Clinical Experience of Intrafractional Motion Monitoring of Patients Under Head and Neck Radiation Therapy Using ExacTrac Dynamic System.

Purpose: The combination of surface-guided radiation therapy (SGRT) and image-guided radiation therapy (IGRT) can provide complementary information of patient positioning throughout treatments. The ExacTrac Dynamic (EXTD) system is a combined SGRT and IGRT system that can provide real-time motion detection via optical surface and thermal tracking during treatment delivery, with stereoscopic x-ray for positional verification. The purpose of this study was to examine the performance of EXTD for intrafractional motion monitoring using real clinical cases. Methods and Materials: Treatment log files exported from EXTD for 40 patients with 335 fractions were retrospectively analyzed. Frequency of beam-hold triggered during treatments were recorded, with the comparison of shifts detected by optical surface tracking (EXTD_Thml) and x-ray verification (EXTD_Xray). Results: Among the 335 fractions, automatic beam-holds were triggered 41 times, followed by x-ray positional verification with internal anatomy. The difference of shifts detected by EXTD_Thml and EXTD_Xray were less than 1 mm and 1° in translational and rotational directions, respectively. After x-ray verification, none of them required the application of positional correction. Conclusions: The availability of x-ray imaging with optical surface tracking in EXTD is essential to verify whether geometric shifts are required to correct patient position. Considering the ability of continuous monitoring of patient positions with optical surface tracking and internal imaging, EXTD is an effective tool for intrafractional motion monitoring during radiation therapy.

Intergenerational transmission of lifetime stressor exposure in adolescent girls at differential maternal risk for depression.

OBJECTIVE: Adolescent girls who grow up with mothers who are depressed are themselves highly vulnerable to developing depression (i.e., "intergenerational transmission of depression"). Stressor exposure is a strong risk factor for depression, and the transmission of depression risk from mothers to daughters is partly due to mothers experiencing more stressors, increasing daughters' stressor burden. However, research in this area has only assessed recent stressors, making the role of cumulative lifetime stressors unclear. METHOD: To address this issue, we recruited 52 dyads of mothers and adolescent daughters, of which 22 daughters were at high maternal risk for depression. Participants completed diagnostic interviews, and daughters additionally self-reported their depressive symptoms. Participants also completed the Stress and Adversity Inventory, a new-generation instrument for assessing cumulative lifetime history of acute and chronic stressors based on the contextual threat approach. We tested moderated mediation models evaluating the conditional indirect effects of mothers' lifetime stressors on high- versus low-risk daughters' depressive symptoms through daughters' lifetime stressors. RESULTS: As hypothesized, mothers of high-risk (but not low-risk) adolescent daughters who reported more lifetime acute stressors had daughters who reported more lifetime acute stressors and current depressive symptoms. Moreover, this finding was driven specifically by mothers' stressors occurring after their daughters' births. There was also tentative evidence that high-risk daughters' lifetime chronic stressors potentiated the impact of daughters' acute stressors on their depressive symptoms. CONCLUSION: These findings provide new insights into how stressful contexts are transmitted intergenerationally.

The effect of material assignment in nasal cavity on dose calculation for nasopharyngeal carcinoma (NPC) using Acuros XB.

PURPOSE: To evaluate the effect of material assignment in nasal cavity on dose calculation for the volumetric modulated arc therapy (VMAT) of nasopharyngeal carcinoma (NPC) using Acuros XB (AXB) algorithm. METHODS: The VMAT plans of 30 patients with NPC were calculated using AXB with material auto-assignment of nasal cavity to lung and reassignment to air respectively. The doses to the planning target volumes (PTVs) overlapping with nasal cavity with material auto-assignment of lung (AXB_Lung) were compared to the values obtained when nasal cavity was reassigned to air (AXB_Air) under the dose-to-medium (Dm ) reporting mode of AXB. RESULTS: For dose calculated under AXB_Lung, the D98% , D2% , and Dmean of the PTV69.96 _Air Cavity (PTV of prescription dose 69.96 Gy overlapping with nasal cavity) were on average 16.1%, 1.6%, and 8.6% larger than that calculated under AXB_Air, respectively. Up to 19.5% difference in D98% , 3% difference in D2% , and 11.2% difference in Dmean were observed in the worst cases for PTV69.96 . Similar trend was observed for the PTV5940 _Air Cavity, in which the D98% , D2% , and Dmean calculated under AXB_Lung were on average 14.7%, 2.5%, and 10.2% larger than that calculated under AXB_Air, respectively. In the worst cases, the difference observed in D98% , D2% , and Dmean could be up to 17.7%, 4.5%, and 12.7%, respectively. CONCLUSIONS: Significant dose difference calculated by AXB between the material assignment of lung and air in nasal cavity for NPC cases might imply the possibility of underdosage to the PTVs that overlap with inhomogeneity. Therefore, attention should be put to ensure that accurate material assignment for dose calculation under AXB such that optimal dosage was given for tumor control.

The radiobiological effect of using Acuros XB vs anisotropic analytical algorithm on hepatocellular carcinoma stereotactic body radiation therapy.

The purpose of this work was to study the radiobiological effect of using Acuros XB (AXB) vs Analytic Anisotropic Algorithm (AAA) on hepatocellular carcinoma (HCC) stereotactic body radiation therapy (SBRT). Seventy SBRT volumetric modulated arc therapy (VMAT) plans for HCC were calculated using AAA and AXB respectively with the same treatment parameters. Published tumor control probability (TCP) and normal tissue complication probability (NTCP) models were used to quantify the effect of dosimetric difference between AAA and AXB on TCP, NTCP and uncomplicated tumor control probability (UTCP). There was an average decrease of 2.5% in 6-month TCP. Normal liver has the largest average decrease in NTCP which was 59.7%. Bowels followed with 26.6% average decrease in NTCP. Duodenum, stomach and esophagus had 10.2%, 5.1%, and 4.3% average decrease in NTCP. There was an average decrease of 1.8% and up to 7.2% in 6-month UTCP. There was an overall decrease in TCP, NTCP, and UTCP for HCC SBRT plans calculated using AXB compared to AAA which could be clinically significant.

Shift detection discrepancy between ExacTrac Dynamic system and cone-beam computed tomography.

Accurate detection of patient shift is essential during radiation therapy such that optimal dose is delivered to the tumor while minimizing radiation to surrounding normal tissues. The shift detectability of a newly developed optical surface and thermal tracking system, which was known as ExacTrac Dynamic (EXTD), was evaluated by comparing its performance with the image guidance under cone-beam computed tomography (CBCT). Anthropomorphic cranial and pelvis phantoms with internal bone-like structures and external heat pad were utilized to study the shift detection discrepancy between EXTD system and CBCT. Random displacements within the range of ± 2 cm for translations and ± 2 degrees for rotations were intentionally applied to the phantom. Positional shifts detected by optical surface and thermal tracking (EXTD_Thml), stereoscopic X-ray (EXTD_Xray), and CBCT were compared in 6 degrees of freedom. The translational difference between EXTD_Thml and CBCT was 0.57 ± 0.41 mm and 0.66 ± 0.40 mm for cranial and pelvis phantom, respectively, while it was 0.60 ± 0.43 mm and 0.76 ± 0.49 mm between EXTD_Xray and CBCT, respectively. For rotational movement, the difference between EXTD_Thml and CBCT was 0.19 ± 0.16° and 0.19 ± 0.22° for cranial and pelvis phantom, respectively, while it was 0.13 ± 0.18° and 0.65 ± 0.46° between EXTD_Xray and CBCT, respectively. This study demonstrated that the EXTD system with thermal mapping ability could offer comparable accuracy for shift detection with CBCT on both cranial and pelvis phantoms.

Recalled Neighborhood Environments, Parental Control, and Cytokine-Mediated Response to Viral Challenge.

OBJECTIVE: Neighborhood risk in childhood is associated with poor health across the life span. However, many people who are reared in risky neighborhoods remain healthy in adulthood. In the context of high-risk neighborhoods, parenting practices that are controlling might promote better physical health outcomes later in life. The current study used a viral challenge paradigm to examine whether parental control throughout childhood moderated the association between recalled neighborhood risk and cytokine-mediated cold susceptibility. METHODS: A sample of 209 healthy adults completed questionnaires to assess recalled neighborhood risk and parental control over the first 15 years of life, were exposed to a common cold virus, and were quarantined for 6 days. Researchers assessed nasal proinflammatory cytokine production and objective markers of illness. Participants were diagnosed with a clinical cold if they met the infection and objective illness criteria. RESULTS: A significant Neighborhood Risk by Parental Control interaction emerged to predict proinflammatory cytokine production. Furthermore, parental control moderated the cytokine-mediated association between neighborhood risk and cold diagnosis (index = -0.073, 95% confidence interval [CI] = -0.170 to -0.016), likelihood of infection (index = -0.071, 95% CI = -0.172 to -0.015), and meeting the objective symptom criteria (index = -0.074, 95% CI = -0.195 to -0.005). Specifically, there was a negative association between neighborhood risk and objective cold diagnosis and infection status at higher levels of parental control, but a nonsignificant association at lower levels of parental control. CONCLUSIONS: Findings suggest that the degree to which recalled neighborhood risk is related to adult health varies as a function of parental control throughout childhood.

Analysis of Hepatocellular Carcinoma Stereotactic Body Radiation Therapy Dose Prescription Method Using Uncomplicated Tumor Control Probability Model.

PURPOSE: This work was to establish an uncomplicated tumor control probability (UTCP) model using hepatocellular carcinoma (HCC) stereotactic body radiation therapy (SBRT) clinical data in our institution. The model was then used to analyze the current dose prescription method and to seek the opportunity for improvement. METHODS AND MATERIALS: A tumor control probability (TCP) model was generated based on local clinical data using the maximum likelihood method. A UTCP model was then formed by combining the established TCP model with the normal tissue complication probability model based on the study by Dawson et al. The authors investigated the dependence of maximum achievable UTCP on planning target volume equivalent uniform dose (EUD) at various ratio between planning target volume EUD and normal liver EUD (T/N EUD ratios). A new term uncomplicated tumor control efficiency (UTCE) was also introduced to analyze the outcome. A UTCE value of 1 implied that the theoretical maximum UTCP for the corresponding T/N EUD ratio was achieved. RESULTS: The UTCE of the HCC SBRT patients based on the current dose prescription method was found to be 0.93 ± 0.05. It was found that the UTCE could be increased to 0.99 ± 0.03 by using a new dose prescription scheme, for which the UTCP could be maximized while keeping the normal tissue complication probability value smaller than 5%. CONCLUSIONS: The dose prescription method of the current HCC SBRT in our institution was analyzed using a UTCP model established based on local clinical data. It was shown that there could be a potential to increase the prescription dose of HCC SBRT. A new dose prescription scheme was proposed to achieve better UTCP. Additional clinical trials would be required to validate the proposed dose prescription scheme in the future.

Malnourishment during early lactation disrupts the ontogenetic distribution of the CART and α-MSH anorexigenic molecules in the arcuate/paraventricular pathway and lateral hypothalamus in male rats.

Developmental malnourishment impacts the energetic metabolism control throughout life. In rat offspring, a 0% protein diet during the first 10 days of lactation results in leptin resistance and in alterations in: feeding behavior, serum leptin and neuropeptide Y (NPY) levels in the hypothalamic arcuate nucleus (ARC)/paraventricular (PVN) pathway. Here, the distributions of alpha-melanocyte stimulating hormone (α-MSH) and cocaine and amphetamine regulated transcript (CART), anorexigenic molecules, were immunohistochemically assessed in the ARC, PVN and lateral hypothalamus (LH) nuclei. Rat dams were subjected to one of the following diet protocols from postnatal day (P) 1-10: 1) Protein-free (PFG, 0% protein chow); 2) Pair-fed (UFG, normoprotein chow); 3) Control group (CG, normoprotein chow). PFG, UFG and CG male offspring were analyzed at different time points, from P5 to P180. In the ARC, PFG α-MSH and CART were increased from P10 to P45 when compared to CG and UFG. In the PVN, α-MSH and CART peaks in PFG animals were delayed from P20 to P30 when compared to CG. In the LH, CART was more intense in PFG animals than in UFG and CG ones by P20, and, by P30, UFG immunostaining became less intense than in CG. In conclusion, aproteic diet altered the ontogenetic distribution of both anorexigenic molecules. In the PVN, the peak was delayed to P30, which coincides with the leptin peak and follows the previously described NPY (orexigenic) peak in this model. The permanent LH CART and α-MSH increase may be associated with the previously observed PFG hypophagia.

Ten Surprising Facts About Stressful Life Events and Disease Risk.

After over 70 years of research on the association between stressful life events and health, it is generally accepted that we have a good understanding of the role of stressors in disease risk. In this review, we highlight that knowledge but also emphasize misunderstandings and weaknesses in this literature with the hope of triggering further theoretical and empirical development. We organize this review in a somewhat provocative manner, with each section focusing on an important issue in the literature where we feel that there has been some misunderstanding of the evidence and its implications. Issues that we address include the definition of a stressful event, characteristics of diseases that are impacted by events, differences in the effects of chronic and acute events, the cumulative effects of events, differences in events across the life course, differences in events for men and women, resilience to events, and methodological challenges in the literature.

Receiving a hug is associated with the attenuation of negative mood that occurs on days with interpersonal conflict.

Interpersonal touch is emerging as an important topic in the study of adult relationships, with recent research showing that such behaviors can promote better relationship functioning and individual well-being. This investigation considers whether being hugged is associated with reduced conflict-related decreases in positive affect and increases in negative affect as well as whether these associations differ between women and men. A sample of 404 adults were interviewed every night for 14 consecutive days about their conflicts, hug receipt, and positive and negative affect. Results indicated that there was an interaction between hug receipt and conflict exposure such that receiving a hug was associated with a smaller conflict-related decrease in positive affect and a smaller conflict-related increase in negative affect when assessed concurrently. Hug receipt was also prospectively associated with a smaller conflict-related increase in next day negative affect but was not associated with next day positive affect. Associations between hug receipt and conflict-related changes in affect did not differ between women and men, between individuals who were married or in a marital-like relationship and those who were not, or as a function of individual differences in baseline perceived social support. While correlational, these results are consistent with the hypothesis that hugs buffer against deleterious changes in affect associated with experiencing interpersonal conflict. Possible mechanisms through which hugs facilitate positive adaptation to conflict are discussed.

Social integration and age-related decline in lung function.

OBJECTIVES: We tested the hypothesis that social integration, measured as number of social roles, is associated with less age-related loss of lung function, an important marker of health and longevity. We also investigated possible psychological factors through which social integration might influence lung health. METHODS: Data were analyzed from the Health and Retirement Study (ages 52-94, n = 4,224). RESULTS AND CONCLUSIONS: Each additional social role reported at baseline was associated with less of a decline in lung function between baseline and the follow-up assessment four years later. The association withstood controls for demographics, weight, and height and was mediated by more positive and less negative affect and lower rates of cigarette smoking and more physical activity. Roles were mostly substitutable, with both high (spouse, parent, friends, relatives) and low (employee, religious service attendee, volunteer, members of other groups) intimacy roles independently contributing to less age-related decline in lung function. (PsycINFO Database Record

Maternal protein-free diet during lactation programs male Wistar rat offspring for increased novelty-seeking, locomotor activity, and visuospatial performance.

It is well established that chronic undernutrition has detrimental impacts on brain development and maturation. However, protein malnutrition during the period specifically encompassing the brain growth spurt has not been widely studied, particularly regarding its effects on adolescent and adult offspring behavior. Here, we assessed the effects of a protein-free diet during the 1st 10 postnatal days on the macronutrient content of the milk produced by lactating Wistar rats, on their maternal behavior, and on the offspring's behavior. Lactating dams were fed either a protein-free or a normoprotein diet from litter parturition to Postnatal Day 10 (P10). All dams received the normoprotein diet after P10. Offspring were tested in the elevated plus-maze (anxiety-like behavior), hole board arena (novelty-seeking and locomotor activity), and radial arm water maze (memory-learning) at either P40 (adolescents) or P90 (adults). The protein-free diet reduced milk protein content at P10 but not at P20. Carbohydrate and lipid contents were unaffected. Serum corticosterone levels in the offspring (at P10, P40, or P90) and dams (at P21) were not affected by the protein-free diet. Maternal behavior was also unchanged. In the offspring, no differences were observed between groups regarding anxiety-like behaviors at both ages. The protein-free diet increased adolescent locomotor activity as well as adult novelty-seeking behavior and memory performance. Our results indicate that the brain growth spurt period is particularly sensitive to protein malnutrition, showing that even a brief nutritional insult during this period can cause specific age-dependent behavioral effects on the offspring. (PsycINFO Database Record

Age moderates the association between social integration and diurnal cortisol measures.

Social integration is defined as the degree to which an individual participates in a broad range of social relationships. Although measures of social integration vary across studies, it is often assessed as the number of social roles (e.g., parent, friend, student, volunteer) that an individual reports actively participating in. More socially integrated individuals tend to be healthier than those less socially integrated, but the biological mechanisms through which this occurs remain unclear. One possibility is that social integration might alter the function of the hypothalamic-pituitary-adrenal axis, of which cortisol is a key product, and in turn influence a broad range of health outcomes. This study examined the association between social integration and two indices of cortisol in a community sample of 680 healthy men and women aged 18-55. Because the social roles held by younger individuals may be more numerous yet superficial than those held by older individuals, this study also tested the hypothesis that these associations could be moderated by age such that lower levels of integration would be associated with cortisol dysregulation for older but not younger individuals in our sample. Participants provided salivary cortisol samples during waking hours on three days that were used to calculate diurnal cortisol levels and slopes. Increased social integration was associated with lower cortisol AUC among older (ages 35-55) but not younger (ages 18-34) individuals in our sample. Moreover, while increased social integration was associated with steeper diurnal cortisol slopes regardless of age, this association was strongest among older individuals. Differences in health behaviors, affect, and psychological stress did not mediate these associations. The results of this study support cortisol as a candidate biological mechanism through which increased social integration is associated with better physical health among older individuals.

Column Bioleaching of Fluoride-Containing Secondary Copper Sulfide Ores: Experiments With Sulfobacillus thermosulfidooxidans.

Bioleaching is a mature technology, which is widely employed commercially in the leaching of primary sources of metals (ores, concentrates, and mine residues). The current work discussed the effects of aluminum sulfate additions to the growth medium, PLS recirculation and bleeding on the column bioleaching of secondary copper sulfide ores with a significant content of fluoride-containing minerals. Fluoride is toxic to bacteria at the pH of bioleaching but its toxicity may be overcome in the presence of soluble aluminum and ferric iron. Therefore, experiments were carried out in 10 × 100 cm height aerated columns, loaded with 10 kg of crushed and agglomerated copper ore and inoculated with Sulfobacillus thermosulfidooxidans. Initially, fluoride concentrations of up to 2.5 g/L in the pregnant leach solution were observed due to the fast dissolution of fluoride-bearing minerals. Aluminum was added to the leaching solution to reduce the Al/F ratio so that the concentration of HF (the main toxic species) was decreased, but while the total fluoride concentration was higher than that of aluminum, the bacterial population as low. Therefore, the current work emphasizes that it is possible to set up conditions to enable bioleaching even at high fluoride concentrations. Following this approach, copper extractions above 90% were achieved for a H2SO4 consumption ranging from 128.8 to 206.1 Kg/ton.

Psychosocial functioning and the cortisol awakening response: Meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies.

Cortisol levels rise immediately after awakening and peak approximately 30-45min thereafter. Psychosocial functioning influences this cortisol awakening response (CAR), but there is considerable heterogeneity in the literature. The current study used p-curve and meta-analysis on 709 findings from 212 studies to test the evidential value and estimate effect sizes of four sets of findings: those associating worse psychosocial functioning with higher or lower cortisol increase relative to the waking period (CARi) and to the output of the waking period (AUCw). All four sets of findings demonstrated evidential value. Psychosocial predictors explained 1%-3.6% of variance in CARi and AUCw responses. Based on these effect sizes, cross-sectional studies assessing CAR would need a minimum sample size of 617-783 to detect true effects with 80% power. Depression was linked to higher AUCw and posttraumatic stress to lower AUCw, whereas inconclusive results were obtained for predictor-specific effects on CARi. Suggestions for future CAR research are discussed.

Offspring of parents who were separated and not speaking to one another have reduced resistance to the common cold as adults.

Exposure to parental separation or divorce during childhood has been associated with an increased risk for physical morbidity during adulthood. Here we tested the hypothesis that this association is primarily attributable to separated parents who do not communicate with each other. We also examined whether early exposure to separated parents in conflict is associated with greater viral-induced inflammatory response in adulthood and in turn with increased susceptibility to viral-induced upper respiratory disease. After assessment of their parents' relationship during their childhood, 201 healthy volunteers, age 18-55 y, were quarantined, experimentally exposed to a virus that causes a common cold, and monitored for 5 d for the development of a respiratory illness. Monitoring included daily assessments of viral-specific infection, objective markers of illness, and local production of proinflammatory cytokines. Adults whose parents lived apart and never spoke during their childhood were more than three times as likely to develop a cold when exposed to the upper respiratory virus than adults from intact families. Conversely, individuals whose parents were separated but communicated with each other showed no increase in risk compared with those from intact families. These differences persisted in analyses adjusted for potentially confounding variables (demographics, current socioeconomic status, body mass index, season, baseline immunity to the challenge virus, affectivity, and childhood socioeconomic status). Mediation analyses were consistent with the hypothesis that greater susceptibility to respiratory infectious illness among the offspring of noncommunicating parents was attributable to a greater local proinflammatory response to infection.

Marital status as a predictor of diurnal salivary cortisol levels and slopes in a community sample of healthy adults.

Married people tend to be healthier than both the previously (bereaved, divorced, and separated) and never married, but the mechanisms through which this occurs remain unclear. To this end, research has increasingly focused on how psychological stress experienced by unmarried versus married individuals may differentially impact physiological systems related to health. One key system that is modulated by stress is the hypothalamic-pituitary-adrenal (HPA) axis, of which cortisol is a key hormonal product. Increased cortisol production and disruption of cortisol's daily rhythm have been linked to poorer health outcomes. This study examined the association between current marital status and these two indices of cortisol in a community sample of 572 healthy men and women aged 21-55. It also tested whether marriage buffers against the effect of stress (perceived stress by marital status interaction) on cortisol production. Participants provided salivary cortisol samples during waking hours on three nonconsecutive separate days to calculate diurnal cortisol levels and slopes. Married individuals had lower cortisol levels than either their never married or previously married counterparts. Differences in cortisol levels were due at least in part to currently married individuals having a more rapid decline in cortisol through the afternoon hours compared to individuals who were never married (but not those who were previously married). Furthermore, there was an interaction between perceived stress and marital status in predicting cortisol levels. Specifically, higher stress was associated with higher cortisol levels for previously married individuals but not for the married or never married. The results of this study support cortisol as one candidate mechanism accounting for the association of marital status and health.

Copper extraction from coarsely ground printed circuit boards using moderate thermophilic bacteria in a rotating-drum reactor.

The current work reports on a new approach for copper bioleaching from Printed Circuit Board (PCB) by moderate thermophiles in a rotating-drum reactor. Initially leaching of PCB was carried out in shake flasks to assess the effects of particle size (-208µm+147µm), ferrous iron concentration (1.25-10.0g/L) and pH (1.5-2.5) on copper leaching using mesophile and moderate thermophile microorganisms. Only at a relatively low solid content (10.0g/L) complete copper extraction was achieved from the particle size investigated. Conversely, high copper extractions were possible from coarse-ground PCB (20mm-long) working with increased solids concentration (up to 25.0g/L). Because there was as the faster leaching kinetics at 50°C Sulfobacillus thermosulfidooxidans was selected for experiments in a rotating-drum reactor with the coarser-sized PCB sheets. Under optimal conditions, copper extraction reached 85%, in 8days and microscopic observations by SEM-EDS of the on non-leached and leached material suggested that metal dissolution from the internal layers was restricted by the fact that metal surface was not entirely available and accessible for the solution in the case of the 20mm-size sheets.

Targeted rejection predicts decreased anti-inflammatory gene expression and increased symptom severity in youth with asthma.

Although responses to different stressors are sometimes assumed to be similar, recent research has demonstrated that certain types of stress, such as targeted rejection, are particularly potent. To test such associations in a chronic-disease model, we examined how noninterpersonal, interpersonal, and targeted-rejection major life events predicted changes in gene expression and symptom severity in 121 youths with asthma who were assessed every 6 months for 2 years. Youths who had recently experienced targeted rejection had lower messenger RNA expression for signaling molecules that control airway inflammation and obstruction (specifically, the glucocorticoid receptor and ß2-adrenergic receptor) than youths who had not experienced targeted rejection. These associations were specific to targeted rejection and stronger for youths higher in subjective social status. Higher-status youths exposed to targeted rejection (but not other types of stress) also reported more asthma symptoms. These data demonstrate stressor-specific associations with molecular-signaling pathways and the severity of asthma, and they suggest that threats to the social self may be particularly deleterious.