Learning and memory under stress: implications for the classroom

DRN-SNc serotonergic circuit drives stress-induced motor deficits and Parkinson's disease vulnerability

Stress is a recognized risk factor for Parkinson's disease (PD), but the mechanisms by which stress exacerbates PD symptoms through the serotonergic system are not fully understood. This study investigates the role of serotonergic (5-HT) neurons in the dorsal raphe nucleus (DRN) in mediating stress-induced motor deficits and PD progression. Acute and chronic stress were induced in mice using an elevated platform (EP) and combined with MPTP administration to model early-stage PD. Acute EP stress caused transient motor deficits and significant activation of DRN5-HT neurons projecting to substantia nigra compacta (SNc) dopaminergic (DA) neurons. Manipulating the DRN-SNc pathway with optogenetics and chemogenetics confirmed its critical role in stress-induced motor deficits. Activation of the SNc 5-HT2C receptor with an agonist replicated these deficits, while receptor inhibition prevented them, underscoring its importance. Chronic EP stress worsened MPTP-induced deficits and caused significant SNcDA neurons loss, suggesting it accelerates PD progression. Prolonged chemogenetic inhibition of the DRN-SNc circuit mitigated chronic stress effects in MPTP-treated mice. These findings highlight the crucial role of the DRN-SNc serotonergic circuit and 5-HT2C receptors in stress-related motor deficits, suggesting potential targets for therapies aimed at treating both stress-related motor disorders and Parkinson's disease.

A Monolithic Neuromorphic Device for In-Sensor Tactile Computing

To emulate the tactile perception of human skin, the integration of tactile sensors with neuromorphic devices has emerged as a promising approach to achieve near-sensor information processing. Here, we present a monolithic electronic device that seamlessly integrates tactile perception and neuromorphic computing functionalities within a single architecture, with synaptic plasticity directly tunable by tactile inputs. This unique capability stems from our engineered device structure employing SnO2 nanowires as the conductive channel coupled with a pressure-sensitive chitosan layer ionic gating layer. The device demonstrates pressure-dependent memory retention and learning behaviors, effectively mimicking the enhanced cognitive functions observed in humans under stressful conditions. Furthermore, the integrated design exhibits potential for implementing bioinspired electronic systems requiring adaptive tactile information processing.

Improving communication during damage control surgery: a survey of adult major trauma centres in England

INTRODUCTION

Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery.

METHODS

An online survey was devised and distributed via the national programme of care for trauma in November 2020.

RESULTS

Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning.

CONCLUSIONS

We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.

Exploring the impact of interaction dynamics and professional capacity and development on cognitive medical errors: a multiple-case study of healthcare professionals in Jordan

BACKGROUND

Addressing cognitve medical errors (MEs) and their contributing factors has emerged as a crucial factor in enhancing patient safety and attaining improved clinical outcomes. This study aimed to examine the impact of interaction dynamics and professional capability and development on cognitive MEs (i.e., mistakes, slips, or lapses) from the perspectives of healthcare professionals in Jordan.

METHODS

A multiple-case study design was employed with a cross-sectional approach. Our study investigated three prominent Jordanian hospitals in the northern region (government, private, and teaching) through a pretested, valid, and reliable survey. Using a convenience sampling, 400 participants from three occupational categories, including physicians, nurses, and clinical managers were invloved. The relationships among the study variables were examined through structural equation modeling (SEM) following Confirmatory Factor Analysis (CFA) conducted using AMOS software.

RESULTS

The results of CFA demonstrated that the model fit indices are acceptable (RMSEA = 0.069; CFI = 0.901; Chisq/df = 2.92; p <.05). The SEM analysis revealed a significant positive association between gaps in professional capacity and development, which comprises three subscales: training needs, continuous medical education, and skills, abilities, and competencies of healthcare professionals, and cognitive MEs (β = 0.40; p <.05). In contrast, a significant negative correlation was found between interaction dynamics among healthcare professionals, including two subscales: interpersonal communication, and teamwork and mutual support, and cognitive MEs (β = - 0.21; p <.05).

CONCLUSION

Our findings advocate for fostering a hospital culture that consolidates efforts to prioritize patient care coordination, and teamwork cohesion, while also minimizing gaps in unmet needs for training and continuing education, and addressing shortcomings in the skills and job competence of healthcare professionals as essential proactive steps to migirate cognitive MEs in Jordanian hospitals.

Veterinary Students' Perspectives on Their Relationship with Animals Used in Veterinary Education

Some veterinary still use live animals to teach veterinary students clinical skills. However, there is a lack of literature understanding veterinary students' perspectives on the use of animals in their education. Using a qualitative approach, this study aimed to explore (1) how the perceived quality of life of animals used for teaching affected veterinary students' learning and emotional well-being and (2) how student emotional well-being affected the care they provided for animals used for teaching. We conducted 10 focus groups and 2 interviews with fourth-year veterinary students (n = 43) participating in clinical rotations at two Canadian veterinary colleges. We analyzed the data inductively using template thematic analysis and identified three themes. First, using animals in students' education caused ethical and moral conflicts that had a negative impact on their emotional well-being; many of these conflicts arose when there was a lack of transparency about animal use or when the harm to animals outweighed the benefits to student learning or animal welfare. Second, students' well-being and the welfare of animals used for teaching were intertwined, suggesting that educational practices have implications for both. Third, supervisors and their teaching approaches, including the use of live animals or alternatives, had complex effects on student learning. In general, students preferred realistic and supportive learning experiences in which they could provide a service to animals and their community. This study highlights the nuanced perspectives of veterinary students on the animals used in their education. We encourage veterinary colleges to carefully evaluate their use of institution-owned live animals within the curriculum, improve transparency about how these animals are used, and find effective pedagogical methods that consider implications to both student emotional well-being and animal welfare.

What the Science of Learning Teaches Us About Arithmetic Fluency

High-quality mathematics education not only improves life outcomes for individuals but also drives innovation and progress across society. But what exactly constitutes high-quality mathematics education? In this article, we contribute to this discussion by focusing on arithmetic fluency. The debate over how best to teach arithmetic has been long and fierce. Should we emphasize memorization techniques such as flashcards and timed drills or promote "thinking strategies" via play and authentic problem solving? Too often, recommendations for a "balanced" approach lack the depth and specificity needed to effectively guide educators or inform public understanding. Here, we draw on developmental cognitive science, particularly Sfard's process-object duality and Karmiloff-Smith's implicit-explicit knowledge continuum, to present memorization and thinking strategies not as opposing methods but as complementary forces. This framework enables us to offer specific recommendations for fostering arithmetic fluency based on the science of learning. We define arithmetic fluency, provide evidence on its importance, describe the cognitive structures and processes supporting it, and share evidence-based guidance for promoting it. Our recommendations include progress monitoring for early numeracy, providing explicit instruction to teach important strategies and concepts, implementing well-structured retrieval practice, introducing time-limited practice only after students demonstrate accuracy, and allocating sufficient time for discussion and cognitive reflection. By blending theory, evidence, and practical advice, we equip educators and policymakers with the knowledge needed to ensure all children have access to the opportunities needed to achieve arithmetic fluency.

Describing the Impact of Physician End-of-Life Communication Training on Simulated Stress Using a Novel Stress Marker

IntroductionEmpathetic end-of-life (EOL) communication is important for high quality pediatric patient and family outcomes. Trainees may have limited exposure and training in caring for patients at EOL which may impact communication-related stress. This study had 2 aims: (1) describe pediatric resident physician EOL exposure and training (2) measure objective and subjective stress during simulated critical communication encounters and the impact of prior communication training/exposures on stress responses.MethodsWe performed a prospective, pilot observational cohort study measuring physician exposure to caring for patients/families at EOL and simulated communication stress. Simulated stress was measured subjectively using the state-trait anxiety inventory (STAI) and objectively using heart rate variability (HRV) during a communication training intervention.Results85.7% (18/21) of residents reported seldom/never caring for patients at EOL and universally felt ill-prepared to provide care. Subjective and objective stress increased when directly communicating with the simulated parent/patient actor compared to baseline in all HRV domains. Residents with limited exposure to patients/families at EOL had a smaller stress response than those who cared for a substantial number.ConclusionsPediatric residents report limited opportunities to communicate with patients/families at EOL, which may impact stress responses when communicating life-altering news to families. Simulated communication encounters can be designed to evoke subjective and objective stress which can be measured using novel technology and may help address limited EOL opportunities.

Developmental timing of adversity and neural network organization: An fNIRS study of the impact of refugee displacement

This study investigated the neurodevelopmental impacts of displacement on resettled Syrian refugee children in Canada, focusing on how the timing and duration of adversity experienced during displacement influence neural network organization. Using graph theoretical approaches within a network neuroscience framework, we examined how the developmental timing of displacement (age of displacement, duration of displacement) related to functional integration, segregation, and small-worldness. Syrian refugee children (n = 61, MAge=14 Range = 8-18), completed a resting state scan using functional Near Infrared Spectroscopy (fNIRS) neuroimaging. Data were analyzed to assess the link between neural network properties and developmental timing of adversity. Results indicate that prolonged displacement experienced earlier in life was significantly linked with neural network organization, impacting the balance between the brain's functional integration and segregation as quantified by the overall reduced small worldness in comparison to experiencing displacement at an older age. This study leverages the experiences of refugee children to advance our understanding of how the timing of adversity affects development, providing valuable insights into the broader impacts of early adversity on neurodevelopment.

Investigating Cortisol in a STEM Classroom: The Association Between Cortisol and Academic Performance

Science, technology, engineering, and mathematics (STEM) education can be stressful, but uncertainty exists about (a) whether stressful academic settings elevate cortisol, particularly among students from underrepresented racial/ethnic groups, and (b) whether cortisol responses are associated with academic performance. In four classes around the first exam in a gateway college STEM course, we investigated participants' (N = 271) cortisol levels as a function of race/ethnicity and tested whether cortisol responses predicted students' performance. Regardless of race/ethnicity, students' cortisol, on average, declined from the beginning to the end of each class and across the four classes. Among underrepresented minority (URM) students, higher cortisol responses predicted better performance and a lower likelihood of dropping the course. Among non-URM students, there were no such associations. For URM students, lower cortisol responses may have indicated disengagement, whereas higher cortisol responses may have indicated striving. The implication of cortisol responses can depend on how members of a group experience an environment.

Could the impact of emotional states on learning in children vary with task difficulty?

Emotions are known to influence memory, in particular retention and recall, with positive emotions enhancing performances and negative emotions showing mixed effects. Although the influence of emotions on memory is well-established, their precise impact on the learning process remains a matter of debate and investigation. We implemented two experiments with children aged 6 to 8 years to examine how different emotional states affect training with tasks of varying difficulty. In Experiment 1, children were assessed in a letter recognition task and were assigned to positive, negative, or neutral emotional training conditions. Results showed significant performance improvements across all emotional conditions, indicating that emotional states did not differentially affect this task. In Experiment 2, using a more difficult non-word dictation task, significant improvements were found only in the positive and neutral conditions but not in the negative condition, suggesting that task difficulty modulates the impact of emotional states. These findings highlight the importance of considering both emotional states and task difficulty in educational settings. Positive and neutral emotions may facilitate cognitive processes under challenging conditions, whereas negative emotions might hinder them.

Modified interteaching sessions as application-based examinations reduce student exam stress in an upper-level pathophysiology class

Testing is a highly important tool, used ubiquitously in academia, to assess student comprehension and understanding of material. Unfortunately, the emphasis placed on test grades has resulted in a modern epidemic of test-related anxiety, which can have adverse health effects on students. Over time, novel testing strategies have been developed to more precisely assess individual skills such as remembering, analyzing, and synthesizing. Yet, there exist few strategies that were also developed to simultaneously reduce stress in the testing environment. We posit here a teaching innovation whereby we modified the classic interteaching session developed in the social sciences to serve as a stress-reduction testing format that also builds student communication and critical thinking skills in an upper-level pathophysiology course. After implementing this novel testing approach, we anonymously surveyed the students in the class to understand how the testing format affected their self-perceived stress levels and their self-perceived learning and to identify their testing preferences. Of 28 students, 12 responded (43%). Our survey data highlight that students largely preferred partnered, open-response, case-based exams to multiple-choice exams. Moreover, students perceived themselves as having lower test-related stress when taking partnered, open-response, case-based exams, as well as a strong overall agreement that partnered, open-response, case-based exams enhanced their learning. We posit this application of modified interteaching can be employed in upper-level physiology or pathophysiology courses as a stress-reduction testing strategy.NEW & NOTEWORTHY We have identified an approach to testing in pathophysiology that can simultaneously enhance student learning while reducing test-related stress. In our study, students ubiquitously agreed that open-response, partnered, case-based exams were preferable to multiple-choice exams and that their stress levels were lower while learning was enhanced as a function of this testing strategy.

What can simulation educators learn from the reluctant participant? An exploration of the factors influencing engagement amongst adult learners participating in paediatric simulation training

BACKGROUND

Simulation educators are typically passionate advocates for simulation as a training modality; however, we frequently encounter participants who do not share our enthusiasm. The voice of the highly engaged participant is well publicised; however, the experience of those who do not readily engage in simulation has not been extensively studied and may offer valuable insights for educators. This qualitative study will explore factors which influence learner engagement in paediatric simulation training, informing the practice and approach of simulation educators to optimise learning experiences.

METHODS

We conducted a reflexive thematic analysis of 12 semi-structured interviews with medical and nursing professionals from a large paediatric teaching hospital in New Zealand who self-identified as reluctant participants in simulation-based education. Interviews explored factors which have influenced their engagement in simulation-based education over the course of their careers.

RESULTS

Three overarching themes were developed which describe the factors influencing adult-learner engagement in simulation-based education. The first, participant anxiety, explores the participants' narratives related to anxiety before, during and even following simulation which can impact on their ability to engage in current and subsequent simulation-based education. The second, protective behaviours, relates to the defensive mechanisms employed by participants in response to vulnerability experienced during simulation activities. The third theme, perception of the facilitator, examines the impact of simulation facilitator characteristics and behaviours on learner engagement.

CONCLUSIONS

These narratives highlighted that regular simulation activities with transparent learning objectives in which facilitators demonstrate vulnerability and adopt a co-learner attitude act to reduce participant anxiety. Emergent defensive behaviours, particularly "group shielding", interfere with collective learner engagement and should be both recognised and addressed by facilitators. Finally, there are potential discrepancies in the perceptions of facilitators and learners regarding what constitutes psychologically safe education environments. A collaborative and iterative approach to simulation-based education design may act to improve psychological safety for reluctant participants.

Divergent thinking in groups during cold-water immersion is impaired by cold stress not the cold shock response

Introduction

A primary hazard of working in cold maritime environments is the potential for a substantial man overboard situation in freezing waters. Sudden cold-water immersion (CWI) triggers the cold shock response (CSR), which consists of cardiorespiratory responses that increase the chance of drowning. If cold shock response severity can be mitigated, life-saving actions must be taken within the first 10 min, as after this time frame drowning occurs due to cold incapacitation. To date, research shows that executive functioning is generally impaired by intense, acute stress, which implies the ability to think through potential actions to maximize survival would also be impaired by the cold shock response.

Methods

To examine whether the severity of cold shock response impairs higher-level thinking in a group, 29 active duty service members completed a group format Divergent Association Task (DAT; 4-5 per group) prior to and during a 13-min cold-water immersion (water temperature: 1.3°C, air temperature: -2.7°C).

Results

Results showed no relationship between cold shock response magnitude, indexed by peak heart rate, and DAT performance. However, results indicated that those with lower skin temperatures performed worse on the DAT.

Discussion

Results suggest that the ability to engage in divergent thinking is relatively preserved in the critical ~10-min window although skin cooling may bias attention toward the cold stress impacting task performance. Furthermore, subjective reports of the severity of the initial gasp tracked with peak heart rate demonstrating potential utility of subjective responses in the absence of respiratory measurements.

Nerves of Steel: Bolstering Student Confidence in Gross Anatomy Through a Peer-to-Peer Intervention

Introduction

Increasing confidence and performance in gross anatomy is crucial in medical education. This study identified challenging anatomical topics in a gastrointestinal (GAS) course and applied a peer-to-peer intervention to improve student confidence and performance in these areas in the following endocrine/reproductive (END) course.

Materials and Methods

Thirty gross anatomical structures from a GAS mock practical were classified into six categories. As part of the mock practical, medical students rated their confidence in each answer using a scale of 1-5. Performance and confidence were compared across the six categories, revealing two areas with significantly lower scores. In the following END course, these areas were targeted through a 1-h peer-to-peer intervention.

Results

Forty-two students participated in the GAS mock practical. Significantly lower performance was found in nerves and viscera categories. Students who attended the peer-to-peer intervention during the END course showed marked improvements in both areas on the END mock practical. Average performance for viscera increased from 31 to 68% (p < .001) and for nerves from 35 to 52% (p < .001). Average confidence for viscera increased from 2.22 to 3.32 (p < .001) and for nerves from 2.07 to 2.61 (p < .001).

Discussion

These findings align with the expected benefits of peer-to-peer interventions. However, the difficulty students faced with viscera, more so than with vasculature, was unanticipated. This unexpected outcome underscores the nuanced nature of student learning in anatomy and the importance of targeted educational interventions. Future research should explore whether students consistently struggle with nerves and visceral structures across different organ systems.

The effects of a single bout of high intensity exercise on stress reactivity, mind wandering, and lecture comprehension in young adults

Post-secondary students experience acute stressors daily. Acute stress has been associated with poor cognitive and learning outcomes. Prior work has demonstrated a single bout of exercise can attenuate acute stress responses. The present study examined the effects of a single 30-minute bout of high intensity aerobic exercise on multidimensional stress reactivity and learning-related outcomes. Forty participants were randomized to either engaging in an exercise bout or seated rest. Participants were then exposed to the Trier Social Stress Test followed by a 20-minute video lecture. The video lecture contained embedded mind wandering probes. Acute exercise did not attenuate stress responses, however promoted greater on-task behaviour (i.e., less mind wandering) and improved lecture comprehension scores. Notably, state anxiety was positively associated with mind wandering and mind wandering was negatively associated with lecture comprehension. Collectively, examining the role of acute interventions that reduce state anxiety may promote favourable learning outcomes in young adults.

Mindfulness in Surgical Training (MiST): A Modified Mindfulness Curriculum for Surgical Residents

OBJECTIVES

Residents experience numerous work-related and personal stressors that make it difficult to focus in the operating room, negatively impacting learning and surgical performance. Mindfulness-based cognitive therapy decreases anxiety and improves memory and learning. This study aimed to create a feasible and desirable modified mindfulness curriculum for surgical residents.

DESIGN

This was a prospective cohort study using multiple methods design to assess a 12-week modified mindfulness curriculum tailored to busy surgical trainees involving a 30 min group session weekly and 15 minutes home practice daily. The main outcomes were program feasibility and desirability. Focus groups explored how mindfulness techniques were used in the operating room. Secondary outcomes were measured in a pre- and post- intervention design assessing surgical performance, anxiety, confidence and burnout using validated assessment scales. Outcome measures were collected at baseline, immediately following the course and at 3 months postintervention.

SETTING

Academic obstetrics and gynecology residency program.

PARTICIPANTS

Obstetrics and gynecology residents in postgraduate years 2-5 at the University of Toronto were invited to participate in Mindfulness in Surgical Training.

RESULTS

Twelve (20%) out of 61 eligible residents enrolled in the program and 8 (67%) completed the course. There was a statistically significant decrease in anxiety (p < 0.001) and increase in surgical confidence (p = 0.007) following the mindfulness curriculum using validated survey tools. There was no change in burnout or surgical performance evaluations. Thematic analysis identified that mindfulness tools were beneficial and regularly utilized by participants in the operating room with sustained use 3 months post intervention. The biggest barrier to participation in the mindfulness curriculum was time. Participants felt the residency program should support ongoing mindfulness training to promote a positive culture shift.

CONCLUSIONS

A modified mindfulness curriculum designed for surgical trainees is feasible, desirable, reduces anxiety and increases surgical confidence.

eHealth, digital information and technology use of men with prostate cancer

Background

The investigation of digital information sources and technologies specifically used by men with prostate cancer is scarce. This study seeks to address current gaps in the literature by investigating prostate cancer-specific internet and technology use by men with prostate cancer and factors associated with this use.

Methods

Cross-sectional surveys were conducted in three Australian urology clinics (local in Sydney, Western Sydney and Murrumbidgee) in 2023. Data analysis included descriptive and bivariate analysis. Chi square tests of independence, Mann-Whitney U tests and Fischer exact tests were used to assess demographic, prostate cancer-specific and psychometric variables with prostate cancer-specific usage of each website, social media and technology type.

Results

A total of 349 men responded. Mean age of respondents was 69.6 years (SD 7.8). 74.5% (n = 260) had undergone radical prostatectomy, while 10% (n = 35) reported locally advanced/metastatic disease. Information websites were used by 77.7% (n = 271) of men. Social media was used by 37% (n = 129), and total internet use was 79.1% (n = 276). Younger age, higher education and higher income were commonly associated with a greater extent of use of information source and technology types. High variability in usage and factor association was demonstrated between and within analysed group categories.

Conclusions

Men with prostate cancer use a broad variety of digital information sources and technologies to access prostate cancer information at a higher rate than ever before. This work stresses the significant variability in the extent of use which men demonstrate among these resources and the factors which may play a role in this behaviour.

Effectiveness of mental health literacy intervention and contact-based education on knowledge, attitude, and stigma towards mental health among secondary school students in Chennai, South India: A cluster randomized controlled trial

BACKGROUND

Global trends indicate a rise in mental health disorders among youth, prompting need for effective interventions. Mental health literacy interventions have demonstrated benefits such as improved knowledge, treatment understanding, help-seeking behaviors, and stigma reduction. This study aimed to assess the impact of a comprehensive mental health literacy program on knowledge, attitudes, and stigma related to mental health among secondary school students in Chennai.

METHODS

Cluster-randomized controlled trial was conducted among students from four secondary schools. Randomization was at cluster level to minimize contamination. Participating schools provided consent, and all ninth-grade students were invited to participate. Written informed consent was obtained from parents/guardians, and assent was obtained from students. There were no specific exclusion criteria, except for students who declined to participate. Analyses were performed using intention-to-treat principles, with multiple imputation for missing outcome data.

RESULTS

After adjusting for cluster effects, the intervention group showed a significant improvement in attitude scores compared to the control group (mean difference 0.85, 95 % CI: 0.32-1.39, p = 0.002). However, no significant differences were observed between the two groups in terms of knowledge and stigma.

CONCLUSION

The findings suggest that delivering a mental health literacy curriculum alongside contact-based education involving individuals with lived experiences of mental disorders positively influences students' attitudes toward mental health. Although no significant changes were observed in knowledge and stigma levels, the integration of mental health literacy programs with personal narratives from those with lived experiences holds promise for addressing mental health stigma and promoting positive attitudes among school students.

Reciprocal cognitive and emotional interaction in STEMM university learning and teaching

University learning and teaching involves contrasting and interacting emotional experiences. Even in disciplines considered as objective as Science and Engineering, emotion plays a significant role in catalysing and sustaining learning. Although emotions are individually felt, they are socially constructed between people. This is especially relevant in group-based learning evident in much contemporary higher education. This paper applies the concept of emotion socialization to illustrate how groups of students and teachers cope and succeed in cognitively and emotionally challenging learning settings. The study is based on qualitative data collected across six STEMM university departments, from 280 students via in-situ questionnaires and from 20 teachers via group and follow-up interviews. Two key findings offer insight into processes of reciprocal influence on cognition and emotion. The first relates to ways in which students' and teachers' differing knowledge-related goals and relationships with knowledge influenced cognition and emotion, uncovering previously unacknowledged connections. The second relates to how students' comparisons of progress towards academic goals with peers contributed considerably to their emotional experiences in cognitively and emotionally helpful and unhelpful ways. Practical implications are presented, including possibilities for capitalising on existing emotion socialization processes and enhancing how they influence cognition and emotional well-being.

The relationship of academic procrastination on non-English majors' English classroom anxiety: a moderated mediation model

Objective

Academic procrastination is negatively associated with English classroom anxiety among non-English major college students. However, current research has less explored the underlying mechanisms. The present study aims to investigate the relationship between academic procrastination and college students' English classroom anxiety as well as the mediating role of learning engagement and the moderating role of appraisals of intrinsic values.

Methods

The academic procrastination scale, English classroom anxiety scale, learning engagement scale and appraisals of intrinsic values scale were used to measure 1,079 non-English majors in Jiangsu Province, China.

Results

(1) There was a significant positive correlation between academic procrastination and English classroom anxiety of non-English majors. (2) Learning engagement plays a part of mediating role between academic procrastination and English classroom anxiety; (3) When the appraisals of intrinsic values are high, the impact effect of learning engagement on English classroom anxiety is greater.

Conclusion

Academic procrastination can affect university students' English classroom anxiety through learning engagement, and this relational pattern is modulated by appraisals of intrinsic values. This finding provides an important theoretical basis and practical insights for understanding and intervening in academic procrastination and classroom anxiety among college students.

Noradrenergic alterations associated with early life stress

Significant stress in childhood or adolescence is linked to both structural and functional changes in the brain in human and analogous animal models. In addition, neuromodulators, such as noradrenaline (NA), show life-long alterations in response to these early life stressors, which may impact upon the sensitivity and time course of key adrenergic activities, such as rapid autonomic stress responses (the 'fight or flight response'). The locus-coeruleus noradrenergic (LC-NA) network, a key stress-responsive network in the brain, displays numerous changes in response to significant early- life stress. Here, we review the relationship between NA and the neurobiological changes associated with early life stress and set out future lines of research that can illuminate how brain circuits and circulating neurotransmitters adapt in response to childhood stressors.

Review: seizure-related consolidation and the network theory of epilepsy

Epilepsy is a complex, multifaceted disease that affects patients in several ways in addition to seizures, including psychological, social, and quality of life issues, but epilepsy is also known to interact with sleep. Seizures often occur at the boundary between sleep and wake, patients with epilepsy often experience disrupted sleep, and the rate of inter-ictal epileptiform discharges increases during non-REM sleep. The Network Theory of Epilepsy did not address a role for sleep, but recent emphasis on the interaction between epilepsy and sleep suggests that post-seizure sleep may also be involved in the process by which seizures arise and become more severe with time ("epileptogenesis") by co-opting processes related to the formation of long-term memories. While it is generally acknowledged that recurrent seizures arise from the aberrant function of neural circuits, it is possible that the progression of epilepsy is aided by normal, physiological function of neural circuits during sleep that are driven by pathological signals. Studies recording multiple, single neurons prior to spontaneous seizures have shown that neural assemblies activated prior to the start of seizures were reactivated during post-seizure sleep, similar to the reactivation of behavioral neural assemblies, which is thought to be involved in the formation of long-term memories, a process known as Memory Consolidation. The reactivation of seizure-related neural assemblies during sleep was thus described as being a component of Seizure-Related Consolidation (SRC). These results further suggest that SRC may viewed as a network-related aspect of epilepsy, even in those seizures that have anatomically restricted neuroanatomical origins. As suggested by the Network Theory of Epilepsy as a means of interfering with ictogenesis, therapies that interfered with SRC may provide some anti-epileptogenic therapeutic benefit, even if the interference targeted structures that were not involved originally in the seizure. Here, we show how the Network Theory of Epilepsy can be expanded to include neural plasticity mechanisms associated with learning by providing an overview of Memory Consolidation, the mechanisms thought to underlie MC, their relation to Seizure-Related Consolidation, and suggesting novel, anti-epileptogenic therapies targeting interference with network activation in epilepsy following seizures during post-seizure sleep.

Visual sequence encoding is modulated by music schematic structure and familiarity

Music is omnipresent in daily life and may interact with critical cognitive processes including memory. Despite music's presence during diverse daily activities including studying, commuting, or working, existing literature has yielded mixed results as to whether music improves or impairs memory for information experienced in parallel. To elucidate how music memory and its predictive structure modulate the encoding of novel information, we developed a cross-modal sequence learning task during which participants acquired sequences of abstract shapes accompanied with paired music. Our goal was to investigate whether familiar and structurally regular music could provide a "temporal schema" (rooted in the organized and hierarchical structure of music) to enhance the acquisition of parallel temporally-ordered visual information. Results revealed a complex interplay between music familiarity and music structural regularity in learning paired visual sequences. Notably, compared to a control condition, listening to well-learned, regularly-structured music (music with high predictability) significantly facilitated visual sequence encoding, yielding quicker learning and retrieval speed. Conversely, learned but irregular music (where music memory violated musical syntax) significantly impaired sequence encoding. While those findings supported our mechanistic framework, intriguingly, unlearned irregular music-characterized by the lowest predictability-also demonstrated memory enhancement. In conclusion, this study demonstrates that concurrent music can modulate visual sequence learning, and the effect varies depending on the interaction between both music familiarity and regularity, offering insights into potential applications for enhancing human memory.

Effect of acute and chronic stress on memory impairment and hippocampal oxidative stress following global cerebral ischemia in adult male rats

Background and purpose

Stress, especially immobility stress, is quite common and one of the most important and influential risk factors in neurological disorders. This study aimed to investigate the effect of acute and chronic immobility stress on the level of cortical and hippocampal oxidative stress indicators and memory impairment following global cerebral ischemia.

Experimental approach

In this study, 48 male Wistar rats were randomly divided into 6 groups: 1, sham (S); 2, sham-acute stress (SSA); 3, sham-chronic stress (SSC); 4, ischemia (IS); 5, ischemia-acute stress (ISA); 6, ischemia-chronic stress (ISC). The Morris water maze (MWM) test was performed 14 days after surgery, and cortisol levels and oxidative stress factors such as malondialdehyde MDA and total thiol were measured.

Findings/Results

In the MWM test, the time to find the platform (latency time) in the ISC and IS groups significantly increased compared to the S group. The time spent in the target quarter in these two groups was significantly reduced compared to the S group on the day of the probe. The results showed a significant increase in cortisol levels and malondialdehyde concentration in the ISA, ISC, and IS groups compared to the S group, but there was no significant difference in total thiol concentration. No significant difference was observed in the level of oxidative stress factors in the cortex.

Conclusion and implication

Chronic immobility stress could reduce antioxidant factors in the hippocampus and exacerbate memory impairment caused by global ischemia.

Effects of Acute Mental Stress on Choroidal Thickness

Purpose: Previous studies have indicated an association between education and myopia, suggesting that numerous stress events during the educational process may influence eye health. This study aimed to investigate the impact of mental stress induced by mental arithmetic (MA) on choroidal thickness (CT). Methods: This study included 33 participants aged between 19 and 29 years. Swept-source optical coherence tomography (SS-OCT) was used to capture images of the posterior segment of the left eye during baseline and MA to assess changes in the CT. After denoising and compensation, the baseline images and MA images that had been rigidly registered and resampled to the baseline images were segmented using a deep learning-based method. Based on the segmentation results, the CT within the regions of 1 mm and 3 mm diameter centered at the lowest point of the fovea was calculated. Results: Significant increases were observed in both CT1mm and CT3mm during MA, with mean changes of 2.742 ± 7.098 μm (p = 0.034) and 3.326 ± 6.143 μm (p < 0.001), respectively. Conclusions: Thickening of the choroid has been observed during acute mental stress. We speculate that long-term or chronic mental stress could have a potential adverse impact on myopia progression.

How emotions shape memory? The moderating effect of healthy emotionality on eyewitness testimony

The influence of emotions on memory is a significant topic in the psychology of eyewitness testimony. However, conflicting results have arisen, possibly due to varying approaches and methodologies across studies. These discrepancies might also arise from inadequate consideration of individual differences in emotionality. Therefore, this study aims to analyze the moderating effect of healthy emotionality on the relationship between emotion and memory of criminal events. The results of our laboratory experiment (N = 150) conducted with VR technology indicate that eyewitnesses of crimes, unlike observers of neutral events, recall details concerning the perpetrators' actions immediately preceding the crime act better. Notably, individuals with lower scores on a scale measuring healthy emotionality (ESQ) demonstrate enhanced recollection for these details. At the same time, emotionality plays no significant role in recollection in repeated measurement, as well as in remembering the neutral event. The emotions experienced during crime observation appear to hinder the recollection of perpetrator appearance and behavior unrelated to the crime. These findings are discussed in light of the adaptive role of negative emotions in detecting danger and preparing for unpleasant stimuli.

The mediating role of ICT learning confidence and technostress between executive functions and digital skills

Having good digital skills is essential today, yet little is known about the cognitive factors that influence the development of these skills. Given the importance of executive functions (EFs) in adapting to environmental changes and acquiring skills, EFs might contribute to acquiring digital skills too. EFs might also influence people's approach toward ICTs and affect digital skills through emotional variables. Therefore, here, we tested whether cognitive control and flexibility are connected to computer and smartphone skills through emotional factors (learning confidence, stress, and attitude). A total of 269 participants (56 males, M = 30 years) filled out our survey which included questionnaires on demographic variables (age, education, and socioeconomic status), ICT motivation, digital skills, EFs, and technology-related emotional factors. EFs were also investigated through two performance-based measures. We used generalized linear models and structural equation modeling to test the associations between these variables. The results showed that smartphone skills were positively associated with self-reported cognitive flexibility through ICT learning confidence and technology-induced stress. Self-reported cognitive control and age were connected to smartphone skills directly. Self-reported cognitive flexibility was also associated with computer skills through ICT learning confidence. In addition, performance-based cognitive control and the level of education were directly linked to computer skills. These results may provide guidance to support digital skills and create digital skill training.

Impaired free recall of neutral but not negative material tested 105 min after cortisol administration

Pharmacological studies have consistently shown memory retrieval impairment after administration of cortisol, particularly pronounced for emotional laboratory material (i.e. list of emotional words). However, it is unclear how pharmacological elevation of cortisol affects memory retrieval of ecologically-relevant emotional material (i.e. similar to a newspaper article about an emotional event). In the present study, we aimed to explore whether cortisol administration affects the recall of ecologically-relevant emotional and neutral material, and when memory retrieval occurs after a longer delay (105 min). In this double-blind, pseudo-randomized, placebo-control study, 79 participants learned a negative text and a neutral text. Twenty-four hours later, they were administrated either 10 mg of hydrocortisone or placebo. After 105 min, participants engaged in free recall of both texts. The group with cortisol administration showed significantly reduced free recall compared to the placebo group. Interestingly, this memory retrieval impairment was driven by significantly lower recall after cortisol vs. placebo administration for neutral texts, but not negative texts. The current finding suggests that cortisol administration impairs neutral ecologically-relevant material while leaving emotional material unaffected. These divergent findings, compared to existing literature, emphasize the necessity of employing more ecologically validated material to gain a more comprehensive understanding of the intricate interplay between cortisol administration and memory for ecological material.

Comparing the stress response using heart rate variability during real and simulated crises: a pilot study

Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.

Maladaptation of dentate gyrus mossy cells mediates contextual discrimination deficit after traumatic stress

Fear overgeneralization is a maladaptive response to traumatic stress that is associated with the inability to discriminate between threat and safety contexts, a hallmark feature of post-traumatic stress disorder (PTSD). However, the neural mechanisms underlying this deficit remain unclear. Here, we show that traumatic stress exposure impairs contextual discrimination between threat and safety contexts in the learned helplessness (LH) model. Mossy cells (MCs) in the dorsal hippocampus are suppressed in response to traumatic stress. Bidirectional manipulation of MC activity in the LH model reveals that MC inhibition is causally linked to impaired contextual discrimination. Mechanistically, MC inhibition increases the number of active granule cells in a given context, significantly overlapping context-specific ensembles. Our study demonstrates that maladaptive inhibition of MCs after traumatic stress is a substantial mechanism underlying fear overgeneralization with contextual discrimination deficit, suggesting a potential therapeutic target for cognitive symptoms of PTSD.

New Insights on Expert Opinion About Eyewitness Memory Research

Experimental psychologists investigating eyewitness memory have periodically gathered their thoughts on a variety of eyewitness memory phenomena. Courts and other stakeholders of eyewitness research rely on the expert opinions reflected in these surveys to make informed decisions. However, the last survey of this sort was published more than 20 years ago, and the science of eyewitness memory has developed since that time. Stakeholders need a current database of expert opinions to make informed decisions. In this article, we provide that update. We surveyed 76 scientists for their opinions on eyewitness memory phenomena. We compared these current expert opinions to expert opinions from the past several decades. We found that experts today share many of the same opinions as experts in the past and have more nuanced thoughts about two issues. Experts in the past endorsed the idea that confidence is weakly related to accuracy, but experts today acknowledge the potential diagnostic value of initial confidence collected from a properly administered lineup. In addition, experts in the past may have favored sequential over simultaneous lineup presentation, but experts today are divided on this issue. We believe this new survey will prove useful to the court and to other stakeholders of eyewitness research.

Alternation of social behaviors for zebrafish (Danio rerio) in response to acute cold stress

Low temperature is one of the most common abiotic stresses for aquatic ectotherms. Ambient low temperatures reduce the metabolic rate of teleosts, therefore, teleosts have developed strategies to modulate their physiological status for energy saving in response to cold stress, including behaviors, circulatory system, respiratory function, and metabolic adjustments. Many teleosts are social animals and they can live in large schools to serve a variety of functions, including predator avoidance, foraging efficiency, and reproduction. However, the impacts of acute cold stress on social behaviors of fish remain unclear. In the present study, we test the hypothesis that zebrafish alter their social behaviors for energy saving as a strategy in response to acute cold stress. We found that acute cold stress increased shoaling behavior that reflected a save-energy strategy for fish to forage and escape from the predators under cold stress. The aggressive levels measured by fighting behavior tests and mirror fighting tests were reduced by cold treatment. In addition, we also found that acute cold stress impaired the learning ability but did not affect memory. Our findings provided evidence that acute cold stress alters the social behaviors of aquatic ectotherms for energy saving; knowledge of their responses to cold is essential for their conservation and management.

Effect of emotions on learning, memory, and disorders associated with the changes in expression levels: A narrative review

Emotions, in general, have no scientific definition. Emotions can be denoted as the mental state because of the neurophysiological changes. Emotions are related to mood, personality, temperament, and consciousness. People exhibit different emotions in different situations causing changes in cognitive functions. One of the major cognitive functions is the ability to learn, to store the acquired information in the parts of the brain such as the hippocampus, amygdala, cortex, and cerebellum. Learning and memory are affected by different types of emotions. Emotional responses such as fear, depression, and stress have impaired effects on cognitive functions such as learning and memory, whereas optimistic and happy emotions have positive effects on long-term memory. Certain disorders have greater effects on the regions of the brain which are also associated with synaptic plasticity and Learning and Memory(LM). Neuroimaging techniques are involved in studying the changing regions of the brain due to varied emotions and treatment strategies based on the changes observed. There are many drugs, and in advancements, nanotechnology is also utilized in the treatment of such psychiatric disorders. To improve mental health and physical health, emotional balance is most important, and effective care should be provided for people with less emotional quotient and different types of disorders to inhibit cognitive dysfunctions. In this review, emotions and their varied effects on a cognitive function named learning and memory, disorders associated with the defects of learning due to emotional instability, the areas of the brain that are in control of emotions, diagnosis, and treatment strategies for psychiatric disorders dependent on emotions are discussed.

Effectiveness of Online Food-Safety Educational Programs: A Systematic Review, Random-Effects Meta-Analysis, and Thematic Synthesis

Online food-safety educational programs are increasingly important to educate different populations as technology and culture shift to using more technology. However, the broad effectiveness of these programs has yet to be examined. A systematic review, random-effects meta-analysis, and thematic synthesis are conducted to identify the effect size of online food-safety educational programs on knowledge, attitudes, and practices of consumers, food workers, and students and their respective barriers and recommendations. Online food-safety education was found to be of moderate and low effectiveness, with attitudes being the lowest in all populations. Consumers struggled with staying focused, and it was found that messaging should focus on risk communication. Students struggled with social isolation and a lack of time, and it was recommended that videos be used. Food workers struggled with a lack of time for training and difficulty understanding the material, and future programs are recommended to implement shorter but more frequent trainings with simple language. Future online food-safety educational programs should focus on incorporating social elements, as they can remain a huge barrier to learning. They should also focus on changing the participant's attitude to risk perception and beliefs in the importance of food safety.

Psychological and physiological effects of an acute bout of yoga before a simulated academic exam in university students

Objective: Test anxiety is common among nursing students. Yoga is one form of physical activity which may be beneficial for pretest anxiety. Participants: Thirteen undergraduate students (85% nursing majors, 15% awaiting program entry, 20 ± 4.9 years of age) completed the crossover design study. Methods: Participants completed a yoga or control intervention (independent quiet study) on opposing testing days. At three time points, participants provided ratings of anxiety (visual analog scales), saliva samples for cortisol and alpha amylase, and seated heart rate variability (HRV, time and frequency domains) was recorded. Results: Yoga prior to a simulated exam had a positive impact on subjective measures of stress but did not positively impact cortisol or HRV compared to the control condition. Conclusions: There may be benefits to participating in 30 min of moderate intensity yoga for reduced perception of stress before a scholarly examination. Further research regarding the impacts of acute yoga on physiological measures of HRV and/or cortisol are warranted.

Acute stress negatively impacts on-task behavior and lecture comprehension

Acute stress has been shown to disrupt cognitive and learning processes. The present study examined the effects of acute stress on mind wandering during a lecture and subsequent lecture comprehension in young adults. Forty participants were randomized to acute stress induction via the Trier Social Stress Test or rest prior to watching a twenty-minute video lecture with embedded mind wandering probes, followed by a lecture comprehension assessment. Stress responses were assessed via heart rate, blood pressure, salivary cortisol, and state anxiety. Individuals exposed to acute stress endorsed greater mind wandering at the first checkpoint and lower lecture comprehension scores. Moreover, state anxiety post stress was positively associated with mind wandering at the first and second checkpoint and negatively associated with lecture comprehension. Only mind wandering at the third checkpoint was negatively correlated with overall lecture comprehension. Taken together, these data suggest that acute stress, mind wandering, and lecture comprehension are inextricably linked.

Grade prediction in the middle east: a post-pandemic case study of the optimism bias

Evidence exists that the pandemic has brought about stress, and altered study habits and academic performance. No evidence exists regarding whether metacognition has also been altered. The present field study examined the accuracy and confidence with which college students make grade predictions in a general education course after the pandemic. It tested whether one of three types of biases affected students' predictions as a way to cope with the uncertainty of a final exam's outcome: illusion-of-knowing, optimism, and pessimistic bracing. Students made predictions both before and after completing the final exam (summative assessment) to determine the impact of each of the hypothesized biases on estimates made in a context of varying uncertainty. Accuracy was computed as the difference between expected and actual grades on the final exam. Confidence in the predictions made was measured on a Likert scale. Exam performance was categorized as good, poor, or inadequate. In this study, less-than-desirable performance was accompanied by overestimations. However, overestimations were made with little confidence and benefited from the information acquired from completing the exam. This pattern of results suggests that students who are not doing well are not under the spell of the illusion-of-knowing phenomenon. Indeed, their optimistic predictions are punctured by the awareness of a likely undesirable outcome (as indicated by their weak confidence in the predictions made). Implications and applications of these findings are discussed.

A paradoxical switch: the implications of excitatory GABAergic signaling in neurological disorders

Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the central nervous system. In the mature brain, inhibitory GABAergic signaling is critical in maintaining neuronal homeostasis and vital human behaviors such as cognition, emotion, and motivation. While classically known to inhibit neuronal function under physiological conditions, previous research indicates a paradoxical switch from inhibitory to excitatory GABAergic signaling that is implicated in several neurological disorders. Various mechanisms have been proposed to contribute to the excitatory switch such as chloride ion dyshomeostasis, alterations in inhibitory receptor expression, and modifications in GABAergic synaptic plasticity. Of note, the hypothesized mechanisms underlying excitatory GABAergic signaling are highlighted in a number of neurodevelopmental, substance use, stress, and neurodegenerative disorders. Herein, we present an updated review discussing the presence of excitatory GABAergic signaling in various neurological disorders, and their potential contributions towards disease pathology.

Stress-related cellular pathophysiology as a crosstalk risk factor for neurocognitive and psychiatric disorders

In this narrative review, we examine biological processes linking psychological stress and cognition, with a focus on how psychological stress can activate multiple neurobiological mechanisms that drive cognitive decline and behavioral change. First, we describe the general neurobiology of the stress response to define neurocognitive stress reactivity. Second, we review aspects of epigenetic regulation, synaptic transmission, sex hormones, photoperiodic plasticity, and psychoneuroimmunological processes that can contribute to cognitive decline and neuropsychiatric conditions. Third, we explain mechanistic processes linking the stress response and neuropathology. Fourth, we discuss molecular nuances such as an interplay between kinases and proteins, as well as differential role of sex hormones, that can increase vulnerability to cognitive and emotional dysregulation following stress. Finally, we explicate several testable hypotheses for stress, neurocognitive, and neuropsychiatric research. Together, this work highlights how stress processes alter neurophysiology on multiple levels to increase individuals' risk for neurocognitive and psychiatric disorders, and points toward novel therapeutic targets for mitigating these effects. The resulting models can thus advance dementia and mental health research, and translational neuroscience, with an eye toward clinical application in cognitive and behavioral neurology, and psychiatry.

Berberine derivatives as inhibitors of acetylcholinesterase: A systematic review

Alzheimer's disease (AD) is a chronic age-related neurodegenerative brain disorder characterized by the impairment of memory accompanied by worsening of thinking ability of an individual. The exact pathophysiology of AD is not fully understood. However low level of the neurotransmitter named acetylcholine (ACh), aggregation of Aβ peptide into toxic Aβ plaque, hyperphosphorylation of tau, bio-metal imbalance, and oxidative stress are the main hallmarks of this disease. Due to the complex pathophysiology of AD, no specific treatment is available in the market, and treatment is only limited to the symptomatic relief. So, there is an urgent need for the development of new drug candidate, which can have disease-modifying effect and improve learning and memory in AD patient. Therefore, berberine-based multifunction compounds with potential cholinesterase inhibitory properties were reviewed in this article. Structure-activity relationship (SAR) and biological activity provide highlights on the new derivatives used for the management of AD.

Psychophysiological fidelity: A comparative study of stress responses to real and simulated clinical emergencies

INTRODUCTION

Experiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real-world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real-world clinical practice.

METHODS

In this within-subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real-world emergencies in a 6-month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (SD) participant age was 33 (8) years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20 min after simulated and real-world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State-Trait Anxiety Inventory, respectively. High-frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings.

RESULTS

Simulation was associated with greater likelihood of threat appraisal and higher state anxiety. High-frequency HRV reduced from baseline in simulated and real-world emergencies but recovered further towards baseline 20 min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post-simulation debrief and feedback.

DISCUSSION

This study identifies important differences in psychophysiological stress responses to simulated and real-world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real-world clinical practice.

Modeling Brain Dynamics During Virtual Reality-Based Emergency Response Learning Under Stress

BACKGROUND

Stress affects learning during training, and virtual reality (VR) based training systems that manipulate stress can improve retention and retrieval performance for firefighters. Brain imaging using functional Near Infrared Spectroscopy (fNIRS) can facilitate development of VR-based adaptive training systems that can continuously assess the trainee's states of learning and cognition.

OBJECTIVE

The aim of this study was to model the neural dynamics associated with learning and retrieval under stress in a VR-based emergency response training exercise.

METHODS

Forty firefighters underwent an emergency shutdown training in VR and were randomly assigned to either a control or a stress group. The stress group experienced stressors including smoke, fire, and explosions during the familiarization and training phase. Both groups underwent a stress memory retrieval and no-stress memory retrieval condition. Participant's performance scores, fNIRS-based neural activity, and functional connectivity between the prefrontal cortex (PFC) and motor regions were obtained for the training and retrieval phases.

RESULTS

The performance scores indicate that the rate of learning was slower in the stress group compared to the control group, but both groups performed similarly during each retrieval condition. Compared to the control group, the stress group exhibited suppressed PFC activation. However, they showed stronger connectivity within the PFC regions during the training and between PFC and motor regions during the retrieval phases.

DISCUSSION

While stress impaired performance during training, adoption of stress-adaptive neural strategies (i.e., stronger brain connectivity) were associated with comparable performance between the stress and the control groups during the retrieval phase.

Nursing students' perceived anxiety and heart rate variability in mock skill competency assessment

BACKGROUND

Skill competency assessments induce stress and anxiety and may affect nursing student performance. Little is known about stress and perceived anxiety levels and their relationship in the mock skill competency assessment.

METHODS

A cross-sectional study was conducted to examine the stress levels (as assessed by heart rate variability, HRV) and perceived anxiety before, during and after the mock skill competency assessment, and to explore their relationships to performance in a total of ninety first-year undergraduate nursing students.

RESULTS

The HRV decreased significantly during the assessment and increased significantly 10 min after the assessment (p < 0.01). Higher performers showed significantly lower HRV during and after the assessment (p < 0.01). The assessment score was negatively correlated with HRV during and after the assessment (p < 0.05).

CONCLUSIONS

Considering assessment-related stress and anxiety through a mock assessment prior to the actual skill assessment provides implications for future nursing education.

Acute stress impacts reaction times in older but not in young adults in a flanker task

Acute psychosocial stress effects on inhibition have been investigated in young adults, but little is known about these effects in older adults. The present study investigated effects of the Trier Social Stress Test on cognitive inhibition (i.e., ability to ignore distracting information) using a cross-over (stress vs. control) design in healthy young (N = 50; 18-30 years; Mage = 23.06) versus older adults (N = 50; 65-84 years; Mage = 71.12). Cognitive inhibition was measured by a letter flanker task and psychophysiological measures (cortisol, heart rate, subjective stress) validated the stress induction. The results showed that while stress impaired overall accuracy across age groups and sessions, stress (vs. control) made older adults' faster in session 1 and slower in session 2. Given that session 2 effects were likely confounded by practice effects, these results suggest that acute psychosocial stress improved older adults' RTs on a novel flanker task but impaired RTs on a practiced flanker task. That is, the interaction between stress and learning effects might negatively affect response execution when testing older adults on flanker tasks. If confirmed by future research, these results might have important implications especially in settings where repeated cognitive testing is performed under acute stress.

Time-course adaptive changes in hippocampal transcriptome and synaptic function induced by simulated microgravity associated with cognition

Introduction

The investigation of cognitive function in microgravity, both short-term and long-term, remains largely descriptive. And the underlying mechanisms of the changes over time remain unclear.

Methods

Behavioral tests, electrophysiological recording, and RNA sequencing were used to observe differences in behavior, synaptic plasticity, and gene expression.

Results

Initially, we measured the performance of spatial cognition exposed to long-term simulated microgravity (SM). Both working memory and advanced cognitive abilities were enhanced. Somewhat surprisingly, the synaptic plasticity of the hippocampal CA3-CA1 synapse was impaired. To gain insight into the mechanism of changing regularity over time, transcriptome sequencing in the hippocampus was performed. The analysis identified 20 differentially expressed genes (DEGs) in the hippocampus after short-term modeling, 19 of which were up-regulated. Gene Ontology (GO) analysis showed that these up-regulated genes were mainly enriched in synaptic-related processes, such as Stxbp5l and Epha6. This might be related to the enhancement of working memory performance under short-term SM exposure. Under exposure to long-term SM, 7 DEGs were identified in the hippocampus, all of which were up-regulated and related to oxidative stress and metabolism, such as Depp1 and Lrg1. Compensatory effects occurred with increased modeling time.

Discussion

To sum up, our current research indicates that the cognitive function under SM exposure is consistently maintained or potentially even being enhanced over both short and long durations. The underlying mechanisms are intricate and potentially linked to the differential expression of hippocampal-associated genes and alterations in synaptic function, with these effects being time-dependent. The present study will lay the experimental and theoretical foundation of the multi-level mechanism of cognitive function under space flight.

Psychological Stress Experienced by First-Year Medical Undergraduates: A Cross-Sectional Study From Eastern India

Background While medical education is vital for producing competent physicians, its rigorous curriculum can harm students' mental well-being. This study focuses on assessing psychological stress in first-year medical students in Eastern India and aims to identify its primary causes. Methods This cross-sectional study involved 125 first-year MBBS students in a tertiary care medical teaching institution in eastern India. They completed the Medical Student Stressor Questionnaire (MSSQ-40) questionnaire to measure stress and provided academic records to be reviewed.  Results Among the 125 students included in the study, male students demonstrated greater academic and interpersonal stress. The findings revealed that a substantial proportion (79%) of the student population experienced high to severe levels of academic stress, followed by 88% who reported moderate to high levels of social-related stress. Furthermore, it was observed that those students who experienced high to severe stress across all six domains tended to perform poorly during the initial half of their academic year. Conclusion The high levels of stress experienced by medical students can have significant implications for their academic performance. However, the nature of our study limits us to only highlight the existence of a correlation between the two. Future studies on the same should be conducted to assess the causal relation between these factors.

Understanding underperformance in a high-stakes clinical-based simulation assessment in physiotherapy: a descriptive analysis

BACKGROUND

High-stakes assessments are often used as a 'gate-keeper' activity for entry into the health professions by ensuring that the minimum core competency thresholds of the profession are met. The aim of the study was to explore if common areas of underperformance existed in international candidates assessed with a high-stakes clinical-based simulation assessment for entry into the physiotherapy profession in Australia.

METHODS

A retrospective mixed methods analysis of the clinical assessments completed by international candidates over a one-month period in 2021 that were deemed as not meeting competency. The clinical assessments were completed in one of the three practice areas: cardiorespiratory, musculoskeletal, or neurological rehabilitation. Each assessment was scored by two independent assessors, who discussed the performance and then completed a moderated assessment form. The assessment form used to score competency included seven domains such as initial assessment, effective treatment, communication skills, and risk management.

RESULTS

Fifty-one clinical assessments graded as not competent were analysed. Across the practice areas, a high failure rate was found in domains related to interpreting assessment findings and developing a treatment plan. This trend was also observed in the qualitative data, suggesting candidates struggled to meet competency in areas of planning and prioritisation, interpretation and implementation of the information gathered, and selection and evaluation of effective treatment.

CONCLUSION

These findings align with published data on the underperformance of Australian physiotherapy students in clinical placement settings, suggesting these issues are not specific to high stakes assessment of overseas physiotherapists, and that education needs to focus on improving these skills within the profession at all levels. With the identified areas of underperformance aligning with the ability to use higher order thinking and skills integral to clinical reasoning, improvements in the education and implementation of clinical reasoning may be a place to start.

Strong but Fragmented Memory of a Stressful Episode

While it is commonly assumed that stressful events are vividly remembered, it remains largely unknown whether all aspects of memory for a stressful episode are enhanced. In this preregistered study, we tested whether stress enhances later remembering of individual elements of a stressful episode at the cost of impaired processing of the association between these elements. Therefore, male and female participants (N = 122) underwent a stressful (or control) episode during which they encoded a series of stimuli. To investigate stress effects on the memory for individual events and the links between these, we used temporal sequence effects in recognition memory tested 24 h after encoding. Specifically, we tested whether stress would affect the memory enhancement for a target item if this is preceded by another item that also preceded the target during encoding (recognition priming). Our results showed that participants recalled single events encoded under stress better than those encoded under nonstressful conditions, but were less able to leverage the temporal sequence of events encoded under stress to cue memory at delayed recall, reflected in reduced memory for items preceded by the item that preceded them also during encoding. Functional near-infrared spectroscopy further revealed that encoding under stress was accompanied by opposite changes in inferotemporal and dorsolateral prefrontal areas. Together, our data suggest that acute stress induces a mode of memory formation that results in strong but less integrated memories.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis

AIM

To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation.

REVIEW METHODS

This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods.

RESULTS

Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence.

CONCLUSIONS

Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions.

RELEVANCE TO CLINICAL PRACTICE

These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Learning by Heart or with Heart: Brain Asymmetry Reflects Pedagogical Practices

Brain hemispheres develop rather symmetrically, except in the case of pathology or intense training. As school experience is a form of training, the current study tested the influence of pedagogy on morphological development through the cortical thickness (CTh) asymmetry index (AI). First, we compared the CTh AI of 111 students aged 4 to 18 with 77 adults aged > 20. Second, we investigated the CTh AI of the students as a function of schooling background (Montessori or traditional). At the whole-brain level, CTh AI was not different between the adult and student groups, even when controlling for age. However, pedagogical experience was found to impact CTh AI in the temporal lobe, within the parahippocampal (PHC) region. The PHC region has a functional lateralization, with the right PHC region having a stronger involvement in spatiotemporal context encoding, while the left PHC region is involved in semantic encoding. We observed CTh asymmetry toward the left PHC region for participants enrolled in Montessori schools and toward the right for participants enrolled in traditional schools. As these participants were matched on age, intelligence, home-life and socioeconomic conditions, we interpret this effect found in memory-related brain regions to reflect differences in learning strategies. Pedagogy modulates how new concepts are encoded, with possible long-term effects on knowledge transfer.