The role of adjuvant treatment for early-stage uterine clear cell carcinomas

BACKGROUND

Uterine clear cell carcinoma is a rare and aggressive subtype of endometrial carcinoma. Prospective clinical trials have not been feasible for this rare tumor, and data regarding the optimal adjuvant treatment regimen for early-stage uterine clear cell carcinomas is limited. Our study's objective was to determine if adjuvant chemotherapy or radiation therapy improves patients' outcomes in stage I and II uterine clear cell carcinoma.

METHODS

Patients with stage I and II uterine clear cell carcinoma were identified at a single institution. All cases were reviewed by a gynecologic pathologist. Both pure and mixed non-serous uterine clear cell carcinomas were included. Primary outcomes were recurrence free survival and overall survival.

RESULTS

A total of 71 patients were identified including 39 (55%) pure and 32 (45%) mixed clear cell carcinoma. Most patients were FIGO stage IA (77.5%). Most patients (n = 58, 82%) received adjuvant therapy, including 43 (61%) receiving chemotherapy, 50 (70%) receiving radiation therapy, and 35 (49%) receiving both. Recurrence free survival was not significantly different among patients receiving no or <6 cycles of chemotherapy versus patients receiving 6 cycles of chemotherapy (p = 0.39). However, median OS was significantly different among patients receiving no or <6 cycles of chemotherapy versus 6 cycles of chemotherapy (p = 0.004). On univariable analysis, 6 cycles of chemotherapy was significantly associated with improved OS (HR 0.1, 95% CI 0.01-0.07). Presence of LVSI, mutated p53, number of pelvic and para-aortic lymph nodes assessed, adjuvant chemotherapy (any number of cycles), and >2 medical co-morbidities were not significant predictors of OS on univariable analysis. On multivariable analysis, 6 cycles of adjuvant chemotherapy remained a significant predictor of improved OS (HR 0.1, 95% CI 0.01-0.8).

CONCLUSIONS

In this study, administration of 6 cycles of chemotherapy appears to significantly improve OS. This finding suggests consideration of 6 cycles of adjuvant chemotherapy in patients with early-stage uterine clear cell carcinoma, however clinical trials are needed to confirm these findings.

Cost-effectiveness analysis of tumor molecular classification in high-risk early-stage endometrial cancer

PURPOSE

Tumor molecular analyses in endometrial cancer (EC) includes 4 distinct subtypes: (1) POLE-mutated, (2) mismatch repair protein (MMR) deficient, (3) p53 mutant, and (4) no specific molecular profile. Recently, a sub-analysis of PORTEC-3 demonstrated notable differences in treatment response between molecular classification (MC) groups. Cost of testing is one barrier to widespread adoption of MC. Therefore, we sought to determine the cost-effectiveness of MC in patients with stage I and II high-risk EC.

METHODS

A Markov decision model was developed to compare tumor molecular classification (TMC) vs. no testing (NT). A healthcare payor's perspective and 5-year time horizon were used. Base case data were abstracted from PORTEC-3 and the molecular sub-analysis. Cost and utility data were derived from public databases, peer-reviewed literature, and expert input. Strategies were compared using the incremental cost-effectiveness ratio (ICER) with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Sensitivity analyses were performed to test model robustness.

RESULTS

When compared to NT, TMC was cost effective with an ICER of $25,578 per QALY gained; incremental cost was $1780 and incremental effectiveness was 0.070 QALYs. In one-way sensitivity analyses, results were most sensitive to the cost of POLE testing, but TMC remained cost-effective over all parameter ranges.

CONCLUSIONS

TMC in early-stage high-risk EC is cost-effective, and the model results were robust over a range of parameters. Given that MC can be used to guide adjuvant treatment decisions, these findings support adoption of TMC into routine practice.

Effects of COVID-19 on EMS Refresher Course Completion and Delivery

Introduction: The COVID pandemic has significantly impacted educational development and delivery, yet there is little quantitative research on this topic. The primary objective of this study was to compare the total number of Emergency Medical Service (EMS) Refresher (ER) course completions during 2020 versus prior years. Secondary outcomes examined in person versus on-line/distributive learning during the study period. Methods: The Commission on Accreditation for Prehospital Continuing Education (CAPCE) is the only national organization that accredits continuing education (CE) for paramedics and EMTs and currently has a database with over 14 million CE records. The total number of ER course completions each month in 2020 were compared to 2019 and 2018. We also compared the different educational format types: live in-person (LIP), asynchronous on-line distributive learning (DL), and virtual instructor lead training (VILT) synchronous DL courses. Data was analyzed using descriptive and two-way ANOVA statistics. Results: There were 1,922,783 ER course completions in 2020 versus 1,166,335 in 2019 and 1,074,636 in 2018, representing a 179% increase during the study period. Asynchronous DL course completions in 2020 were 1,830,513 EMS versus 1,078,580 in 2019 and 987,749 in 2018 a 185% increase over the three-year study period. Asynchronous DL monthly means by year was statistically significant, F(2, 99) = 95.632, p < .001. Mean monthly LIP and VLIT educational deliveries by year were not significantly different, p = .802, p = .754, respectively. Total LIP course completions in 2020 were 20,045 versus 51,552 in 2019 and 63,058 in 2018. In 2020 LIP courses made up only 1.0% (20,045/1,922,783) of all ER completions. This study was limited to only EMS professionals taking ER course completions in the CAPCE database. However EMS is not unique, since previous research has suggested that DL has flourished in other health care disciplines while LIP courses have continued to decrease. Conclusion: This large nationwide study of EMS profession has shown the trend toward DL education and a trend away from LIP courses. Future studies should examine the advantages and disadvantages of DL education.

Early outcomes after definitive chemoradiation therapy with Vienna/Venezia hybrid high-dose rate brachytherapy applicators for cervical cancer: A single-institution experience

PURPOSE

The Vienna and Venezia (Elekta) are hybrid intracavitary/interstitial brachytherapy (BT) applicators for cervical cancers unsuitable for intracavitary BT alone to improve target coverage or reduce critical organ dose. There is limited outcome data with the use of these applicators outside published experience of the EMBRACE group. We report feasibility and early outcomes with the use of these hybrid applicators at our institution.

METHODS AND MATERIALS

Hybrid applicators were used to treat 61 patients with cervical cancer from November 2011 to December 2019. Indications for hybrid applicator use were involvement of the vagina in 10 patients (16%), residual central or parametrial disease in 46 patients (75%), and a narrow introitus in 5 patients (9%). Toxicities were graded using the CTCAE v4.0. Outcomes were assessed with the Kaplan-Meier method.

RESULTS

Median follow-up was 16 months (IQR 9-32 mos). Median HRCTV volume was 31.6 cm³ (IQR 25-48 cm³). Median HRCTV D90 was 86.1 Gy (IQR 84.3-88.0 Gy). In 54 patients with follow-up PET/CT at 3 months, complete initial imaging response locally was seen in 46 patients.Estimated 12-month Kaplan-Meier overall survival, locoregional control, distant control, and recurrence-free survival estimates were 86.9%, 80.6%, 73.8%, and 65.9%, respectively. The 12-month incidence of Grade 3+ GI/GU chronic toxicities was 5.7%, consisting of vesicovaginal fistula, rectovaginal fistula, and ureterovesical fistula.

CONCLUSIONS

Our single-institution data support the use of the hybrid applicators, as an alternative to traditional BT applicators when clinically warranted. Use of hybrid applicators is feasible with adequate coverage of disease in the vagina and parametrium.

Social Cognition evolves: Illustrations from our work on Intergroup Bias and on Healthy Adaptation

When we first wrote Social Cognition (1984), social psychology's crisis critiqued methods, replicability, theory, and relevance. Social cognition research illustrates four phases of response to these challenges. First, the Cognitive Miser approach introduced methods less prone to experimenter or participant interference: looking time as attention, categorical memory for who said what. Next, the Motivated Tactician approach addressed replicability by identifying moderator variables, primarily goals and motivations. For example, interdependence (Fiske) and threat (Taylor) are prominent motivations in our respective research. The third wave, perceivers as Activated Actors, translated mental states to behavior, using theory-guided prediction. In intergroup bias, for example, Fiske's Stereotype Content Model predicts patterns of discriminatory behavior distinctive to each combination of stereotypic warmth and competence. Going beyond reported behavior, distinctive activations emerged in brain-imaging and muscle responses. In health psychology, Taylor's Positive Illusions theory predicts people cope with life-threatening illness by viewing the odds optimistically, the self positively, and possible control affirmatively. Again, the social cognitive processes interplay with psycho-physiology. Recently, social cognitive approaches have increasingly addressed inequality: health disparities, bias interventions, power dynamics, class effects, social morality, and intent inferences. Viewing perceivers as Inequality Enablers answers any remaining doubts about the field's continuing relevance.

The ALERT-B questionnaire: A screening tool for the detection of gastroenterological late effects after radiotherapy for prostate cancer

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ALERT-B provides an effective screening tool for gastroenterological late effects.

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84.4% and 95.7% of patients demonstrated complications at 6 and 12 months post-treatment.

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ROC curves at baseline indicated an AUC of 0.867 compared to the GSRS diarrhoea subscale.

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ROC curves at baseline indicated an AUC of 0.765 compared to the EPIC bowel subscale.

There is an increasing need to measure treatment-related side effects in normal tissues following cancer therapy. The ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) questionnaire is a screening tool that is composed of four items related specifically to bowel symptoms. Those patients that respond with a “yes” to any of these items are referred on to gastroenterologist in order to improve the long-term consequences of these side effects of radiological treatment. Here we wish to test the ability of this questionnaire to identify these subsequent gastroenterological complications by tracking prostate cancer patients that were positive with respect to ALERT-B. We also carry out receiver-operator curve (ROC) analysis for baseline data for an overall ALERT-B questionnaire score with respect to subscale data for the Gastrointestinal Symptom Rating Scale (GSRS) and the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. 84.4% and 95.7% of patients identified by the ALERT-B questionnaire demonstrated complications diagnosed at 6 and 12 months post-treatment, respectively. ROC curve analysis of baseline data showed that ALERT-B detected clinically relevant levels of side effects established at baseline by the GSRS diarrhoea subscale (AUC = 0.867, 95% CI = 0.795 to 0.926) and at the minimally important level of side effects for the EPIC bowel subscale (AUC = 0.765, 95% CI = 0.617 to 0.913). These results show that ALERT-B provides a simple and effective screening tool for identifying gastroenterological complications after treatment for prostate cancer.

Metabolomic analysis of synovial fluid from Thoroughbred racehorses diagnosed with palmar osteochondral disease using magnetic resonance imaging

BACKGROUND

Palmar osteochondral disease (POD) is a common cause of lameness in competition horses. Magnetic resonance imaging (MRI) is the most sensitive diagnostic modality currently available, however it may not be financially or logistically practical for routine screening of POD. There is increasing interest in the use of metabolomics for diagnosis prior to progression to irreversible damage.

OBJECTIVES

To determine metabolite levels in synovial fluid (SF) of horses with a clinical diagnosis of POD based on diagnostic analgesia and MRI, with the hypothesis that metabolomic profiles differ between diseased and healthy joints.

STUDY DESIGN

Prospective clinical study.

METHODS

Synovial fluid was collected from metacarpo/tarsophalangeal joints (MC/TPJ) of 29 horses (n = 51 joints), including 14 controls (n = 26) and 15 cases (n = 25), the latter with lameness localised to the MC/TPJ and MR changes consistent with POD (n = 23). Spectra were produced using ¹ H-nuclear magnetic resonance (NMR) spectroscopy and analysed.

RESULTS

Twenty-five metabolites were recognised associated with various biosynthetic and degradation pathways. The metabolite abundances within the controls demonstrated increased variability compared with the clinical group. The low level of variance between the spectra of the two groups was explained by five principal components. Cross-validation of the cohort demonstrated modest separation of predictive power (R²  = 0.67; Q²  = 0.34). Although statistical significance was not achieved, the most influential metabolites were glucose and lactate.

MAIN LIMITATIONS

The modest sample size and variation in signalment, background and presenting condition of the controls may have impacted the discriminative power of the constructed models. The lack of matched controls, differences in time of fluid collection and freezing times may have also reduced accuracy when representing metabolite profiles.

CONCLUSIONS

This study identified and quantified metabolites present in MC/TPJ SF of clinical cases with POD.

Depressive symptoms and immune transcriptional profiles in late adolescents

BACKGROUND

Rates of depression increase and peak during late adolescence and alterations in immune processes are thought to be both a risk factor and outcome of depression. However, few studies have examined depression-immune dynamics among adolescents. Using a functional genomics approach, the current study examined whether depressive symptoms were associated with activation of a gene expression profile, characterized by upregulated expression of pro-inflammatory-related genes and downregulated expression of antiviral-related genes in a sample of older adolescents (M_age = 18.37, SD = 0.51).

METHOD

Participants (n = 87) reported on their depressive symptoms during the past week using the CES-D, and provided blood samples for genome-wide transcriptional profiling of mRNA.

RESULTS

Adolescents with clinically-significant levels of depressive symptoms (CES-D ≥ 16) exhibited upregulated expression of inflammation-related genes and downregulated expression of antiviral-related genes compared to their peers with lower levels of depressive symptoms (CES-D < 16). Bioinformatics analyses suggested that this pattern of differential gene expression was mediated by greater activity of the pro-inflammatory transcription factor, nuclear factor-kappa B (NF-κB), and reduced activity of glucocorticoid receptors (GRs) and interferon response factors (IRFs). Additional analyses implicated monocytes, B cells, and dendritic cells as primary cellular sources of the observed gene expression patterns associated with depressive symptoms.

CONCLUSION

Results are consistent with past work demonstrating links between depression and altered immunity. They provide a molecular basis for these associations and suggest that the underlying molecular signature may emerge as early as late adolescence when rates of depression tend to increase.

Daily interpersonal stress, sleep duration, and gene regulation during late adolescence

BACKGROUND

Psychological stress and poor sleep are associated with a wide range of negative health outcomes, which are thought to be mediated in part by alterations in immune processes. However, the molecular bases of links among stress, sleep, and immune processes are not completely understood, particularly during adolescence when sensitivity to stress and problems with sleep tend to increase. In the current study, we investigated whether various stressors (daily stress, major life events, perceived stress), sleep indices (duration, efficiency), and their interactions (e.g., moderating effects) are associated with expression of genes bearing response elements for transcription factors that regulate inflammatory and anti-viral processes.

METHOD

Eighty-seven late adolescents completed daily checklists of their social experiences across a 15-day period and reported on their major life events during the previous year. They also completed actigraphy-based assessments of sleep quality and duration during 8 consecutive nights. An average of 5.5 months later, participants reported on their global perceptions of stress during the previous month and provided blood samples for genome-wide expression profiling of mRNA from peripheral blood mononuclear cells (PBMCs).

RESULTS

Higher levels of daily interpersonal stress and shorter sleep duration were associated with upregulation of inflammation-related genes bearing response elements for proinflammatory transcription factor nuclear factor kappa B (NF-κB). Shorter sleep duration was also linked to downregulation of antiviral-related genes bearing response elements for interferon response factors (IRFs). Lastly, there was a significant interaction between daily stress and shorter sleep duration, such that the association between daily stress and inflammation-related gene expression was exacerbated in the context of shorter sleep duration. Results were independent of sex, ethnicity, parent education, body mass index, and smoking and alcohol history.

CONCLUSION

Everyday interpersonal stress and shortened sleep can be consequential for upstream NF-κB signaling pathways relevant to inflammatory processes during late adolescence. Notably, the occurrence of both may lead to even greater activation of NF-κB signaling.

Interview with Shelley E. Taylor

Shelley Taylor's autobiographical interview (conducted by Annual Review of Psychology Editor and long-time collaborator Susan Fiske) touches on some of her favorite ideas. For example, positive illusions: "The traditional textbook definition of mental health included the stipulation that people see the world accurately, and what we were suggesting is that actually, a lot of times, people don't see the world accurately. They see it with a positive spin on it." She also discusses how to found fields (social cognition, health psychology, and social neuroscience) and the challenges of boundary crossing (from social to biological). Her practical comments describe the joy of teaching methods, running a lab, and being a solo female. The interview ends with her advice to follow your instincts about the next big idea: "Trusting your own ideas is a very important way of coming up with a research program that is novel and exciting, and that ultimately wins people over."

Adiposity moderates links from early adversity and depressive symptoms to inflammatory reactivity to acute stress during late adolescence

Both early adversity and depression are associated with heightened inflammation. However, few studies have focused on inflammatory reactivity to psychosocial stress and examined adiposity as a potential moderator. Yet, repeated heightened inflammatory reactivity over time is thought to contribute to low-grade chronic inflammation and adipose tissue is a key source of pro-inflammatory cytokines. The purpose of the present study was to examine whether early adversity and depressive symptoms were related to stress-induced inflammation and whether these associations varied by total body and abdominal adiposity as measured by body mass index (BMI) and waist circumference (WC) in a sample of late adolescents. Participants reported on their early family environment and current depressive symptoms, had their height, weight, and WC assessed for adiposity markers, and provided blood samples for IL-6 assessment before and after a standardized laboratory stress task. No main effect of early adversity on IL-6 reactivity to acute stress was observed. However, significant interactions between early adversity and BMI and WC emerged. Greater exposure to early adversity was associated with greater IL-6 responses only among adolescents with higher BMI or WC. The same pattern of findings was observed for depressive symptoms. Additionally, moderated mediation analyses indicated that among adolescents with greater adiposity, early adversity indirectly influenced IL-6 reactivity via current depressive symptoms. These findings contribute to our understanding of vulnerability factors that may amplify the associations between early adversity and depressive symptoms and inflammation during relatively early stages of life.

The honeybee as a model insect for developmental genetics

Honeybees are an important component of modern agricultural systems, and a fascinating and scientifically engrossing insect. Honeybees are not commonly used as model systems for understanding development in insects despite their importance in agriculture. Honeybee embryogenesis, while being superficially similar to Drosophila, is molecularly very different, especially in axis formation and sex determination. In later development, much of honeybee biology is modified by caste development, an as yet poorly understood, but excellent, system to study developmental plasticity. In adult stages, developmental plasticity of the ovaries, related to reproductive constraint exhibits another aspect of plasticity. Here they review the tools, current knowledge and opportunities in honeybee developmental biology, and provide an updated embryonic staging scheme to support future studies.

Neural responses to social threat and predictors of cognitive behavioral therapy and acceptance and commitment therapy in social anxiety disorder

Previous research has often highlighted hyperactivity in emotion regions to simple, static social threat cues in social anxiety disorder (SAD). Investigation of the neurobiology of SAD using more naturalistic paradigms can further reveal underlying mechanisms and how these relate to clinical outcomes. We used fMRI to investigate responses to novel dynamic rejection stimuli in individuals with SAD (N=70) and healthy controls (HC; N=17), and whether these responses predicted treatment outcomes following cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). Both HC and SAD groups reported greater distress to rejection compared to neutral social stimuli. At the neural level, HCs exhibited greater activations in social pain/rejection regions, including dorsal anterior cingulate cortex and anterior insula, to rejection stimuli. The SAD group evidenced a different pattern, with no differences in these rejection regions and relatively greater activations in the amygdala and other regions to neutral stimuli. Greater responses in anterior cingulate cortex and the amygdala to rejection vs. neutral stimuli predicted better CBT outcomes. In contrast, enhanced activity in sensory-focused posterior insula predicted ACT responses.

The Effect of Mental Simulation on Goal-Directed Performance

Mental simulations can have beneficial effects on goal-directed effort and performance. We make a theoretical distinction between simulations of desired goals (outcome simulation) versus simulation of the steps leading to a desired goal (process simulation). In the present study, participants simulated the outcome of writing an effective essay, the process of preparing the effective essay, or they completed no simulation. Following the simulation (or not), participants either wrote on the expected essay topic or were switched to a new topic. Both outcome and process simulations demonstrated enhanced performance on the expected task. There was some evidence that process simulations, but not outcome simulations, facilitated planning of the essay. Outcome simulations enhanced motivation and self-efficacy, but these variables did not mediate the effects of outcome simulations on performance. We discuss the beneficial effects of mental simulation for goal-directed activity.

Differential sub-nuclear distribution of hypoxia-inducible factors (HIF)-1 and -2 alpha impacts on their stability and mobility

Cellular adaptation to hypoxia occurs via a complex programme of gene expression mediated by the hypoxia-inducible factor (HIF). The oxygen labile alpha subunits, HIF-1α/-2α, form a heterodimeric transcription factor with HIF-1β and modulate gene expression. HIF-1α and HIF-2α possess similar domain structure and bind to the same consensus sequence. However, they have different oxygen-dependent stability and activate distinct genes. To better understand these differences, we used fluorescent microscopy to determine precise localization and dynamics. We observed a homogeneous distribution of HIF-1α in the nucleus, while HIF-2α localized into speckles. We demonstrated that the number, size and mobility of HIF-2α speckles were independent of cellular oxygenation and that HIF-2α molecules were capable of exchanging between the speckles and nucleoplasm in an oxygen-independent manner. The concentration of HIF-2α into speckles may explain its increased stability compared with HIF-1α and its slower mobility may offer a mechanism for gene specificity.

The solubility of nickel and its migration through the cementitious backfill of a geological disposal facility for nuclear waste

This work describes the solubility of nickel under the alkaline conditions anticipated in the near field of a cementitious repository for intermediate level nuclear waste. The measured solubility of Ni in 95%-saturated Ca(OH)2 solution is similar to values obtained in water equilibrated with a bespoke cementitious backfill material, on the order of 5×10(-7)M. Solubility in 0.02M NaOH is one order of magnitude lower. For all solutions, the solubility limiting phase is Ni(OH)2; powder X-ray diffraction and scanning transmission electron microscopy indicate that differences in crystallinity are the likely cause of the lower solubility observed in NaOH. The presence of cellulose degradation products causes an increase in the solubility of Ni by approximately one order of magnitude. The organic compounds significantly increase the rate of Ni transport under advective conditions and show measurable diffusive transport through intact monoliths of the cementitious backfill material.

Cognitive Bases of Stereotyping

Subjects observed a slide and tape presentation of a political discussion group involving three men and three women. They then rated all speakers on measures of competence and completed a recall task matching up which speaker had said what. Subjects evidenced substantial prejudice toward female speakers relative to males. They also made substantial within-sex recall errors but relatively few cross-sex errors, indicating the u were organizing incoming information according to sex of the speaker; this strategy was more evident in sex-typed than androgynous individuals. However, recall errors and prejudice effects were uncorrelated, suggesting that the cognitive and affective components of stereotyping are relatively autonomous. A simple categorization model of stereotyping is challenged by these results.

Effects of Environmental Predictability and Personal Mastery on Self-Regulatory and Physiological Processes

College student participants high and low in personal mastery were exposed to an experimental priming manipulation that made salient the unpredictable aspects of college, the predictable aspects of college, or neutral features of the college environment. They then completed a thought-listing task regarding thoughts about college and measures of self-regulatory processes. Blood pressure and pulse data were collected every 2 minutes. Participants exposed to the predictable manipulation made more references to the future and more references to personal goals and had lower systolic blood pressure and pulse pressure reactivity compared with those in the neutral condition and to those in the unpredictable condition. Participants high (vs. low) in mastery showed more evidence of active self-regulation. Implications for the study of stress are discussed.

Does Self-Affirmation, Cognitive Processing, or Discovery of Meaning Explain Cancer-Related Health Benefits of Expressive Writing?

Although expressive writing has positive effects on health, little is known about the underlying psychological mechanisms for these effects. The present study assessed self-affirmation, cognitive processing, and discovery of meaning as potential mediators of the effects of expressive writing on physical health in early-stage breast cancer survivors. A content analysis of the essays showed that self-affirmation writing was associated with fewer physical symptoms at a 3-month follow-up assessment, with self-affirmation writing fully mediating the effects of the emotional expression and benefit-finding writing conditions on reduced physical symptoms. Cognitive processing and discovery of meaning writing were not associated with any physical health outcomes. Consistent with evidence showing that self-affirmation plays an important role in buffering stress, the present study provides the first evidence for self-affirmation as a viable mechanism underlying the health benefits of expressive writing.

Self-Evaluation Processes

Four motives (self-assessment, self-enhancement, self-verification, and self-improvement) are hypothesized to guide self-evaluation. Results of an empirical investigation suggest that two sets of circumstances may commonly elicit all four motives: a situation of past threat or failure and anticipation of some important future threat or challenge. These findings suggest the need to develop an integrative approach to self-evaluation that specifies not only the distinctive circumstances in which each motive may be satisfied but also the ways multiple motives may be simultaneously satisfied. Evidence is presented to suggest that the four motives are satisfied by drawing on different information sources. Individual differences and domain under investigation are also found to moderate self-evaluation processes. Directions for future integrative efforts are suggested.

Positive and Negative Effects of HIV Infection in Women with Low Socioeconomic Resources

Predictions generated by cognitive adaptation theory and conservation of resources theory were tested with regard to positive and negative changes associated with HIV infection in an ethnically diverse, low socioeconomic status sample of 189 HIV-positive women. Women reported a significantly greater number of benefits than losses in their experiences with HIV infection. Changes in the domains of the self and life priorities were significantly positive, whereas changes in romantic/sexual relations and view of body were significantly negative. Women who reported more benefits were less likely to report depressive and anxious symptoms. Although health status and optimism significantly predicted depression, anxiety, and negative HIV-related changes, socioeconomic resources (education and income) were the most significant predictors of HIV-related benefit finding. Implications of these results are discussed.

From Thought to Action: Effects of Process-Versus Outcome-Based Mental Simulations on Performance

Mental simulations enhance the links between thought and action. The present research contrasted mental simulations that emphasize the process required to achieve a goal versus the outcome of goal achievement. For 5 to 7 days prior to a midterm examination, college freshmen mentally simulated either the process for doing well on the exam (good study habits) or simulated a desired outcome (getting a good grade) or both. A self-monitoring control condition was included. Results indicated that process simulation enhanced studying and improved grades; the latter effect was mediated by enhanced planning and reduced anxiety. Implications of process and outcome simulations for effective goal pursuit are discussed.

The Effects of Mindset on Behavior: Self-Regulation in Deliberative and Implemental Frames of Mind

The effects of deliberative and implemental mindsets—cognitive and motivational states associated with predecisional and postdecisional frames of mind, respectively—were examined in the context of the self-regulation of behavior. Participants who had been induced to deliberate the merits of participating in a specified task formulated more pessimistic expectations about this task than did participants who had been induced to imagine implementing a plan to complete the task. Moreover, participants in the deliberation condition underperformed relative to the participants in the implemental condition, demonstrating that deliberative and implemental thinking can influence behavior as well as cognition.

Social Cognition and Health

Health settings provide an important arena within which to test and refine social psychological theories. Using interview data from cancer patients, results are presented pertaining to four areas of social psychological theory: attribution theory, psychological control, social comparison theory, and victimization.

Date with an Earthquake

This study explored reactions to an impending disaster whose occurrence is highly likely but whose timing is unknown. Fifty-one students who lived in suites rated "good" seismically, and 50 students who lived in dormitories rated "very poor" seismically were canvassed concerning their perceptions and coping strategies with respect to the impending California earthquake. Results indicated that respondents in the very poor structures were significantly more likely to deny the seriousness of the situation and to doubt the experts' predictions than were respondents in the good suites. Both groups showed ignorance of basic earthquake safety information and had taken no measures to prepare for an earthquake.

Social Comparison, Stress, and Coping

In recent years, basic research and theory on social comparison activities has been applied to understanding the coping processes of people undergoing stressful events. These investigations have both elucidated coping and highlighted issues that need reconsideration in traditional social comparison frameworks. These issues include the predominant motives that guide social comparison activity; the role of cognitive processes in the creation of targets and the selection of dimensions for evaluation; the limits imposed on available social comparison information by stressful or victimizing circumstances; the role of similarity in social comparisons under threat; the inherent meaning of upward and downward comparisons; and the divergence of evaluative versus information-seeking comparative activities. Implications for theoretical integration and for understanding coping and social support are discussed.

Pursuit of Comfort and Pursuit of Harmony: Culture, Relationships, and Social Support Seeking

This research examined whether people from collectivistic cultures are less likely to seek social support than are people from individualistic cultures because they are more cautious about potentially disturbing their social network. Study 1 found that Asian Americans from a more collectivistic culture sought social support less and found support seeking to be less effective than European Americans from a more individualistic culture. Study 2 found that European Americans' willingness to seek support was unaffected by relationship priming, whereas Asian Americans were willing to seek support less when the relationship primed was closer to the self. Study 3 replicated the results of Study 2 and found that the tendency to seek support and expect social support to be helpful as related to concerns about relationships. These findings underscore the importance of culturally divergent relationship patterns in understanding social support transactions.

A Developing Role for Social Psychology in Medicine and Medical Practice

Social psychology has the potential to make valuable contributions to significant medical issues including problems of etiology, prevention, management, and treatment of illness and the delivery of health care services. This paper summarizes some of these potential contributions and concludes that, though there are liabilities involved in social psychology -- medicine liaisons, they are far outweighed by the benefits.

The Effects of Mental Simulation on Coping with Controllable Stressful Events

Previous research has revealed that writing or talking about traumatic stressors can improve health and psychological well-being. The present study investigated whether similar benefits may be conferred by mental simulation and whether such simulations can improve coping and affective responses to ongoing stressful events. All participants designated an ongoing stressful event in their lives. One third of the participants visualized the event and the emotions they had experienced (event simulation), one third visualized having resolved the problem (outcome simulation), and one third were simply followed over time (control). Event simulation participants reported more positive affect, both immediately and 1 week later, and indicated higher levels of planned and reported active coping strategies, compared with the other two conditions. Discussion focuses on the potential of structured mental simulation to facilitate coping with stressful events.

Tend and Befriend

In addition to fight-or-flight, humans demonstrate tending and befriending responses to stress—responses underpinned by the hormone oxytocin, by opioids, and by dopaminergic pathways. A working model of affiliation under stress suggests that oxytocin may be a biomarker of social distress that accompanies gaps or problems with social relationships and that may provide an impetus for affiliation. Oxytocin is implicated in the seeking of affiliative contact in response to stress, and, in conjunction with opioids, it also modulates stress responses. Specifically, in conjunction with positive affiliative contacts, oxytocin attenuates psychological and biological stress responses, but in conjunction with hostile and unsupportive contacts, oxytocin may exacerbate psychological and biological stress responses. Although significant paradoxes remain to be resolved, a mechanism that may underlie oxytocin's relation to the health benefits of social support may be in view.

Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation

Self-affirmation theory posits that people are motivated to maintain a positive self-view and that threats to perceived self-competence are met with resistance. When threatened, self-affirmations can restore self-competence by allowing individuals to reflect on sources of self-worth, such as core values. Many questions exist, however, about the underlying mechanisms associated with self-affirmation. We examined the neural mechanisms of self-affirmation with a task developed for use in a functional magnetic resonance imaging environment. Results of a region of interest analysis demonstrated that participants who were affirmed (compared with unaffirmed participants) showed increased activity in key regions of the brain's self-processing (medial prefrontal cortex + posterior cingulate cortex) and valuation (ventral striatum + ventral medial prefrontal cortex) systems when reflecting on future-oriented core values (compared with everyday activities). Furthermore, this neural activity went on to predict changes in sedentary behavior consistent with successful affirmation in response to a separate physical activity intervention. These results highlight neural processes associated with successful self-affirmation, and further suggest that key pathways may be amplified in conjunction with prospection.

Social Neuroscience: Progress and Implications for Mental Health

Social neuroscience is a new, interdisciplinary field devoted to understanding how biological systems implement social processes and behavior. Social neuroscience capitalizes on biological concepts and methods to inform and refine theories of social behavior, and it uses social and behavioral constructs and data to inform and refine theories of neural organization and function. We focus here on the progress and potential of social neuroscience in the area of mental health. Research in social neuroscience has grown dramatically in recent years. Among the most active areas of research we found are brain-imaging studies in normal children and adults; animal models of social behavior; studies of stroke patients; imaging studies of psychiatric patients; and research on social determinants of peripheral neural, neuroendocrine, and immunological processes. We also found that these areas of research are proceeding along largely independent trajectories. Our goals in this article are to review the development of this field, examine some currently promising approaches, identify obstacles and opportunities for future advances and integration, and consider how this research can inform work on the diagnosis and treatment of mental disorders.

The role of multiple negative social relationships in inflammatory cytokine responses to a laboratory stressor

The present study examined the unique impact of perceived negativity in multiple social relationships on endocrine and inflammatory responses to a laboratory stressor. Via hierarchical cluster analysis, those who reported negative social exchanges across relationships with a romantic partner, family, and their closest friend had higher mean IL-6 across time and a greater increase in TNF-α from 15 min to 75 min post stress. Those who reported negative social exchanges across relationships with roommates, family, and their closest friend showed greater IL-6 responses to stress. Differences in mean IL-6 were accounted for by either depressed mood or hostility, whereas differences in the cytokine stress responses remained significant after controlling for those factors. Overall, this research provides preliminary evidence to suggest that having multiple negative relationships may exacerbate acute inflammatory responses to a laboratory stressor independent of hostility and depressed mood.

Social working memory and its distinctive link to social cognitive ability: an fMRI study

Engaging social working memory (SWM) during effortful social cognition has been associated with neural activation in two neurocognitive systems: the medial frontoparietal system and the lateral frontoparietal system. However, the respective roles played by these systems in SWM remain unknown. Results from this study demonstrate that only the medial frontoparietal system supports the social cognitive demands managed in SWM. In contrast, the lateral frontoparietal system supports the non-social cognitive demands that are needed for task performance, but that are independent of the social cognitive computations. Moreover, parametric increases in the medial frontoparietal system, but not the lateral frontoparietal system, in response to SWM load predicted performance on a challenging measure of perspective-taking. Thus, the medial frontoparietal system may uniquely support social cognitive processes in working memory and the working memory demands afforded by effortful social cognition, such as the need to track another person's perspective in mind.

Altered emotion regulation capacity in social phobia as a function of comorbidity

Social phobia (SP) has been associated with amygdala hyperreactivity to fear-relevant stimuli. However, little is known about the neural basis of SP individuals' capacity to downregulate their responses to such stimuli and how such regulation varies as a function of comorbid depression and anxiety. We completed an functional magnetic resonance imaging (fMRI) study wherein SP participants without comorbidity (n = 30), with comorbid depression (n = 18) and with comorbid anxiety (n = 19) and healthy controls (n = 15) were scanned while completing an affect labeling emotion regulation task. Individuals with SP as a whole exhibited a reversal of the pattern observed in healthy controls in that they showed upregulation of amygdala activity during affect labeling. However, subsequent analyses revealed a more complex picture based on comorbidity type. Although none of the SP subgroups showed the normative pattern of amygdala downregulation, it was those with comorbid depression specifically who showed significant upregulation. Effects could not be attributed to differences in task performance, amygdala reactivity or right ventral lateral prefrontal cortex (RVLPFC) engagement, but may stem from dysfunctional communication between amygdala and RVLPFC. Furthermore, the particularly altered emotion regulation seen in those with comorbid depression could not be fully explained by symptom severity or state anxiety. Results reveal altered emotion regulation in SP, especially when comorbid with depression.

Oxytocin and vasopressin receptor polymorphisms interact with circulating neuropeptides to predict human emotional reactions to stress

Oxytocin (OT) and a polymorphism (rs53576) in the oxytocin receptor gene (OXTR) have been independently associated with stress reactivity, whereas oxytocin's sister peptide, arginine vasopressin (AVP) and polymorphisms in the vasopressin receptor gene (AVPR1A) have been independently associated with aggressive behavior. In this study, 68 men and 98 women were genotyped for the OXTR rs53576 polymorphism and the AVPR1A RS1 polymorphism. Baseline and poststressor levels of plasma OT, plasma AVP, positive affect, and anger were assessed. Women, but not men, with high levels of poststressor OT and the GG genotype of rs53576 felt the most positive affect after the stressor. Men, but not women, with high levels of poststressor AVP and the 320 allele of the RS1 polymorphism reported more poststressor anger than noncarriers. These data constitute the first evidence that oxytocin and vasopressin receptor genes interact with levels of OT and AVP to predict sex-specific emotional stress responses.

Childhood family psychosocial environment and carotid intima media thickness: the CARDIA study

Little is known about whether the childhood family psychosocial environment (characterized by cold, unaffectionate interactions, conflict, aggression, neglect and/or low nurturance) affects coronary heart disease (CHD) risk. Objectives were to evaluate associations of childhood family psychosocial environment with carotid intima media thickness (IMT), a subclinical measure of atherosclerosis. The study population included 2659 CARDIA study participants, aged 37-52 years. Childhood family psychosocial environment was measured using a risky family questionnaire via self-report. Carotid IMT was calculated using the average of 20 measurements of mean common carotid, bulb and internal carotid IMT, assessed using high-resolution B-mode ultrasound images. Utilizing linear regression analyses adjusted for age, a 1-unit (range 0-21) increase in risky family score was associated with 0.0036 (95% CI: 0.0006,0.0066 mm) and 0.0020 (95% CI: 0.0002,0.0038) mm increase in mean IMT in white males and females, respectively. Formal mediation analyses and covariate adjustments suggested childhood socioeconomic position and smoking may be important mechanisms in white males and females, as well as education and depressive symptomatology in white males. No associations were found in black participants. Formal statistical tests for interaction between risky family score and sex, and between risky family score and race/ethnicity, demonstrated borderline evidence of interactions for both sex (p = 0.12) and race/ethnicity (p = 0.14) with risky family score for associations with mean IMT. In conclusion, childhood family psychosocial environment was positively associated with IMT in white participants, with little evidence of association in black participants. Mechanisms in white participants may include potential negative impacts of socioeconomic constraints on parenting quality, potentially influencing offspring's cardiovascular risk factors (e.g. smoking), socioeconomic position (e.g. education), and/or psychosocial functioning (e.g. depression), which may in turn lead to atherosclerotic processes. Borderline racial/ethnic differences in findings should be replicated, but add to literature exploring race/ethnicity-specific associations of parenting approaches with health outcomes.

Deep digital flexor tendon injury within the hoof capsule; does lesion type or location predict prognosis?

The type and location of deep digital flexor tendon (DDFT) lesions may be important in predicting outcome. The objectives of this study were to determine the frequency of different types of DDFT lesions within the hoof capsule and to determine whether lesion type predicts return to athletic activity. Lesions of the DDFT were divided into: core lesions, dorsal border lesions and parasagittal splits. Lesion location was documented, and follow-up information was obtained by telephone survey at least 18 months after diagnosis. Of 168 horses with primary DDFT injury, 54 horses had dorsal border lesions, 59 had parasagittal splits and 55 had core lesions. Twenty-five per cent of all horses returned to previous levels of athletic activity within 18 months of MRI evaluation. Horses with complete splits or core lesions of the DDFT were significantly less likely to return to some level of athletic activity than horses with dorsal border lesions P<0.001. Dorsal border lesions of the DDFT appear to have a better prognosis than core lesions or parasagittal splits. This study provides additional information that may help clinicians predict the prognosis for different types of DDFT injury.