Climate Change ECHO: Telementoring to Improve Climate Literacy for Health Professionals.

Introduction: Climate change is a global public health crisis. Most clinicians and public health professionals do not receive adequate education to manage and communicate climate-related health impacts to their patients. Methods: From July 2021 to February 2022, the Project ECHO Climate Change and Human Health program completed 22 weekly trainings for health professionals. These virtual telementoring sessions were designed to improve both knowledge and self-efficacy about climate-related health impacts and climate change‒related communication skills. Results: Between July 2021 and February 2022, a total of 804 unique participants (from 44 states and 25 countries) attended the sessions. Participants were nurses (24.7%), physicians (16.8%), and public health professionals (8.5%). They completed weekly Zoom polls measuring their knowledge and self-efficacy. On average, participants strongly agreed or agreed that they had learned skills taught in each session (average percentage of those who strongly agreed or agreed=94.6%, range=66.7%-100.0%). Participants (31%) also completed a weekly postsession survey. A total of 91% rated the sessions as excellent or very good regarding evidenced-basis, and 89% rated sessions as excellent or very good regarding improved communication skills with patients and colleagues. Conclusions: Given the global climate crisis, the Climate Change and Human Health ECHO is successfully building resources and capacity for clinicians and public health professionals.

Educating Community Health Professionals About the Health-Related Effects of Climate Change Through ECHO Telementoring.

INTRODUCTION: Climate change is a global public health emergency causing extensive morbidity and mortality worldwide. Although most large medical organizations endorse the need to train health care professionals in climate change, such trainings are not readily available. METHODS: This article describes the results of an 8-week, 75-min per week, Climate Change and Human Health ECHO (CCHH ECHO) synchronous telementoring course for post-licensure health professionals. The primary goals were: to increase knowledge, self-efficacy, and communication skills. Participants were eligible to receive up to 10 h of no-cost continuing education credits and a certificate for completing the program. RESULTS: The 8-week course included 625 unique participants from 25 countries. An interprofessional group of clinicians, health professionals, and educators included: 130/28% PhD, 92/20% MD/DO, 52/12% RN/NP/PA, 50/11% MPH. The prospective survey demonstrated a significant improvement in knowledge, confidence, attitudes (P < .001) and communication skills (P = .029) at 3 months post course. CONCLUSIONS: The climate crisis is a public health emergency, and health professionals worldwide are considered the most trusted source of health information. Training current and future health professionals regarding the health-related effects of global warming is vital. The CCHH ECHO may be a successful model to facilitate knowledge transfer and promote communication skills between subject matter experts and course participants.

Climate Change and Human Health ECHO: Global Telementoring for Health Professionals.

OBJECTIVE: To increase the knowledge and communication skills of health professionals related to climate change and human health (CCHH). METHODS: From February to April 2021, Project ECHO (Extension for Community Healthcare Outcomes) created an 8-week, synchronous and virtual, CCHH ECHO telementoring series for health professionals. Didactics, simulated cases, and climate change tools were used to educate the interprofessional group of participants. RESULTS: During this CCHH ECHO pilot series, 625 unique participants represented 45 US states and 25 countries. The participants reported that they increased their knowledge, skills, and communication techniques regarding climate change and health. CONCLUSIONS: The human health effects of climate change is an emerging field, and increasing knowledge and communication skills among health practitioners is of critical importance. The CCHH ECHO is one potential platform that may reach a diverse community of health professionals globally due to the diffusion and demonopolization of knowledge.

Common circuit or paradigm shift? The functional brain in emotional scene perception and emotional imagery.

Meta-analytic and experimental studies investigating the neural basis of emotion often compare functional activation in different emotional induction contexts, assessing evidence for a "core affect" or "salience" network. Meta-analyses necessarily aggregate effects across diverse paradigms and different samples, which ignore potential neural differences specific to the method of affect induction. Data from repeated measures designs are few, reporting contradictory results with a small N. In the current study, functional brain activity is assessed in a large (N = 61) group of healthy participants during two common emotion inductions-scene perception and narrative imagery-to evaluate cross-paradigm consistency. Results indicate that limbic and paralimbic regions, together with visual and parietal cortex, are reliably engaged during emotional scene perception. For emotional imagery, in contrast, enhanced functional activity is found in several cerebellar regions, hippocampus, caudate, and dorsomedial prefrontal cortex, consistent with the conception that imagery is an action disposition. Taken together, the data suggest that a common emotion network is not engaged across paradigms, but that the specific neural regions activated during emotional processing can vary significantly with the context of the emotional induction.

Transdiagnostic trauma severity in anxiety and mood disorders: Functional brain activity during emotional scene processing.

Exposure to traumatic events is not unique to post-traumatic stress disorder (PTSD) and is a significant factor in the development of physical and mental disease across the diagnostic spectrum. Using fMRI, this study assesses functional activation in the amygdala and visual cortex during emotional scene processing in a sample of anxiety and mood disorder patients (N = 162). Replicating previous studies with healthy young participants, a strong covariation was found between functional activity in the amygdala and ventral visual cortex, with blood-oxygen-level dependent (BOLD) activity overall significantly enhanced in both regions when viewing emotionally arousing, compared to neutral, scenes. BOLD changes during emotional processing predicted questionnaire reports of experienced trauma and PTSD-like symptoms (e.g., intrusive thoughts, bad dreams, re-experiencing) and associated functional impairment. Patients showing the smallest BOLD changes when viewing emotional (compared to neutral) scenes in the amygdala and ventral visual cortex reported the highest trauma scores, whereas those patients with the largest amygdala emotional reactivity differences reported the lowest trauma scores. Experiencing a life-threatening event (to self or other) that prompts high fear, distress, and functional impairment was associated with reduced functional limbic-visual activity, independent of a PTSD diagnosis. The findings suggest that experienced trauma may be a transdiagnostic vulnerability factor contributing significantly to psychopathology in many patients with anxiety and mood disorders.

An intra-individual approach for detecting evaluation with event-related potentials.

The P3-based concealed information test (CIT) is an accurate indirect measure of non-evaluative memories (e.g., knowledge of an incriminating item). Less clear and established, however, is the accuracy of indirect measures that rely on the P3-like late positive potentials (LPPs) in discriminating evaluative (e.g., pleasant or unpleasant) memories. Using an LPP-based evaluative oddball paradigm in which participants were truthful on half of the trials about their evaluation toward pictures and concealed their evaluation on the other half of trials toward pictures, we applied an intra-individual Bayesian scheme to classify whether participants' evaluations were congruent or incongruent with a preceding context. LPPs were predictably larger to evaluatively incongruent than congruent pictures, and this LPP effect was reduced during misreporting presumably because of enhanced cognitive load. Notably, across two experiments the sensitivity (80%) was respectable during truth telling, but poor during concealment (sensitivity = 35%). Taken together, these data suggest that indirect measures such as the LPP-based evaluative oddball may be useful for detecting individual evaluation, but more work is warranted that explores conditions under which concealment of evaluation may be more accurately assessed.

The Startle-Evoked Potential: Negative Affect and Severity of Pathology in Anxiety/Mood Disorders.

BACKGROUND: The National Institute of Mental Health Research Domain Criteria initiative encourages a search for dimensional biological measures of psychopathology unconstrained by current diagnostic categories. Consistent with this aim, the presented research studies a large sample of anxiety and mood disorder patients, assessing differences in principal diagnoses and comorbidity patterns, clinicians' ratings, and questionnaire measures of negative affect and life dysfunction as they relate to a potential brain marker of pathology: the amplitude of the event-related potential (ERP) elicited by a startle-evoking stimulus. METHODS: Patients seeking evaluation or treatment for anxiety and mood disorders (N = 208) participated in two tasks at the University of Florida (Gainesville, FL): 1) imagining emotional and neutral events and 2) viewing emotional and neutral pictures while acoustic startle probes were presented and the ERP was recorded. For a comparison patient group (N = 120), startle probes were administered and ERPs recorded at the University of Greifswald (Greifswald, Germany) while performing the same imagery task. RESULTS: Reduced positive amplitude of a centroparietal startle-evoked ERP (156-352 ms after onset) significantly predicted higher questionnaire scores of anxiety/depression, reports of increased life dysfunction, greater comorbidity, and clinician ratings of heightened severity and poorer prognosis. The effect was general across principal diagnoses, found for both the Florida and German samples, and consistent in pattern despite differences in the tasks administered. CONCLUSIONS: The startle-evoked ERP reliably predicts severity and breadth of psychopathology, independent of task context. It is a potential significant contributor to a needed array of biological measures that might improve classification of anxiety and mood disorders.

What does the dot-probe task measure? A reverse correlation analysis of electrocortical activity.

The dot-probe task is considered a gold standard for assessing the intrinsic attentive selection of one of two lateralized visual cues, measured by the response time to a subsequent, lateralized response probe. However, this task has recently been associated with poor reliability and conflicting results. To resolve these discrepancies, we tested the underlying assumption of the dot-probe task-that fast probe responses index heightened cue selection-using an electrophysiological measure of selective attention. Specifically, we used a reverse correlation approach in combination with frequency-tagged steady-state visual potentials (ssVEPs). Twenty-one participants completed a modified dot-probe task in which each member of a pair of lateralized face cues, varying in emotional expression (angry-angry, neutral-angry, neutral-neutral), flickered at one of two frequencies (15 or 20 Hz), to evoke ssVEPs. One cue was then replaced by a response probe, and participants indicated the probe orientation (0° or 90°). We analyzed the ssVEP evoked by the cues as a function of response speed to the subsequent probe (i.e., a reverse correlation analysis). Electrophysiological measures of cue processing varied with probe hemifield location: Faster responses to left probes were associated with weak amplification of the preceding left cue, apparent only in a median split analysis. By contrast, faster responses to right probes were systematically and parametrically predicted by diminished visuocortical selection of the preceding right cue. Together, these findings highlight the poor validity of the dot-probe task, in terms of quantifying intrinsic, nondirected attentive selection irrespective of probe/cue location.

On the automatic activation of attitudes: a quarter century of evaluative priming research.

Evaluation is a fundamental concept in psychological science. Limitations of self-report measures of evaluation led to an explosion of research on implicit measures of evaluation. One of the oldest and most frequently used implicit measurement paradigms is the evaluative priming paradigm developed by Fazio, Sanbonmatsu, Powell, and Kardes (1986). This paradigm has received extensive attention in psychology and is used to investigate numerous phenomena ranging from prejudice to depression. The current review provides a meta-analysis of a quarter century of evaluative priming research: 73 studies yielding 125 independent effect sizes from 5,367 participants. Because judgments people make in evaluative priming paradigms can be used to tease apart underlying processes, this meta-analysis examined the impact of different judgments to test the classic encoding and response perspectives of evaluative priming. As expected, evidence for automatic evaluation was found, but the results did not exclusively support either of the classic perspectives. Results suggest that both encoding and response processes likely contribute to evaluative priming but are more nuanced than initially conceptualized by the classic perspectives. Additionally, there were a number of unexpected findings that influenced evaluative priming such as segmenting trials into discrete blocks. We argue that many of the findings of this meta-analysis can be explained with 2 recent evaluative priming perspectives: the attentional sensitization/feature-specific attention allocation and evaluation window perspectives.

How different are their experiences and outcomes? Comparing aged out and other child welfare involved youth.

This paper adds to the growing body of research examining the experiences of youth aging out of the child welfare system. Through a comparison of youth aging out with two other groups of child welfare-involved youth-those whose families received child welfare services but were never placed out of home and those who were in out-of-home placement but did not age out-it presents a profile of their care careers and other system involvement (e.g., mental health, justice system). Analyses indicate that young people aging out of care have experienced significant amounts of time in out-of-home placement, a great deal of placement instability, and high levels of other system involvement. In general, their involvement is more extensive than that of the two comparison groups. However, the justice system involvement of youth who experienced out-of-home placement but did not age out is just as high as that of youth who have aged out. This finding highlights the importance of devoting resources not only to youth aging out of care but also to similarly-aged young people with prior child welfare involvement.

Patterns of mental health, substance abuse, and justice system involvement among youth aging out of child welfare.

Although research on youth aging out of the child welfare system has increased, there has been limited focus on how their experiences vary. In particular, there is a need to examine patterns in the involvement of these youth in other systems, which indicate constellations of challenges facing these young people as they transition out of care and into adulthood. Using administrative data from a large birth cohort of individuals born between 1985 and 1994 whose families have been involved in the child welfare system, this article presents an analysis of the mental health, substance abuse, juvenile justice, and criminal justice system involvement of youth who have aged out of child welfare. Using a 2-step cluster analysis, we identify 5 subgroups of youth. Two of these groups, accounting for almost half of the youth, have little other system involvement and have child welfare care careers of relative stability. The other 3 groups, consisting of just over half of the youth, have much more extensive other system involvement, as well as care careers marked by instability and a greater proportion of time spent in congregate care.

Electrophysiological responses to evaluative priming: the LPP is sensitive to incongruity.

Previous studies examining event-related potentials and evaluative priming have been mixed; some find evidence that evaluative priming influences the N400, whereas others find evidence that it affects the late positive potential (LPP). Three experiments were conducted using either affective pictures (Experiments 1 and 2) or words (Experiment 3) in a sequential evaluative priming paradigm. In line with previous behavioral findings, participants responded slower to targets that were evaluatively incongruent with the preceding prime (e.g., negative preceded by positive) compared to evaluatively congruent targets (e.g., negative preceded by negative). In all three studies, the LPP was larger to evaluatively incongruent targets compared to evaluatively congruent ones, and there was no evidence that evaluative incongruity influenced the N400 component. Thus, the present results provide additional support for the notion that evaluative priming influences the LPP and not the N400. We discuss possible reasons for the inconsistent findings in prior research and the theoretical implications of the findings for both evaluative and semantic priming.

Coherent with laughter: subjective experience, behavior, and physiological responses during amusement and joy.

Emotion research historically has adopted a fairly homogeneous view of positive emotions. The aim of the current study was to explore how two positive emotions, amusement and joy, differ in subjective, behavioral, cardiovascular, and respiratory characteristics. Thirty-nine participants viewed two film clips, each selected to elicit amusement or joy. As predicted, participants reported more amusement, showed more positive facial expressions and laughter, and exhibited less heart rate deceleration and a larger increase in respiratory amplitude in response to the amusement clip than in response to the joy clip. In addition, subjective, behavioral, and physiological indicators were more closely related in amusement than joy, which was largely attributable to laughter during amusement. The current study adds to a growing literature suggesting the importance of adopting a more nuanced conceptualization of positive emotion.

The expression of beta human chorionic gonadotrophin (ß-HCG) in human urothelial carcinoma.

INTRODUCTION: Studies regarding the immuno-histological expression and relevance of Beta-Human Chorionic Gonadotrophin (=-HCG) in urothelial carcinoma are few. There is also no clear cut way of predicting exactly which superficial urothelial carcinomas would subsequently recur or progress and which muscle-invasive urothelial tumours would progress. The objective of the study was to study the immunohistological expression of =-HCG in urothelial carcinoma with regards to grade, category and outcome following treatment METHODS: The expression of =-HCG in urothelial carcinomas of 86 patients was studied with regards to grade, stage and outcome using an immunohistological (ABC) method and formalin fixed/paraffin embedded tumours. RESULTS: Of the 86 tumours (55 superficial and 31 muscle-invasive) studied 45, 16 and 26 were graded as G1, G2, and G3 respectively. Thirteen of the 55 superficial tumours were positively stained for ß=-HCG and 42 negatively stained. Twenty of the 31 muscle-invasive tumours studied were positively stained for ß=-HCG and 11 were negative. Of the 13 ß=-HCG positive superficial tumours only one did not recur at follow up and 12 subsequently recurred, of the 42 ß=-HCG negative superficial tumours 19 did not recur and 23 recurred. Only one of twenty patients with ß=-HCG positive muscle-invasive tumours survived; 6 of 11 patients with ß=-HCG negative muscle-invasive tumours survived. The results indicate that positive staining of the tumours was more commonly associated with tumours of higher grade, higher stage and inferior outcome. CONCLUSION: The Immunohistological expression of ß=-HCG would likely predict superficial tumours that would recur and muscle-invasive tumours with inferior outcome.