); skin erythema (n = 21); and rhinorrhea (n = 20). CONCLUSIONS: Symptoms and signs of exposure to IS lasted longer than was expected (a mean of 2.8 h). Approximately 30 % of those exposed had ocular effects and 20 % had skin effects. The findings of this study will enable the guidelines on the expected effects and duration of symptoms resulting from exposure to incapacitant sprays to be reviewed and suggestions for their management to be refined.

Corrigendum: Uncovering Disease Mechanisms in a Novel Mouse Model Expressing Humanized APOEε4 and Trem2*R47H.

[This corrects the article DOI: 10.3389/fnagi.2021.735524.].

Uncovering Disease Mechanisms in a Novel Mouse Model Expressing Humanized APOEε4 and Trem2*R47H.

Late-onset Alzheimer's disease (AD; LOAD) is the most common human neurodegenerative disease, however, the availability and efficacy of disease-modifying interventions is severely lacking. Despite exceptional efforts to understand disease progression via legacy amyloidogenic transgene mouse models, focus on disease translation with innovative mouse strains that better model the complexity of human AD is required to accelerate the development of future treatment modalities. LOAD within the human population is a polygenic and environmentally influenced disease with many risk factors acting in concert to produce disease processes parallel to those often muted by the early and aggressive aggregate formation in popular mouse strains. In addition to extracellular deposits of amyloid plaques and inclusions of the microtubule-associated protein tau, AD is also defined by synaptic/neuronal loss, vascular deficits, and neuroinflammation. These underlying processes need to be better defined, how the disease progresses with age, and compared to human-relevant outcomes. To create more translatable mouse models, MODEL-AD (Model Organism Development and Evaluation for Late-onset AD) groups are identifying and integrating disease-relevant, humanized gene sequences from public databases beginning with APOEε4 and Trem2*R47H, two of the most powerful risk factors present in human LOAD populations. Mice expressing endogenous, humanized APOEε4 and Trem2*R47H gene sequences were extensively aged and assayed using a multi-disciplined phenotyping approach associated with and relative to human AD pathology. Robust analytical pipelines measured behavioral, transcriptomic, metabolic, and neuropathological phenotypes in cross-sectional cohorts for progression of disease hallmarks at all life stages. In vivo PET/MRI neuroimaging revealed regional alterations in glycolytic metabolism and vascular perfusion. Transcriptional profiling by RNA-Seq of brain hemispheres identified sex and age as the main sources of variation between genotypes including age-specific enrichment of AD-related processes. Similarly, age was the strongest determinant of behavioral change. In the absence of mouse amyloid plaque formation, many of the hallmarks of AD were not observed in this strain. However, as a sensitized baseline model with many additional alleles and environmental modifications already appended, the dataset from this initial MODEL-AD strain serves an important role in establishing the individual effects and interaction between two strong genetic risk factors for LOAD in a mouse host.

Comprehensive Evaluation of the 5XFAD Mouse Model for Preclinical Testing Applications: A MODEL-AD Study.

The ability to investigate therapeutic interventions in animal models of neurodegenerative diseases depends on extensive characterization of the model(s) being used. There are numerous models that have been generated to study Alzheimer's disease (AD) and the underlying pathogenesis of the disease. While transgenic models have been instrumental in understanding AD mechanisms and risk factors, they are limited in the degree of characteristics displayed in comparison with AD in humans, and the full spectrum of AD effects has yet to be recapitulated in a single mouse model. The Model Organism Development and Evaluation for Late-Onset Alzheimer's Disease (MODEL-AD) consortium was assembled by the National Institute on Aging (NIA) to develop more robust animal models of AD with increased relevance to human disease, standardize the characterization of AD mouse models, improve preclinical testing in animals, and establish clinically relevant AD biomarkers, among other aims toward enhancing the translational value of AD models in clinical drug design and treatment development. Here we have conducted a detailed characterization of the 5XFAD mouse, including transcriptomics, electroencephalogram, in vivo imaging, biochemical characterization, and behavioral assessments. The data from this study is publicly available through the AD Knowledge Portal.

Anxiety Symptoms and Disorders in College Students With ADHD.

Objective: This study examined anxiety symptoms and disorders in college students with ADHD. Method: Forty-six college students with ADHD and a matched group of students without ADHD participated. Participants completed self-report measures of anxiety symptoms and associated features, including worry, maladaptive beliefs about worry, panic symptoms, social anxiety, obsessive-compulsive symptoms, and self-efficacy. Participants also completed a diagnostic interview to assess lifetime and current anxiety disorders. Results: Participants with ADHD endorsed more maladaptive beliefs about worry, more obsessive-compulsive symptoms, and poorer self-efficacy compared with comparison participants. There were no group differences in rates of current anxiety disorders. Participants with ADHD were over 2 times more likely than comparison participants to endorse this lifetime history. Conclusion: College students with ADHD are more likely to have a lifetime history of an anxiety disorder and are at greater risk for some anxiety symptoms and associated features.

Cognitive-Behavioral Therapy for College Students With ADHD: Temporal Stability of Improvements in Functioning Following Active Treatment.

Objective: This study examined the extent to which college students with ADHD continued to benefit from a cognitive-behavioral therapy (CBT) program beyond the active phase of treatment. Method: In successive cohorts over a 4-year period, a total of 88 college students with well-defined ADHD received CBT in an open clinical trial format that included active treatment and maintenance phases delivered across two consecutive semesters. Results: Immediately following active treatment, participants displayed statistically significant reductions in ADHD symptoms, improvements in executive functioning, and declines in anxiety and depression symptoms. Although grade point average did not improve significantly, there were statistically significant increases in the number of credit hours that participants attempted and earned across active treatment. Improvements in symptom severity, executive functioning, and educational functioning remained stable 5 to 7 months after active treatment concluded. Conclusion: Findings from this study support the use of CBT interventions for college students with ADHD.

Determination of in situ polychlorinated biphenyl elimination rate coefficients in the freshwater mussel biomonitor Elliptio complanata deployed in the Huron-Erie corridor, southeast Michigan, USA, and southwest Ontario, Canada.

Quantitative mussel biomonitoring studies often use laboratory-measured whole-body elimination rate coefficients (k(tot) in conjunction with concentration data from field-deployed mussels to estimate bioavailable steady-state contaminant concentrations (C(m(ss)) in aquatic systems. However, the validity of applying laboratory k(tot) values to field-deployed mussels has not been verified. The present study quantified in situ k(tot) values by the common mussel biomonitor species Elliptio complanata for a group of performance reference compound polychlorinated biphenyl (PCB) congeners (International Union of Pure and Applied Chemistry 23, 61, 109, and 173) at 11 sites along the Lake Huron-Lake Erie corridor (southeast MI, USA, and southwest ON, Canada). Predictive site-specific k(tot) versus log K(ow) relationships were derived to estimate in situ k(tot) values for the bioaccumulated environmental PCB congeners, and the resultant steady-state concentration estimates were compared against values estimated using laboratory-derived k(tot) values. In situ k(tot) values were almost always faster (1.3-10-fold) than rate coefficients determined by laboratory studies, with a mean difference +/- standard error of 3.89 +/- 0.28-fold. Consequently, control adjusted steady-state concentrations of sum PCBs in the mussels were overestimated by factors ranging from 1.30 to 3.45 across sites when using laboratory-derived k(tot) values in place of in situ k(tot) values and a field deployment period of 90 d. This error was shown to increase with increasing congener hydrophobicity, as represented by their log K(ow) values, and when shorter field deployment times are performed. To more accurately predict the steady-state concentrations of environmentally accumulated PCBs in mussels, it is recommended that future quantitative biomonitoring studies employ the reference compound approach for measuring site-specific in situ k(tot) values.

Elimination of 10 polybrominated diphenyl ether (PBDE) congeners and selected polychlorinated biphenyls (PCBs) from the freshwater mussel, Elliptio complanata.

Mussel biomonitors are widely used as screening tools for polybrominated diphenyl ethers (PBDEs) in marine and aquatic environments. This study determined elimination rate coefficients (k(tot)) for eight PBDE and five PCB congeners in the freshwater mussel, Elliptio complanata, over a 120d depuration period. Elimination of BDE 15, 28, 47, 75 and 100 was similar to PCBs of equivalent hydrophobicity and negatively related to chemical K(OW). Rapid elimination of BDE 190 and an inferred rapid elimination of BDE 183 indicate mussels are capable of biotransformation of certain highly brominated PBDEs. Time to 90% steady state ranged from 48 to 66d for di- and tribromoDE congeners and from 91 to >250d for tetra- to hexabromoDE congeners. Given the long time periods required for steady state, mussel accumulated PBDE residues should be interpreted in the context of calibrated bioaccumulation models.

Therapist-Reported Features of Exposure Tasks That Predict Differential Treatment Outcomes for Youth With Anxiety.

OBJECTIVE: Exposure tasks are recognized widely as a key component of cognitive-behavioral therapy (CBT) for child and adolescent anxiety. However, little research has examined specific exposure characteristics that predict outcomes for youth with anxiety and that may guide its application in therapy. METHOD: This study draws on a sample of 279 children and adolescents (48.4% male; 79.6% white) with a principal anxiety disorder who received 14 sessions of CBT, either alone or in combination with medication, through the Child/adolescent Anxiety Multimodal treatment Study (CAMS). The present study examines therapist-reported quantity, difficulty level, compliance, and mastery of exposure tasks as they related to CBT response (i.e., Clinical Global Impressions-Improvement ratings). Secondary treatment outcomes included reduction in anxiety symptom severity on the Pediatric Anxiety Rating Scale, global impairment measured via the Children's Global Assessment Scale, and parent-report of anxiety-specific functional impairment on the Child Anxiety Impairment Scale. RESULTS: Regression analyses indicated a dose-response relationship between therapist-reported quantity of exposure and independent evaluations of treatment outcome, with more time devoted to exposure linked to better outcomes. Similarly, greater time spent on more difficult (rather than mild or moderate) exposure tasks predicted better outcomes, as did therapist ratings of child compliance and mastery. CONCLUSION: The present findings highlight the importance of challenging children and adolescents with difficult exposure tasks and of collaborating to ensure compliance and mastery.

Ochratoxin A Concentrations in a Variety of Grain-Based and Non-Grain-Based Foods on the Canadian Retail Market from 2009 to 2014.

The extent of ochratoxin A (OTA) contamination of domestically produced foods sold across Canada was determined from 2009 to 2014 with sampling and testing occurring each fiscal year. Cereal-based, fruit-based, and soy-based food samples (n = 6,857) were analyzed. Almost half of the samples (3,200; 47%) did not contain detectable concentrations of OTA. The remaining 3,657 samples contained OTA at 0.040 to 631 ng/g. Wheat, oats, milled products of other grains (such as rye and buckwheat), and to a lesser extent corn products and their derived foods were the most significant potential sources of OTA exposure for the Canadian population. Wine, grape juice, soy products, beer, dairy-based infant formula, and licorice candy were not significant contributors to OTA consumption. Spices had the highest OTA concentrations; but because so little is ingested, these foods are not considered to be a significant source of OTA. In contrast, infant formulas and cereals can be important dietary sources of OTA. Infant cereals containing oats and infant formulas containing soy had detectable concentrations of OTA, some of which exceeded the proposed Canadian guidelines. The prevalence and concentrations of OTA in major crops (wheat, corn, and oats) varied widely across years. Because these foods were purchased at retail stores, no information was available on the OTA concentrations in the raw materials, the storage conditions before purchase of the samples, or the origin of the ingredients (may include blends of raw materials from different years and/or different geographical regions of Canada); therefore, impact of these factors could not be assessed. Overall, 2.3% of the samples exceeded the proposed Canadian OTA regulatory limits and 2.7% exceeded the current European Union (EU) OTA regulatory limits. These results are consistent with a Health Canada exposure assessment published in 2010, despite the inclusion of a wider range of products and confirm the safety of foods widely available across Canada.

Spatial and temporal variability of PCBs in Detroit River water assessed using a long term biomonitoring program.

An assessment of polychlorinated biphenyls (PCBs) in water of the Detroit River, North America, was performed using mussel biomonitoring data generated between 1996 and 2010. The study included a temporal monitoring program at six locations and an enhanced spatial survey performed during 2002. Mussels were transplanted at biomonitoring stations and collected after 21-226 d. A toxicokinetic model was used to perform steady state and control corrections followed by an equilibrium partitioning model to estimate bioavailable water concentrations of PCBs. Bioavailable water concentrations of PCBs were similar in magnitude and trends to dissolved water concentrations reported in previous studies using direct sampling approaches. PCB concentrations exhibited complex temporal patterns at the six biomonitoring stations with multi-year declines in PCB trajectories between 1996 and 2002 and less consistent trends occurring across stations in later years. Spatial patterns of PCBs during 2002 revealed significantly higher water contamination on the US side of the river (seasonal average mean ± standard error (SE) sum PCB concentration of 0.63 ± 0.11 ng L(-1)) compared to the Canadian side (mean ± SE sum PCB concentration of 0.09 ± 0.01 ng L(-1)). Spatial/temporal variability of bioavailable PCB concentrations was greatest between countries, followed by moderate variation across years and by river reach (upstream, midstream and downstream sections within a country) and lowest when comparing intra-seasonal variation.

Determination of laboratory and field elimination rates of polychlorinated biphenyls (Pcbs) in the freshwater mussel, Elliptio complanata.

Chemical elimination rate constants (k2) were determined for 41 polychlorinated biphenyl (PCB) congeners in dosed freshwater mussels, Elliptio complanta, following a 150-day laboratory depuration period. Congener-specific elimination rates were inversely dependent on the n-octanol/water partition coefficient (K(ow)) of the chemical according to the regression equation: logk2 = (-0.59 +/- 0.05) logK(ow) + (2.05 +/- 0.28) (R2 = 0.80, p < 0.001). PCB elimination rate constants in E. complanta were lower than reported for zebra mussels and green-lipped mussels but similar in magnitude and K(ow) dependence to data reported for American oysters. In order to validate the laboratory-derived PCB elimination rate constants, mussels dosed with [13C]PCB153 were allowed to depurate at one of the biomonitoring stations utilized in the Detroit River Biomonitoring Program and sampled at the same time intervals as laboratory animals. The field elimination rate constant for [13C]PCB153 was significantly greater than, but within a factor of 3 of, the laboratory elimination rate constant determined for unlabeled PCB153. This similarity in estimates of k2 for labeled and unlabeled PCB153 indicates that there is relatively little error introduced by using laboratory PCB elimination rate constants to estimate PCB153 toxicokinetics in mussels deployed at this field station. Elimination rate constants determined for PCBs in this species were lower and exhibited a stronger K(ow) dependence than elimination rate constants reported for selected PAHs. This suggests that E. complanata may possess some capability for PAH biotransformation.