The influence of emotion regulation flexibility on negative emotions: Evidence from experience sampling

In our complex social environments, life situations are ever-changing. When dealing with these changes, there is no one-size-fits-all response or regulatory strategy suitable for all situations. Emotion regulation flexibility (ERF)—a framework for understanding individual differences in adaptive responding to ever-changing life contexts—emphasizes that individuals can flexibly deploy and adjust emotion regulation strategies according to specific characteristics of stressful situations in daily life. To achieve regulatory efficacy, it is important that one can utilize a balanced profile of ER strategies and select strategies that fit well with particular stressful situations. Specifically, using multiple ER strategies in daily life, rather than relying on only single-strategies, would indicate higher ERF. Additionally, based on leading models of strategy-situation fit, certain ER strategies are more appropriate for high versus low intensity stressful events. For instance, distraction involves with shielding oneself from negative stimuli and replacing them with irrelevant things, which may have a greater regulatory effect in high-intensity negative situations. Conversely, strategies such as reappraisal, which involves the processing of negative situations through deep cognitive change, may be more effective in lower-intensity negative situations and as a cornerstone of longer-term ER. We used the experience-sampling method (ESM) to quantify individual's ERF;more specifically we assess participants for 1) having more or less balanced ER strategy profiles and 2) showing greater strategy-situation fit, in regard to the use of distraction versus reappraisal in the regulation of high-intensity versus low-intensity negative life events. To test the adaptive value of ERF on negative emotions and mental health, we investigated the influence of ERF on depressive and anxiety symptoms in two samples. We hypothesized that individuals with a more balanced profile of ER strategy use and a great level of strategy-situation fit would have higher levels of mental health, indicated by low levels of anxiety and depressive feelings. In sample 1, two hundred eight college students finished the ESM procedure (2859 beeps). Intensity of negative situations was measured by self-reported negative feelings for the time points where participants reported an adverse event. Simultaneously, we assessed participants' use of two ER strategies (i.e., distraction and reappraisal). Considering the negative impact of COVID-19 on people's daily life, we collected another sample (sample 2, 3462 beeps) with one hundred people who lived in Hubei Province, where Wuhan was in lockdown during the severe phase of COVID-19 (March 7-13, 2020). We measured intensity of negative situations (by averaging individuals' negative feelings), as well as the use of two ER strategies at corresponding time points. After completing the ESM procedure, the participants were asked to fill out a series of emotional health questionnaires, including Beck Depression Inventory-II, Beck Anxiety Inventory and Spielberger State Anxiety Scale. Multilevel models were used to fit the covariation between the use of distraction versus reappraisal ER strategies and the intensity of negative events. Additionally, we used multiple level regression models to test whether high level of strategy-situation fit would result in lower negative feelings. To test whether a single-strategy preference would lead to higher levels of anxiety and depressive feelings compared to a multiple-strategy preference, latent profile analyses (LPA) was used. Results from the LPA indicated that individuals with preferences for rumination and express suppression reported higher levels depression and anxiety than individuals with a multi-strategy preference. In the multilevel models, results of the two independent samples both suggested individuals who were more inclined to use a higher level of distraction in response to high-intensity negative situations (e.g., adverse events or during COVID-19) and use hi her levels of reappraisal during low-intensity situations (i.e., high level of ERF) reported lower levels of anxiety and depressive feelings. On the converse, individuals who tended to use more distraction in low intensity situations and more reappraisal in high intensity situations, (i.e., those showing lower ERF) reported a higher level of negative feelings. Together, our findings revealed a negative relationship between ERF and mental health problems in two samples, suggesting that having balanced ER profiles and flexibly deploying strategies in specific life contexts may have adaptive value in facilitating positive mental health. This work deepens our understanding of the interaction between ER strategies and situational demands, paving the way for future intervention research to help alleviate negative emotions associated with affective disorders or the experience of major traumatic events (such as epidemics, earthquakes, etc.). © The Authors.

Lung-Kidney Injury Caused by Innate Derived Mediator suPAR

Background: Soluble urokinase plasminogen activator receptor suPAR is an innate-immune system derived circulating kidney disease risk factor that has its highest physiological expression at baseline in the upper airway. Critical illnesses with high mortality rates often exhibit both acute lung and kidney injury as complications. The objective of our study is to understand whether murine pulmonary airway injury can induce kidney injury, perhaps in a suPAR dependent manner. In the injured human lung, uPAR is documented in several pathological respiratory conditions including COPD, pneumonia and tuberculosis and recently also in COVID-19. Since suPAR levels increase prior to and during kidney injury, we aimed to explore a lung-kidney connection. Method(s): Injection of naphthalene, an aromatic hydrocarbon present in tobacco smoke constitutes a well-characterized model for acute airway injury in mice. SuPAR over-expressing mice (suPARTg) and UPAR knockout mice (UPARKO) were injected intraperitoneally with naphthalene. To begin to explore mechanisms of lung-kidney axis, lung lavage and serum inflammation was assessed by multi-plex ELISA and flow cytometry. Result(s): SuPAR overexpression accelerated mortality in naphthalene injured mice by 40%. Furthermore, injecting an UPAR antibody in naphthalene injured suPARTg mice increased led to significant reduction in mortality. UPARKO mice exhibited a 100% survival rate post injury. Increased survival observed in UPARKO mice could be attributed to significantly increased IL6 levels in both lung lavage and serum, thereby altering the outcome of naphthalene mediated injury. Conclusion(s): In conclusion, immune derived factors such as suPAR connect the lung with the kidney. Targeting suPAR may be beneficial in increasing survival in cases where mortality may be attributed to multi-organ failure induced by lung injury.

The influence of emotion regulation flexibility on negative emotions: Evidence from experience sampling

In our complex social environments, life situations are ever-changing. When dealing with these changes, there is no one-size-fits-all response or regulatory strategy suitable for all situations. Emotion regulation flexibility (ERF)—a framework for understanding individual differences in adaptive responding to ever-changing life contexts—emphasizes that individuals can flexibly deploy and adjust emotion regulation strategies according to specific characteristics of stressful situations in daily life. To achieve regulatory efficacy, it is important that one can utilize a balanced profile of ER strategies and select strategies that fit well with particular stressful situations. Specifically, using multiple ER strategies in daily life, rather than relying on only single-strategies, would indicate higher ERF. Additionally, based on leading models of strategy-situation fit, certain ER strategies are more appropriate for high versus low intensity stressful events. For instance, distraction involves with shielding oneself from negative stimuli and replacing them with irrelevant things, which may have a greater regulatory effect in high-intensity negative situations. Conversely, strategies such as reappraisal, which involves the processing of negative situations through deep cognitive change, may be more effective in lower-intensity negative situations and as a cornerstone of longer-term ER. We used the experience-sampling method (ESM) to quantify individual’s ERF;more specifically we assess participants for 1) having more or less balanced ER strategy profiles and 2) showing greater strategy-situation fit, in regard to the use of distraction versus reappraisal in the regulation of high-intensity versus low-intensity negative life events. To test the adaptive value of ERF on negative emotions and mental health, we investigated the influence of ERF on depressive and anxiety symptoms in two samples. We hypothesized that individuals with a more balanced profile of ER strategy use and a great level of strategy-situation fit would have higher levels of mental health, indicated by low levels of anxiety and depressive feelings. In sample 1, two hundred eight college students finished the ESM procedure (2859 beeps). Intensity of negative situations was measured by self-reported negative feelings for the time points where participants reported an adverse event. Simultaneously, we assessed participants’ use of two ER strategies (i.e., distraction and reappraisal). Considering the negative impact of COVID-19 on people’s daily life, we collected another sample (sample 2, 3462 beeps) with one hundred people who lived in Hubei Province, where Wuhan was in lockdown during the severe phase of COVID-19 (March 7-13, 2020). We measured intensity of negative situations (by averaging individuals’ negative feelings), as well as the use of two ER strategies at corresponding time points. After completing the ESM procedure, the participants were asked to fill out a series of emotional health questionnaires, including Beck Depression Inventory-II, Beck Anxiety Inventory and Spielberger State Anxiety Scale. Multilevel models were used to fit the covariation between the use of distraction versus reappraisal ER strategies and the intensity of negative events. Additionally, we used multiple level regression models to test whether high level of strategy-situation fit would result in lower negative feelings. To test whether a single-strategy preference would lead to higher levels of anxiety and depressive feelings compared to a multiple-strategy preference, latent profile analyses (LPA) was used. Results from the LPA indicated that individuals with preferences for rumination and express suppression reported higher levels depression and anxiety than individuals with a multi-strategy preference. In the multilevel models, results of the two independent samples both suggested individuals who were more inclined to use a higher level of distraction in response to high-intensity negative situations (e.g., adverse events or during COVID-19) and use hi her levels of reappraisal during low-intensity situations (i.e., high level of ERF) reported lower levels of anxiety and depressive feelings. On the converse, individuals who tended to use more distraction in low intensity situations and more reappraisal in high intensity situations, (i.e., those showing lower ERF) reported a higher level of negative feelings. Together, our findings revealed a negative relationship between ERF and mental health problems in two samples, suggesting that having balanced ER profiles and flexibly deploying strategies in specific life contexts may have adaptive value in facilitating positive mental health. This work deepens our understanding of the interaction between ER strategies and situational demands, paving the way for future intervention research to help alleviate negative emotions associated with affective disorders or the experience of major traumatic events (such as epidemics, earthquakes, etc.). © The Authors.

A Neural Predictive Model of Negative Emotions for COVID-19

The long-lasting global pandemic of Coronavirus disease 2019 (COVID-19) has changed our daily life in many ways and put heavy burden on our mental health. Having a predictive model of negative emotions during COVID-19 is of great importance for identifying potential risky population. To establish a neural predictive model achieving both good interpretability and predictivity, we have utilized a large-scale (n =542) longitudinal dataset, alongside two independent samples for external validation. We built a predictive model based on psychologically meaningful resting state neural activities. The whole-brain resting-state neural activity and social-psychological profile of the subjects were obtained from Sept. to Dec. 2019 (Time 1). Their negative emotions were tracked and re-assessed twice, on Feb 22 (Time 2) and Apr 24 (Time 3), 2020, respectively. We first applied canonical correlation analysis on both the neural profiles and psychological profiles collected on Time 1, this step selects only the psychological meaningful neural patterns for later model construction. We then trained the neural predictive model using those identified features on data obtained on Time 2. It achieved a good prediction performance (r =0.44, p =8.13 ×10-27). The two most important neural predictors are associated with self-control and social interaction. This study established an effective neural prediction model of negative emotions, achieving good interpretability and predictivity. It will be useful for identifying potential risky population of emotional disorders related to COVID-19. IEEE

The relationship between negative emotions and risk perception of front-line medical staff in the early stage of novel coronavirus pneumonia

Objective To investigate the influence of negative emotions on risk perception in frontline medical staff at the early stage of coronavirus disease 2019 (COVID-19) outbreak. Methods An online questionnaire survey was conducted on the dispatched medical staff of Wuhan Huoshenshan Hospital and the frontline anti-epidemic medical staff of Changhai Hospital of Naval Medical University (Second Military Medical University) from Feb. 3 to 5, 2020. The negative emotions were measured by the reduced version of negative affection scale composed of 7 negative emotions. The risk perception level was evaluated by the risk perception questionnaire of frontline anti-epidemic medical staff adapted from nursing staff risk perception questionnaire. Results A total of 220 valid questionnaires were collected, with an effective rate of 85.94%. The total score of negative emotions of frontline medical staff at the early stage of COVID-19 outbreak was 11.18±4.58, and the scores of 7 negative emotions from high to low were tension (1.92±0.90), upset (1.75±0.92), fear (1.61±0.84), impatience (1.58±0.84), sadness (1.51±0.83), trembling (1.50±00.83) and guilt (1.31±0.64). The scores of impatience, sadness, upset and guilt of non-nursing staff were significantly higher than those of nursing staff (all P＜0.05). The total score of risk perception of medical staff was 17.68±4.60, and the score of time risk dimension was the highest (3.20±1.20). The organizational risk score (3.39±1.01 vs 2.88±1.01) and time risk score (3.46±1.22 vs 3.09±1.18) of the non-nursing staff were significantly higher than those of the nursing staff (P＜0.01 or P＜0.05). There was a positive correlation between the total score of negative emotions and the total score of risk perception (r＝0.499, P＜0.01). The score of each negative emotion classification had an indicating effect on different risk perception tendencies, and impatience had the most obvious indicating effect on time risk (β＝0.227, P＝0.033). Conclusion Medical staff with high negative emotions have high risk perception. The negative emotion management at the early stage of the epidemic can help frontline anti-epidemic medical staff to correctly understand the risk. © 2021 Second Military Medical University Press. All rights reserved.

Teaching From Afar: Development of a Telemedicine Curriculum for Healthcare Workers in Global Settings.

The Stanford Department of Emergency Medicine joined forces with Digital Medic to create educational materials to teach global healthcare providers how to evaluate patients via telemedicine in the setting of COVID-19. Users then asked for additional education on best practices surrounding the use of telemedicine as a communication medium. Here, we describe our experience in the creation of this additional module and provide some basic feedback received from end-users. We scripted, filmed, and edited a video module for this application over the course of 14 weeks. It was subsequently deployed as part of the larger COVID-19 educational program. To date, the course has had over 28,000 participants. Each was asked to take a pre- and post-test to assess the knowledge of telemedicine best practices before and after the video module; 19,412 elected to take the pre-test and 19,364 took the post-test with overall scores of 84% and 95%, respectively. Anecdotal feedback has been positive. Telemedicine systems have proliferated rapidly around the world, but best practices for physician-to-patient interactions have not been similarly disseminated. We conclude that video modules can be used to fill this educational need quickly and economically.

The value of ROX index in evaluating the efficacy of high-flow nasal cannula oxygen therapy in patients with COVID-19

Objective: To assess the value of the ROX index in evaluating the efficacy of highflow nasal cannula oxygen therapy (HFNC) in patients with coronavirus infected disease (COVID-19). Methods: This is a retrospective study. The included patients were diagnosed as COVID-19 in the intensive care unit (ICU) of the Cancer Center of Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 15, 2020 to March 15, 2020. All the patients were treated by HFNC. According to whether the patient subsequently received non-invasive positive pressure ventilation or invasive positive pressure ventilation, patients were divided into the HFNC success group and the HFNC failure group. Parameters in the two groups such as basic characteristics, lactic acid, number of chest radiographs, APACHE II, lymphocyte count, baseline respiratory rate, baseline percutaneous oxygen saturation, baseline PaO2/FiO2, baseline ROX index, and ROX index after 2, 6 and 12 h HFNC treatment were analyzed with t test, Chi-square test or rank sum test. Results: A total of 57 cases were included in this study. There were no significant differences in sex, age, comorbidities, lactic acid, quadrants of chest radiograph lung infection, APACHE II, lymphocyte count, and baseline respiratory frequency, transcutaneous oxygen saturation, oxygenation index, and ROX index between the HFNC success group and the HFNC faliure group (P>0.05). Logistic regression analysis showed that ROX index after 2 h HFNC treatment (OR=0.069), ROX index after 6 h HFNC treatment (OR=0.194) and ROX index after 12 h HFNC treatment (OR=0.036) were all protective factors for the therapeutic effect of HFNC treatment in COVID-19 patients. ROC curve showed that there were significant differences in ROX index after 2 h HFNC treatment, ROX index after 6 h HFNC treatment, and ROX index after 12 h HFNC treatment (P<0.05). In the evaluation index, the area under the ROC curve of the ROX index after 2 h HFNC treatment was 0.838, the sensitivity was 64.5%, and the specificity was 100%. After 6 h HFNC treatment, the area under the ROX index ROC curve was 0.762, the sensitivity was 64.5%, and the specificity was 92.3%. After 12 h HFNC treatment, the ROX index ROC curve area was 0.866, the sensitivity was 67.7%, and the specificity was 100%. Conclusions: The ROX index can be used to evaluate the efficacy of HFNC in COVID-19 patients in a timely, simple and real-time manner. © 2021 Chinese Medical Association. All rights reserved.

Immunogenicity and efficacy of mRNA COVID-19 vaccine MRT5500 in preclinical animal models.

Emergency use authorization of COVID vaccines has brought hope to mitigate pandemic of coronavirus disease 2019 (COVID-19). However, there remains a need for additional effective vaccines to meet the global demand and address the potential new viral variants. mRNA technologies offer an expeditious path alternative to traditional vaccine approaches. Here we describe the efforts to utilize an mRNA platform for rational design and evaluations of mRNA vaccine candidates based on the spike (S) glycoprotein of SARS-CoV-2. Several mRNA constructs of S-protein, including wild type, a pre-fusion stabilized mutant (2P), a furin cleavage-site mutant (GSAS) and a double mutant form (2P/GSAS), as well as others, were tested in animal models for their capacity to elicit neutralizing antibodies (nAbs). The lead 2P/GSAS candidate was further assessed in dose-ranging studies in mice and Cynomolgus macaques, and for efficacy in a Syrian golden hamster model. The selected 2P/GSAS vaccine formulation, designated MRT5500, elicited potent nAbs as measured in neutralization assays in all three preclinical models and more importantly, protected against SARS-CoV-2-induced weight loss and lung pathology in hamsters. In addition, MRT5500 elicited TH1-biased responses in both mouse and non-human primate (NHP), thus alleviating a hypothetical concern of potential vaccine-associated enhanced respiratory diseases known associated with TH2-biased responses. These data position MRT5500 as a viable vaccine candidate for entering clinical development.

Traditional Chinese Medicine guidelines for coronavirus disease 2019

OBJECTIVE: To summarize the evidence from Traditional Chinese Medicine (TCM) practice in the treatment of coronavirus disease 2019 (COVID-19) and provide timely clinical practice guidance. METHODS: The guidelines were developed in accordance with the World Health Organization rapid guideline process. The evidence on TCM for COVID-19 from published guidelines, direct and indirect published clinical evidence, first hand clinical data, and expert experience and consensus were collected. The grading of recommendations assessment, development and evaluation (GRADE) method was used to grade the evidence and make the recommendations. RESULTS: Based on the available evidence, the guidelines recommended 17 Chinese medicines for COVID-19: 2 Chinese herbal granules, 7 Chinese patent medicines, and 8 Chinese herbal injections. CONCLUSION: As the literature search was conducted on March, any subsequent versions of these guidelines require an up-to-date literature review. We hope that the evidence summary in these guidelines will be helpful in global efforts to address COVID-19. (C) 2020 JTCM. All rights reserved.

COVID-19 outbreak and surgeonsresponse at a Cancer Center in the United States.

In the pandemic of severe acute respiratory syndrome due to coronavirus-2 (SARS-CoV-2), United States (U.S.) also experienced the spread of coronavirus disease 2019 (COVID-19). Here, we report the current status of Houston, Texas and the response to COVID-19 at MD Anderson Cancer Center (MDACC) and in the Department of Surgical Oncology. MDACC has taken the institutional measures in order to prevent its employees and patients from COVID-19. Furthermore, surgeons have also responded aggressively in the outpatient setting, operating room and inpatient care. The predicted peak in Texas is on April 29 and our mitigation measures appear to be effective at the time of writing, however there still remain a lot of unknowns about SARS-CoV-2 and the performance of cancer operations remains an ongoing and delicate issue. In order to minimize the risks to patients, our healthcare system, and our community, MDACC has navigated the countering pressures through honest and open communication with patients, judicious use of alternative treatment strategies, and thoughtful selection of surgical cases.

Immunogenicity of novel mRNA COVID-19 vaccine MRT5500 in mice and non-human primates (preprint)

An effective vaccine to address the global pandemic of coronavirus disease 2019 (COVID-19) is an urgent public health priority. Novel synthetic mRNA and vector-based vaccine technologies offer an expeditious development path alternative to traditional vaccine approaches. Here we describe the efforts to utilize an mRNA platform for rational design and evaluations of mRNA vaccine candidates based on Spike (S) glycoprotein of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus causing COVID-19. Several mRNA constructs expressing various structural conformations of S-protein, including wild type (WT), a pre-fusion stabilized mutant (2P), a furin cleavage-site mutant (GSAS) and a double mutant form (2P/GSAS), were tested in a preclinical animal model for their capacity to elicit neutralizing antibodies (nAbs). The lead 2P/GSAS candidate was further assessed in dose-ranging studies in mice and Cynomolgus macaques. The selected 2P/GSAS vaccine formulation, now designated MRT5500, elicited potent nAbs as measured in two types of neutralization assays. In addition, MRT5500 elicited TH1-biased responses in both mouse and non-human primate species, a result that helps to address a hypothetical concern regarding potential vaccine-associated enhanced respiratory diseases associated with TH2-biased responses. These data position MRT5500 as a viable vaccine candidate for clinical development against COVID-19.

Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience.

OBJECTIVE: To summarize the multi-specialty strategy and initial guidelines of a Case Review Committee in triaging oncologic surgery procedures in a large Comprehensive Cancer Center and to outline current steps moving forward after the initial wave. SUMMARY OF BACKGROUND DATA: The impetus for strategic rescheduling of operations is multifactorial and includes our societal responsibility to minimize COVID-19 exposure risk and propagation among patients, the healthcare workforce, and our community at large. Strategic rescheduling is also driven by the need to preserve limited resources. As many states have already or are considering to re-open and relax stay-at-home orders, there remains a continued need for careful surgical scheduling because we must face the reality that we will need to co-exist with COVID-19 for months, if not years. METHODS: The quality officers, chairs, and leadership of the 9 surgical departments in our Division of Surgery provide specialty-specific approaches to appropriately triage patients. RESULTS: We present the strategic approach for surgical rescheduling during and immediately after the COVID-19 first wave for the 9 departments in the Division of Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. CONCLUSIONS: Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase.

Surgical decision-making and prioritization for cancer patients at the onset of the COVID-19 pandemic: A multidisciplinary approach.

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting "elective" operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.