The role of autonomy-connectedness in stress-modulating effects of social support in women: An experimental study using a virtual Trier Social Stress Test.

Social support is associated with mental well-being and favorable therapy outcomes. As autonomy-connectedness, the capacity for self-governance in interpersonal context, may affect reliance on others, we investigated whether stress-modulating effects of social support are moderated by autonomy-connectedness. Ninety-seven undergraduates completed measures on autonomy-connectedness and trait social anxiety, and attended a laboratory session with a friend (support) or alone (control). All underwent a virtual Trier Social Stress Test and completed anxiety, cortisol and heart rate (variability) measures. Preregistered analyses revealed that social support reduced anxiety reactivity and delayed heart rate variability decreases, but not heart rate. Contrary to hypotheses, autonomy-connectedness did not predict stress-reactivity or interact with condition. Exploratory analyses suggested effects of social support on cortisol reactivity and indicated that reported support quality varied by trait anxiety and self-awareness. Our findings underline the stress-modulating effects of social support and suggest that social support can benefit individuals with varying levels of autonomy-connectedness.

Application of artificial intelligence in cardiac CT: From basics to clinical practice.

Research into the possibilities of AI in cardiac CT has been growing rapidly in the last decade. With the rise of publicly available databases and AI algorithms, many researchers and clinicians have started investigations into the use of AI in the clinical workflow. This review is a comprehensive overview on the types of tasks and applications in which AI can aid the clinician in cardiac CT, and can be used as a primer for medical researchers starting in the field of AI. The applications of AI algorithms are explained and recent examples in cardiac CT of these algorithms are further elaborated on. The critical factors for implementation in the future are discussed.

Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease.

OBJECTIVES: The purpose of this study was to analyze the prognostic value of dynamic CT perfusion imaging (CTP) and CT derived fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE). METHODS: 81 patients from 4 institutions underwent coronary computed tomography angiography (CCTA) with dynamic CTP imaging and CT-FFR analysis. Patients were followed-up at 6, 12, and 18 months after imaging. MACE were defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or revascularization. CT-FFR was computed for each major coronary artery using an artificial intelligence-based application. CTP studies were analyzed per vessel territory using an index myocardial blood flow, the ratio between territory and global MBF. The prognostic value of CCTA, CT-FFR, and CTP was investigated with a univariate and multivariate Cox proportional hazards regression model. RESULTS: 243 vessels in 81 patients were interrogated by CCTA with CT-FFR and 243 vessel territories (1296 segments) were evaluated with dynamic CTP imaging. Of the 81 patients, 25 (31%) experienced MACE during follow-up. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4) compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, including clinical factors, CCTA, CT-FFR, and index-MBF, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2). CONCLUSION: Our study provides initial evidence that dynamic CTP alone has the highest prognostic value for MACE compared to CCTA and CT-FFR individually or a combination of the three, independent of clinical risk factors.

Autonomy deficits as vulnerability for anxiety: evidence from two laboratory-based studies.

BACKGROUND: Autonomous individuals are characterized by self-governance; awareness of and capacity to realize one's wishes and needs, while being connected with and sensitive towards others. In line with earlier research showing consistent associations between autonomy-connectedness deficits and anxiety, we tested in two studies whether autonomy deficits predict anxious responses to acute stressors. METHODS: In Study 1, participants (N = 177) viewed an anxiety-inducing film fragment and reported anxiety before and after viewing the clip. In experimental Study 2, participants (N = 100) were randomly allocated to one of two conditions: giving a short presentation to an audience (impromptu speech task) or watching another person's presentation (control condition). Anxiety was measured at baseline, after a preparation period and directly after the presentation. RESULTS: In Study 1, individuals' anxiety in reaction to watching the movie was positively associated with the autonomy-connectedness component sensitivity to others. In Study 2, individuals' anxiety in reaction to preparing the presentation was negatively associated with the autonomy-connectedness component self-awareness. CONCLUSIONS: Specific autonomy components may be related to experiencing anxiety in differing situations (i.e., related to others' distress or presenting one's personal views). Collectively these results indicate that autonomy-connectedness deficits may form a vulnerability factor for experiencing anxiety.

Diagnostic performance of semi-quantitative and quantitative stress CMR perfusion analysis: a meta-analysis.

BACKGROUND: Stress cardiovascular magnetic resonance (CMR) perfusion imaging is a promising modality for the evaluation of coronary artery disease (CAD) due to high spatial resolution and absence of radiation. Semi-quantitative and quantitative analysis of CMR perfusion are based on signal-intensity curves produced during the first-pass of gadolinium contrast. Multiple semi-quantitative and quantitative parameters have been introduced. Diagnostic performance of these parameters varies extensively among studies and standardized protocols are lacking. This study aims to determine the diagnostic accuracy of semi- quantitative and quantitative CMR perfusion parameters, compared to multiple reference standards. METHOD: Pubmed, WebOfScience, and Embase were systematically searched using predefined criteria (3272 articles). A check for duplicates was performed (1967 articles). Eligibility and relevance of the articles was determined by two reviewers using pre-defined criteria. The primary data extraction was performed independently by two researchers with the use of a predefined template. Differences in extracted data were resolved by discussion between the two researchers. The quality of the included studies was assessed using the 'Quality Assessment of Diagnostic Accuracy Studies Tool' (QUADAS-2). True positives, false positives, true negatives, and false negatives were subtracted/calculated from the articles. The principal summary measures used to assess diagnostic accuracy were sensitivity, specificity, andarea under the receiver operating curve (AUC). Data was pooled according to analysis territory, reference standard and perfusion parameter. RESULTS: Twenty-two articles were eligible based on the predefined study eligibility criteria. The pooled diagnostic accuracy for segment-, territory- and patient-based analyses showed good diagnostic performance with sensitivity of 0.88, 0.82, and 0.83, specificity of 0.72, 0.83, and 0.76 and AUC of 0.90, 0.84, and 0.87, respectively. In per territory analysis our results show similar diagnostic accuracy comparing anatomical (AUC 0.86(0.83-0.89)) and functional reference standards (AUC 0.88(0.84-0.90)). Only the per territory analysis sensitivity did not show significant heterogeneity. None of the groups showed signs of publication bias. CONCLUSIONS: The clinical value of semi-quantitative and quantitative CMR perfusion analysis remains uncertain due to extensive inter-study heterogeneity and large differences in CMR perfusion acquisition protocols, reference standards, and methods of assessment of myocardial perfusion parameters. For wide spread implementation, standardization of CMR perfusion techniques is essential. TRIAL REGISTRATION: CRD42016040176 .

The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI).

Disability is an important health outcome for older persons; it is associated with impaired quality of life, future hospitalization, and mortality. Disability also places a high burden on health care professionals and health care systems. Disability is regarded as an adverse outcome of physical frailty. The main objective of this study was to assess the predictive validity of the eight individual self-reported components of the physical frailty subscale of the TFI for activities of daily living (ADL) and instrumental activities of daily living (IADL) disability. This longitudinal study was carried out with a sample of Dutch citizens. At baseline the sample consisted at 429 people aged 65 years and older and a subset of all respondents participated again two and a half years later (N=355, 83% response rate). The respondents completed a web-based questionnaire comprising the TFI and the Groningen Activity Restriction Scale (GARS) for measuring disability. Five components together (unintentional weakness, weakness, poor endurance, slowness, low physical activity), referring to the phenotype of Fried et al., predicted disability, even after controlling for previous disability and other background characteristics. The other three components of the physical frailty subscale of the TFI (poor balance, poor hearing, poor vision) together did not predict disability. Low physical activity predicted both total and ADL disability, and slowness both total and IADL disability. In conclusion, self-report assessment using the physical subscale of the TFI aids the prediction of future ADL and IADL disability in older persons two and a half years later.

The prediction of quality of life by physical, psychological and social components of frailty in community-dwelling older people.

PURPOSE: To assess the predictive validity of the 15 components of the Tilburg Frailty Indicator (TFI), a self-report questionnaire, for quality of life domains physical health, psychological, social relations and environmental in community-dwelling older persons in a longitudinal study. METHODS: The predictive validity of the components of the TFI was tested in a sample of 484 community-dwelling persons aged 75 years and older in the Netherlands in 2008 (response rate 42%). A subset of all respondents participated two years later, in 2010 (n = 261, 54%), and a subset of these respondents participated again in 2012 (n = 196, 75%). The WHOQOL-BREF was used for measuring four quality of life domains. RESULTS: Four physical frailty components (physical unhealthy, difficulty in maintaining balance, difficulty in walking and physical tiredness), one psychological frailty component (feeling down) and one social frailty component (lack of social support) predicted future scores on quality of life domains, even after controlling for background characteristics and diseases. CONCLUSION: This longitudinal study showed that quality of life is predicted by physical as well as psychological and social frailty components. This finding emphasizes the relevance of a multidimensional assessment of frailty. To improve quality of life of older persons, special attention should go to the screening and subsequent interventions focusing on the frailty components difficulty in walking, feeling down and lack of social support.

[Young frail elderly: assessed using the Tilburg Frailty Indicator]. / Fragiliteit bij jonge ouderen: meting met de Tilburg Frailty Indicator.

BACKGROUND: Frail elderly have a higher risk of adverse outcomes, e.g., hospitalization,institutionalization, or premature death. The Tilburg Frailty Indicator (TFI) is a validated questionnaire for measuring frailty in independently living older people aged 70 years and over. AIMS: Determining the prevalence of frailty among independently living young elderly, and examining which factors predict frailty among this target group. METHODS: 308 young elderly (58 to 64 years) completed the TFI before they visited the ambulatory health screening centre in Roosendaal. The TFI includes questions concerning physical, psychological and social frailty, and questions on possible determinants of frailty. RESULTS: 18-4% of the sample of young elderly was frail. Women scored significantly higher on psychological and social frailty. The determinants explained 37% of the frailty score. As expected,low income, an unhealthy lifestyle, multimorbidity, experiencing life events, and dissatisfaction with the living environment predicted frailty. The three frailty domains(physical, psychological, social) were affected by different determinants. CONCLUSION: A substantial part of the young elderly in the sample turned out to be frail. The finding that the three domains of frailty are predicted by different determinants underlines the importance the importance of a broad perspective regarding the functioning of the individual older person.

Profiles of individually defined recovery of people with major psychiatric problems.

BACKGROUND: Research on factors associated with individually defined recovery is limited. Several phases of recovery have been described in the literature. Individuals in these distinct phases have different characteristics and problems. AIMS: To identify classes of people with major psychiatric problems who have comparable profiles of individually defined recovery, to relate these classes to the phases of recovery as described by Spaniol, Wewiorsky, Gagne, and Anthony (2002), and to associate the classes to demographic and psychiatric characteristics, and health-related variables. METHODS: Data of 333 participants with major psychiatric problems were used. A latent class analysis was conducted on the mean scores of four proxy measures of recovery. RESULTS: Three well-defined classes were found that differed on the recovery measures. The classes differed significantly on variables corresponding to Spaniol's phases of recovery (Spaniol et al., 2002) and on health care utilization, health care needs and anxiety disorder, but not on demographic variables. CONCLUSIONS: It is possible to identify classes of people with major psychiatric problems who have comparable profiles of individually defined recovery that seem to correspond to phases of recovery. More knowledge of the characteristics of people in different phases of recovery will contribute to more fine-tuned and recovery-oriented health care.

Evidence for curvilinear interpolation from dot alignment judgements.

Visual interpolation between dots responsible for rectilinear versus curvilinear contour interpretation was examined with the psychophysical forced directional response (FDR) paradigm. Regular four-dot polygon segments, together with a target dot, were presented to the subjects for 150 ms. Subjects were required to indicate the direction of deviation of the target dot from the midpoint of the intermediate line segment. Crucial variables were the outer angle of the line segments and symmetry axis orientation of the polygon segment. Logistic regression analyses showed that curvilinear interpolation occurred for angles up to 30 degrees, but emerged more pervasively under the vertical symmetry axis orientation for angles up to 60 degrees.