Racial and Ethnic Disparity in Approach for Pediatric Intensive Care Unit Research Participation.

Importance: While disparities in consent rates for research have been reported in multiple adult and pediatric settings, limited data informing enrollment in pediatric intensive care unit (PICU) research are available. Acute care settings such as the PICU present unique challenges for study enrollment, given the highly stressful and emotional environment for caregivers and the time-sensitive nature of the studies. Objective: To determine whether race and ethnicity, language, religion, and Social Deprivation Index (SDI) were associated with disparate approach and consent rates in PICU research. Design, Setting, and Participants: This retrospective cohort study was performed at the Children's Hospital of Philadelphia PICU between July 1, 2011, and December 31, 2021. Participants included patients eligible for studies requiring prospective consent. Data were analyzed from February 2 to July 26, 2022. Exposure: Exposures included race and ethnicity (Black, Hispanic, White, and other), language (Arabic, English, Spanish, and other), religion (Christian, Jewish, Muslim, none, and other), and SDI (composite of multiple socioeconomic indicators). Main Outcomes and Measures: Multivariable regressions separately tested associations between the 4 exposures (race and ethnicity, language, religion, and SDI) and 3 outcomes (rates of approach among eligible patients, consent among eligible patients, and consent among those approached). The degree to which reduced rates of approach mediated the association between lower consent in Black children was also assessed. Results: Of 3154 children included in the study (median age, 6 [IQR, 1.9-12.5] years; 1691 [53.6%] male), rates of approach and consent were lower for Black and Hispanic families and those of other races, speakers of Arabic and other languages, Muslim families, and those with worse SDI. Among children approached for research, lower consent odds persisted for those of Black race (unadjusted odds ratio [OR], 0.73 [95% CI, 0.55-0.97]; adjusted OR, 0.68 [95% CI, 0.49-0.93]) relative to White race. Mediation analysis revealed that 51.0% (95% CI, 11.8%-90.2%) of the reduced odds of consent for Black individuals was mediated by lower probability of approach. Conclusions and Relevance: In this cohort study of consent rates for PICU research, multiple sociodemographic factors were associated with lower rates of consent, partly attributable to disparate rates of approach. These findings suggest opportunities for reducing disparities in PICU research participation.

[Functionality and everyday suitability of commercially wristwear products for frail older people - a comparative product testing]. / Funktionalität und Alltagstauglichkeit kommerziell erhältlicher Wristwear-Produkte für gebrechliche ältere Menschen : Ein vergleichender Produkttest.

BACKGROUND AND AIM: There is a wide range of smartwatches and emergency watches on the market that are specifically designed for older people. The products are freely available, which is why there is an urgent need for information about the reliability and functionality of the products among potential users, but also health professionals and decision-makers. As part of a systematic product comparison test, the functionality and quality of seven smartwatches were investigated. METHOD: Four watches for seniors, one watch for adults and two watches for children, but with comparable functionalities, were included in the test. For the test, real-life situations were simulated and, in addition to emergency calls, GPS tracking, fall detection and geofencing, the battery life, call quality, stability/robustness of the products and service/support were evaluated. From the total number of points, a grade was determined based on the German school grading system (1 = very good to 6 = insufficient). RESULTS: All smartwatches evaluated were rated at least "3-satisfactory". The two best-rated watches received a score of 1.8. The differences were particularly evident in the emergency call functionality, battery life, precision of the tracking function, and service/support. The call quality, with one exception, and the stability/robustness were consistently rated as "1-very good". Three watches in the test were able to detect falls with variable results. CONCLUSION: The functionality and usability of the tested products differed considerably. A focus on a few main functions can even provide added value for older, frail people. Continuous comparative testing of products for this target group with new and updated products is desirable.

Use and benefit of information, communication, and assistive technology among community-dwelling older adults - a cross-sectional study.

BACKGROUND: Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65. METHODS: A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling. RESULTS: The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use. CONCLUSIONS: Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).

Design and CT imaging of casper, an anthropomorphic breathing thorax phantom.

The goal of this work was to build an anthropomorphic thorax phantom capable of breathing motion with materials mimicking human tissues in x-ray imaging applications. The thorax phantom, named Casper, was composed of resin (body), foam (lungs), glow polyactic acid (bones) and natural polyactic acid (tumours placed in the lungs). X-ray attenuation properties of all materials prior to manufacturing were evaluated by means of photon-counting computed tomography (CT) imaging on a table-top system. Breathing motion was achieved by a scotch-yoke mechanism with diaphragm motion frequencies of 10-20 rpm and displacements of 1 to 2 cm. Casper was manufactured by means of 3D printing of moulds and ribs and assembled in a complex process. The final phantom was then scanned using a clinical CT scanner to evaluate material CT numbers and the extent of tumour motion. Casper CT numbers were close to human CT numbers for soft tissue (46 HU), ribs (125 HU), lungs (-840 HU) and tumours (-45 HU). For a 2 cm diaphragm displacement the largest tumour displacement was 0.7 cm. The five tumour volumes were accurately assessed in the static CT images with a mean absolute error of 4.3%. Tumour sizes were either underestimated for smaller tumours or overestimated for larger tumours in dynamic CT images due to motion blurring with a mean absolute difference from true volumes of 10.3%. More Casper information including a motion movie and manufacturing data can be downloaded from http://web.uvic.ca/~bazalova/Casper/.

Efficacy of Augmentation of Cognitive Behavioral Therapy With Transcranial Direct Current Stimulation for Depression: A Randomized Clinical Trial.

Importance: Major depressive disorder (MDD) affects approximately 10% of the population globally. Approximately 20% to 30% of patients with MDD do not sufficiently respond to standard treatment. Therefore, there is a need to develop more effective treatment strategies. Objective: To investigate whether the efficacy of cognitive behavioral therapy (CBT) for the treatment of MDD can be enhanced by concurrent transcranial direct current stimulation (tDCS). Design, Setting, and Participants: The double-blind, placebo-controlled randomized clinical trial PsychotherapyPlus was conducted at 6 university hospitals across Germany. Enrollment took place between June 2, 2016, and March 10, 2020; follow-up was completed August 27, 2020. Adults aged 20 to 65 years with a single or recurrent depressive episode were eligible. They were either not receiving medication or were receiving a stable regimen of antidepressant medication (selective serotonin reuptake inhibitor and/or mirtazapine). A total of 148 women and men underwent randomization: 53 individuals were assigned to CBT alone (group 0), 48 to CBT plus tDCS (group 1), and 47 to CBT plus sham-tDCS (group 2). Interventions: Participants attended a 6-week group intervention comprising 12 sessions of CBT. If assigned, tDCS was applied simultaneously. Active tDCS included stimulation with an intensity of 2 mA for 30 minutes (anode over F3, cathode over F4). Main Outcomes and Measures: The primary outcome was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to posttreatment in the intention-to-treat sample. Scores of 0 to 6 indicate no depression; 7 to 19, mild depression; 20 to 34, moderate depression; and 34 and higher, severe depression. Results: A total of 148 patients (89 women, 59 men; mean [SD] age, 41.1 [13.7] years; MADRS score at baseline, 23.0 [6.4]) were randomized. Of these, 126 patients (mean [SD] age, 41.5 [14.0] years; MADRS score at baseline, 23.0 [6.3]) completed the study. In each of the intervention groups, intervention was able to reduce MADRS scores by a mean of 6.5 points (95% CI, 3.82-9.14 points). The Cohen d value was -0.90 (95% CI, -1.43 to -0.50), indicating a significant effect over time. However, there was no significant effect of group and no significant interaction of group × time, indicating the estimated additive effects were not statistically significant. There were no severe adverse events throughout the whole trial, and there were no significant differences of self-reported adverse effects during and after stimulation between groups 1 and 2. Conclusions and Relevance: Based on MADRS score changes, this trial did not indicate superior efficacy of tDCS-enhanced CBT compared with 2 CBT control conditions. The study confirmed that concurrent group CBT and tDCS is safe and feasible. However, additional research on mechanisms of neuromodulation to complement CBT and other behavioral interventions is needed. Trial Registration: ClinicalTrials.gov Identifier: NCT02633449.

The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials.

BACKGROUND: The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. OBJECTIVE: We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. METHODS: A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ≥65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. RESULTS: A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. CONCLUSIONS: Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. TRIAL REGISTRATION: PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130249.

Neurologic and Cognitive Outcomes in Sickle Cell Disease from Infancy through Adolescence.

Children with sickle cell disease (SCD) are at risk for neurologic and cognitive complications beginning in early childhood. Current treatment for SCD focuses on primary prevention of complications, such as hydroxyurea for prevention of pain and acute chest syndrome, and chronic transfusion therapy for children who are at high risk for strokes. In this article, the prevalence, pathophysiology, and available interventions to prevent and treat neurologic and cognitive complications of SCD will be reviewed.

Obstacles to Using Assistive Technology for Older Adults - Results from a Focus Group Analysis.

Much hope is placed in the use of assistive technologies (AT) to support older adults and retain their independence and quality of life. AT could also be a way to help fulfill the increasing requirements of caring for an aging population. While many devices are freely available, successful and broad adoption is progressing slowly. In a qualitative analysis, we investigated the popularity of AT and the willingness to and obstacles for use. Eleven older adults aged 62-85 participated in three groups, each focusing on a specific age-related case example. Using content analysis, statements have been categorized into three levels: the affected person, their surroundings, and supportive devices. Information (knowledge, consultation) was the topic spoken about the most (n=101), followed by statements focusing on everyday life and the use of assistive devices (n=99). Comments on economic topics carried the least weight (n=28). The biggest obstacles for the reluctant adoption of AT don't seem to be acceptance issues but rather a lack of knowledge of AT and where to get counseling. Thus, the provision and promotion of coherent information material and accessible consultation for users and relatives should be prioritized. AT training for healthcare professionals can provide further opportunities.

Predicting postoperative day 1 hematocrit levels after hysterectomy for malignant indication: Validating a previously published model.

OBJECTIVE: To determine whether the Swenson model of postoperative day 1 (POD1) hematocrit after benign hysterectomy is applicable to gynecologic oncology hysterectomies. METHODS: Data were retrospectively collected from cases of hysterectomy with malignant pathology in Hartford, USA, from 2014 to 2016. Predicted POD1 hematocrit was compared with actual hematocrit. ROC curve analysis was used to determine the optimal cut-off point for predicting hematocrit levels of 30% or less. RESULTS: Among 107 women, mean age was 62.9 years and body mass index was 34.0. Most underwent robotic (44.9%) or abdominal (43.9%) hysterectomy. The published equation correctly predicted hematocrit to within ±5% for 83.2% of women, which was less accurate than observed in the original validation set. The equation was more likely to underestimate lower hematocrit levels, adding safety to its use. By ROC curve analysis, the best cut-off point for predicting actual hematocrit above 30% was predicted hematocrit 32.3% (100% specificity). CONCLUSION: The Swenson equation predicted POD1 hematocrit less accurately in the current dataset. As a screening tool for hematocrit below 30%, however, ordering postoperative hematocrit is probably unnecessary if the predicted value is 32.3% or higher. This equation should be used as a screening tool to reduce unnecessary laboratory tests.

Behavioral and electrophysiological responses to fairness norm violations in antisocial offenders.

Antisocial personality disorder is characterized by a stable, lifelong pattern of disregard for and violation of others' rights. Disruptions in the representation of fairness norms may represent a key mechanism in the development and maintenance of this disorder. Here, we investigated fairness norm considerations and reactions to their violations. To examine electrophysiological correlates, we assessed the medial frontal negativity (MFN), an event-related potential previously linked to violations of social expectancy and norms. Incarcerated antisocial violent offenders (AVOs, n = 25) and healthy controls (CTLs, n = 24) acted as proposers in the dictator game (DG) and ultimatum game (UG) and received fair vs. unfair UG offers from either another human (social context) or a computer (non-social context). Results showed that AVOs made lower offers in the DG but not the UG, indicating more rational and strategic behavior. Most importantly, when acting as recipients in the UG, acceptance rates were modulated by social context in CTLs, while AVOs generally accepted more offers. Correspondingly, ERP data indicated pronounced MFN amplitudes following human offers in CTLs, whereas MFN amplitudes in AVOs were generally reduced. The current data suggest intact fairness norm representations but altered reactions to their violation in antisocial personality disorder.

Enhancing the Lives of Children in Out-Of-Home Care: An Exploration of Mind-Body Interventions as a Method of Trauma Recovery.

The prevalence and impact of trauma exposure among young people in the child welfare system in Canada warrants holistic intervention as a means of trauma recovery for this vulnerable population. A trauma-informed approach to practice is outlined through consideration of traditional trauma treatments and mind-body interventions that serve as complementary methods of therapy. Despite limited research on the effectiveness of mind-body interventions with children and adolescents in out-of-home care in Canada, a review of available literature on mindfulness, arts-based methods, and yoga suggests these therapeutic interventions promote resilience and positive development. Additional research is needed to support the use of mind-body interventions with young people in out-of-home care. Practice implications and recommendations for future research within Canada are included to increase awareness and support a working understanding of the pervasiveness of trauma exposure among this population and the value of trauma-informed, holistic intervention.

Empathy and altruistic behavior in antisocial violent offenders with psychopathic traits.

Deficiencies in empathic functioning are considered a core characteristic of violent behavior. Enhancing empathy in aggressive populations may thus represent a promising intervention target. Hence, the aims of the present work were two-fold: First, we wanted to thoroughly assess empathic competencies and second, we aimed to investigate effects of an empathy induction on experienced empathy levels and prosocial behavior in a sample of violent offenders relative to matched controls. Empathy was assessed using both self-report as well as objective measures. For the empathy induction, participants were presented with empathy inducing and control videos. To assess the effects of the empathy induction on behavior, participants played a dictator game indicative of prosocial behavior after every video. Violent offenders showed no systematic impairment in empathy measures. Despite lower shares in the dictator game across conditions, the empathy induction led to a substantial increase in prosocial behavior in both groups. Importantly, high psychopathy scores were distinctively associated with lower self-reported empathy levels, an attenuated affective responsiveness to the empathy induction, and less altruistic behavior. Treatment programs aiming to improve empathy should take individual characteristics into account and may be applied to distinctive subgroups rather than to violent offenders per se.

Predicting postoperative day 1 hematocrit levels after hysterectomy.

BACKGROUND: The Swenson model was developed as a linear regression model to estimate postoperative day 1 hematocrit levels after benign hysterectomy. Predictive variables included preoperative hematocrit level, patient weight, estimated blood loss, intraoperative crystalloid volume, preoperative platelet count, and hysterectomy route that predicted postoperative day 1 hematocrit level at ±5% for 100% of patients who used an internal validation set. OBJECTIVE: We aimed to validate externally the Swenson model using our hysterectomy population and to further validate the model in a cohort that included robotic-assisted cases. STUDY DESIGN: In a retrospective cohort, data were collected from benign hysterectomies from April 2014 through May 2016. Predicted postoperative day 1 hematocrit level was calculated with the use of the Swenson equation and compared with measured hematocrit values. We compared our results to the Swenson model results using chi-square or Fisher's exact test. We then restricted our analysis to those with actual postoperative day 1 hematocrit level of ≤30%, to determine whether the model performed accurately in this subgroup that may need intervention. We generated a receiver-operating characteristic curve with Louden Index to determine the best cut-point from the Swenson hematocrit level projections for the prediction of an actual hematocrit level of ≤30%. Furthermore, we stratified the Swenson model predicted hematocrit level into 4 ranges: <32%, 32-35%, 35-38%, and >38%. This stratification allowed us to assess the differential accuracy of the Swenson model across hematocrit level ranges. RESULTS: Of 602 hysterectomies, 478 patients had all the variables that were needed for the Swenson model and postoperative day 1 hematocrit level for comparison. The Swenson model was significantly less accurate in our data compared with their validation set with fewer patients whose predicted hematocrit level was accurate at different thresholds from ±1% through ±5% of actual hematocrit level (all P<.001). Only 76.8% of the predicted hematocrits were accurate within ±5%. Analysis of variance showed accuracy that was similar among different surgical routes (P=.193). A quadratic best-fit curve showed accuracy was maximized when hematocrit level of 36.2%. Projected hematocrit level was ±2.5% of actual but deteriorated at higher and lower hematocrit level values. When the analysis was restricted to those patients with postoperative day 1 hematocrit levels of ≤30%, accuracy was worse, with only 55.3% of predicted hematocrit level values within ±5%. In this subset, the Swenson equation was more likely to overestimate hematocrit level and give false reassurance. A receiver-operating characteristic curve analysis showed that the best Swenson cut-point for the prediction of an actual hematocrit level of ≤30% was 31.9% (sensitivity, 75.5%; specificity, 64.0%). Finally, predicted hematocrit level was divided into 4 groups: <32%, 32-35%, 35-38%, and >38%. When predicted hematocrit level was <32% (n=164), the model was more likely to under-predict hematocrit level and was least accurate in the subset of patients who were most likely to need intervention. When predicted hematocrit level was 32-35% (n=192), 17.2% of the patients (approximately 1 in 6) had an actual postoperative day 1 hematocrit level of ≤30%. When a predicted hematocrit level of ≥35% was used as a cut-off point, the percentage of patients who had an actual postoperative day 1 hematocrit level of ≤30% dropped to 8.2%. No patients had an actual hematocrit level of <24%, which makes this a reasonable choice for screening for anemia. CONCLUSION: Although the Swenson model was reliable for the prediction of postoperative day 1 hematocrit level in their internal validation set, it did not perform as well in our hysterectomy population. It may have utility as a screening tool if the projected hematocrit level was ≥35%. Further research is needed to create a model for the prediction of postoperative day 1 hematocrit level that can be incorporated into standard practice.

Frontal alpha asymmetry and callous-unemotional traits in imprisoned violent offenders: A pilot study.

Based on the approach-withdrawal model of hemispheric asymmetry, anger and aggression have been linked to an approach-related pattern, characterized by stronger relative left-hemispheric anterior cortical activity. Recent work suggests that also in individuals with extremely violent tendencies, such as imprisoned offenders, approach-related asymmetry may be associated with self-reported trait anger and aggression. A putative association between alpha asymmetry and further characteristics relevant for aggression, such as callous-unemotional (CU) traits, remains to be explored. CU traits may increase the probability of aggressive behavior; nevertheless, they may also enable individuals to inhibit and postpone the overt display of aggression until circumstances grant its strongest impact. In the current exploratory study, we measured trait aggression, CU traits, and resting-state EEG asymmetry in the alpha band (8-13 Hz) in imprisoned violent offenders in a German high security prison. Results revealed that particularly trait callousness was associated with stronger relative right-hemispheric anterior cortical activity (i.e., a withdrawal-related pattern). An association between alpha asymmetry and aggression was not replicated. These preliminary findings suggest that, due to the involved emotional and interpersonal detachment, callousness might be withdrawal related, despite its potential to bring about aggressive behavior. They also imply that the identification of putative clinical subtypes in prisoners is required, as varying psychopathology might undermine an association between alpha asymmetry and aggression.

PsychotherapyPlus: augmentation of cognitive behavioral therapy (CBT) with prefrontal transcranial direct current stimulation (tDCS) in major depressive disorder-study design and methodology of a multicenter double-blind randomized placebo-controlled trial.

Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders worldwide. About 20-30% of patients do not respond to the standard psychopharmacological and/or psychotherapeutic interventions. Mounting evidence from neuroimaging studies in MDD patients reveal altered activation patterns in lateral prefrontal brain areas. Successful cognitive behavioral therapy (CBT) is associated with a recovery of these neural alterations. Moreover, it has been demonstrated that transcranial direct current stimulation (tDCS) is capable of influencing prefrontal cortex activity and cognitive functions such as working memory and emotion regulation. Thus, a clinical trial investigating the effects of an antidepressant intervention combining CBT with tDCS seems promising. The present study investigates the antidepressant efficacy of a combined CBT-tDCS intervention as compared to CBT with sham-tDCS or CBT alone. A total of 192 patients (age range 20-65 years) with MDD (Hamilton Depression Rating Scale Score ≥ 15, 21-item version) will be recruited at four study sites across Germany (Berlin, Munich, Tuebingen, and Freiburg) and randomly assigned to one of the following three treatment arms: (1) CBT + active tDCS; (2) CBT + sham-tDCS; and (3) CBT alone. All participants will attend a 6-week psychotherapeutic intervention comprising 12 sessions of CBT each lasting 100 min in a closed group setting. tDCS will be applied simultaneously with CBT. Active tDCS includes stimulation with an intensity of 2 mA for 30 min with the anode placed over F3 and the cathode over F4 according to the EEG 10-20 system, if assigned. The primary outcome measure is the change in Montgomery-Åsberg Depression Rating Scale scores from baseline to 6, 18, and 30 weeks after the first session. Participants also undergo pre- and post-treatment neuropsychological testing and functional magnetic resonance imaging (fMRI) to assess changes in prefrontal functioning and connectivity. The study investigates whether CBT can be augmented by non-invasive brain stimulation techniques such as tDCS in the treatment of MDD. It is designed as a proof-of-principle trial for the combined tDCS-CBT treatment, but also allows the investigation of the neurobiological underpinnings of the interaction between both interventions in MDD. Trial registration ClinicalTrials.gov Identifier NCT02633449.

Smooth criminal: convicted rule-breakers show reduced cognitive conflict during deliberate rule violations.

Classic findings on conformity and obedience document a strong and automatic drive of human agents to follow any type of rule or social norm. At the same time, most individuals tend to violate rules on occasion, and such deliberate rule violations have recently been shown to yield cognitive conflict for the rule-breaker. These findings indicate persistent difficulty to suppress the rule representation, even though rule violations were studied in a controlled experimental setting with neither gains nor possible sanctions for violators. In the current study, we validate these findings by showing that convicted criminals, i.e., individuals with a history of habitual and severe forms of rule violations, can free themselves from such cognitive conflict in a similarly controlled laboratory task. These findings support an emerging view that aims at understanding rule violations from the perspective of the violating agent rather than from the perspective of outside observer.

Empathy promotes altruistic behavior in economic interactions.

What are the determinants of altruism? While economists assume that altruism is mainly driven by fairness norms, social psychologists consider empathy to be a key motivator for altruistic behavior. To unite these two theories, we conducted an experiment in which we compared behavior in a standard economic game that assesses altruism (the so-called Dictator Game) with a Dictator Game in which participants' behavioral choices were preceded either by an empathy induction or by a control condition without empathy induction. The results of this within-subject manipulation show that the empathy induction substantially increased altruistic behavior. Moreover, the increase in experienced empathy predicted over 40% of the increase in sharing behavior. These data extend standard economic theories that altruism is based on fairness considerations, by showing that empathic feelings can be a key motivator for altruistic behavior in economic interactions.

Facial Affect Recognition in Violent and Nonviolent Antisocial Behavior Subtypes.

Prior studies provide evidence for impaired recognition of distress cues in individuals exhibiting antisocial behavior. However, it remains unclear whether this deficit is generally associated with antisociality or may be specific to violent behavior only. To examine whether there are meaningful differences between the two behavioral dimensions rule-breaking and aggression, violent and nonviolent incarcerated offenders as well as control participants were presented with an animated face recognition task in which a video sequence of a neutral face changed into an expression of one of the six basic emotions. The participants were instructed to press a button as soon as they were able to identify the emotional expression, allowing for an assessment of the perceived emotion onset. Both aggressive and nonaggressive offenders demonstrated a delayed perception of primarily fearful facial cues as compared to controls. These results suggest the importance of targeting impaired emotional processing in both types of antisocial behavior.

Theory of mind abilities in patients with psychogenic nonepileptic seizures.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) have been frequently linked to deficits in affect regulation and altered processing of emotionally salient information. However, less is known about how patients suffering from PNES actually process and interpret affective social stimuli. Thus, the present study aimed to investigate basal facial affect recognition as well as mind-reading skills in a sample of patients with PNES and matched control subjects. METHODS: Patients with PNES (N=15) and healthy controls (N=15) completed self-report questionnaires that measured alexithymia and perceived stress vulnerability. Affect perception was tested using a series of computerized movies of models whose facial expressions slowly change from neutral to full-blown emotions (anger, fear, sadness, happiness, disgust, and surprise), allowing for a fine-grained assessment of facial emotion recognition impairments. Further, all participants were presented with the Movie for the Assessment of Social Cognition, a well-validated video-based test for the evaluation of subtle mind-reading deficits. RESULTS: Data analyses revealed increased alexithymic traits and, impaired mentalizing skills in individuals with PNES, while basal facial expression recognition was not compromised. DISCUSSION: The present findings are the first to demonstrate that patients with PNES exhibit several deficits in reasoning about their own and other people's mental states. Patients with PNES may benefit from psychotherapeutic interventions that focus on disturbed affect regulation and aim to enhance emotional awareness.

When static media promote active learning: annotated illustrations versus narrated animations in multimedia instruction.

In 4 experiments, students received a lesson consisting of computer-based animation and narration or a lesson consisting of paper-based static diagrams and text. The lessons used the same words and graphics in the paper-based and computer-based versions to explain the process of lightning formation (Experiment 1), how a toilet tank works (Experiment 2), how ocean waves work (Experiment 3), and how a car's braking system works (Experiment 4). On subsequent retention and transfer tests, the paper group performed significantly better than the computer group on 4 of 8 comparisons, and there was no significant difference on the rest. These results support the static media hypothesis, in which static illustrations with printed text reduce extraneous processing and promote germane processing as compared with narrated animations.