Linear Mixed-effects Analysis Research Articles

Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study.

Virtual reality (VR)-based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine.

Settling and transport properties of grass carp and silver carp eggs in the water-hardened phase: Implications for resource protection and invasion control during early life period

Grass carp and silver carp eggs have no swimming ability in the water-hardened phase and need to drift for tens or even hundreds of hours before complete incubation. A full comprehensive understanding of the settling and transport properties of eggs is crucial for the resource protection and invasion control of Four Major Chinese Carps (FMCCs) during their early life stages. Artificial eggs have been used extensively in previous field and flume experiments; however, our understanding of the settling and transport properties of real eggs in the water-hardened phase remains limited. In the present study, a series of column and flume experiments were conducted in stagnant and moving water, respectively. In light of the differences in settling characteristics, caution should be exercised when applying research results obtained from artificial eggs having the closest diameter and specific gravity as real eggs. Compared with grass carp and silver carp eggs in the water-hardening phase, egg diameters in the water-hardened phase were 36% and 33% greater, respectively, and egg hydrostatic settling velocities were 31% and 40% lower, respectively. Significant interspecific differences between the two species exist in terms of egg size and hydrostatic settling velocity. Based on linear mixed effects analysis of dominant transport trajectories and regression analysis between suspending rate and flow velocity, 0.30 m/s can be considered as critical drifting velocity in uniform flow. Adaptive management schemes are discussed to promote resource protection and invasion control of FMCCs during the early life stages. The results of the present study enhance our understanding of drifting egg movement and provide insights that could facilitate the comprehensive management of FMCCs.

Similar cortical morphometry trajectories from 5 to 9 years in children with perinatal HIV who started treatment before age 2 years and uninfected controls

BackgroundLife-long early ART (started before age 2 years), often with periods of treatment interruption, is now the standard of care in pediatric HIV infection. Although cross-sectional studies have investigated HIV-related differences in cortical morphology in the setting of early ART and ART interruption, the long-term impact on cortical developmental trajectories is unclear. This study compares the longitudinal trajectories of cortical thickness and folding (gyrification) from age 5 to 9 years in a subset of children perinatally infected with HIV (CPHIV) from the Children with HIV Early antiRetroviral therapy (CHER) trial to age-matched children without HIV infection.Methods75 CHER participants in follow-up care at FAMCRU (Family Centre for Research with Ubuntu), as well as 66 age-matched controls, received magnetic resonance imaging (MRI) on a 3 T Siemens Allegra at ages 5, 7 and/or 9 years. MR images were processed, and cortical surfaces reconstructed using the FreeSurfer longitudinal processing stream. Vertex-wise linear mixed effects (LME) analyses were performed across the whole brain to compare the means and linear rates of change of cortical thickness and gyrification from 5 to 9 years between CPHIV and controls, as well as to examine effects of ART interruption.ResultsChildren without HIV demonstrated generalized cortical thinning from 5 to 9 years, with the rate of thinning varying by region, as well as regional age-related gyrification increases. Overall, the means and developmental trajectories of cortical thickness and gyrification were similar in CPHIV. However, at an uncorrected p < 0.005, 6 regions were identified where the cortex of CPHIV was thicker than in uninfected children, namely bilateral insula, left supramarginal, lateral orbitofrontal and superior temporal, and right medial superior frontal regions. Planned ART interruption did not affect development of cortical morphometry.ConclusionsAlthough our results suggest that normal development of cortical morphometry between the ages of 5 and 9 years is preserved in CPHIV who started ART early, these findings require further confirmation with longitudinal follow-up through the vulnerable adolescent period.

A Community-Based, Participatory, Multi-Component Intervention Increased Sales of Healthy Foods in Local Supermarkets-The Health and Local Community Project (SoL).

Project SoL was a 19-month (September 2012 to April 2014) community-based multi-component intervention based on the supersetting approach that was designed to promote healthier eating and physical activity among children and their families. The aim of this study was to examine the effects of a multi-component intervention (level 1) and a mass media intervention alone (level 2) compared to a control area (level 3) on food sales. The design was quasi-experimental. Weekly sales data for all Coop supermarkets in the intervention and control areas were analysed via longitudinal linear mixed-effects analyses. Significant increases in the sales of fish (total) (29%; p = 0.003), canned fish (31%; p = 0.025) and oatmeal (31%; p = 0.003) were found for the level 1 intervention area compared to the control area. In the level 2 intervention area, significant increases in the sales of vegetables (total) (17%; p = 0.038), fresh vegetables (20%; p = 0.01), dried fruit (51%; p = 0.022), oatmeal (19%; p = 0.008) and wholegrain pasta (58%; p = 0.0007) were found compared to the control area. The sales of canned fish increased by 30% in the level 1 area compared to the level 2 area (p = 0.025). This study demonstrated significant increases in the sales of healthy foods, both in the areas with multi-component and mass media interventions alone compared to the control area.

Volume of subcortical brain regions in social anxiety disorder: mega-analytic results from 37 samples in the ENIGMA-Anxiety Working Group.

There is limited convergence in neuroimaging investigations into volumes of subcortical brain regions in social anxiety disorder (SAD). The inconsistent findings may arise from variations in methodological approaches across studies, including sample selection based on age and clinical characteristics. The ENIGMA-Anxiety Working Group initiated a global mega-analysis to determine whether differences in subcortical volumes can be detected in adults and adolescents with SAD relative to healthy controls. Volumetric data from 37 international samples with 1115 SAD patients and 2775 controls were obtained from ENIGMA-standardized protocols for image segmentation and quality assurance. Linear mixed-effects analyses were adjusted for comparisons across seven subcortical regions in each hemisphere using family-wise error (FWE)-correction. Mixed-effects d effect sizes were calculated. In the full sample, SAD patients showed smaller bilateral putamen volume than controls (left: d = -0.077, pFWE = 0.037; right: d = -0.104, pFWE = 0.001), and a significant interaction between SAD and age was found for the left putamen (r = -0.034, pFWE = 0.045). Smaller bilateral putamen volumes (left: d = -0.141, pFWE < 0.001; right: d = -0.158, pFWE < 0.001) and larger bilateral pallidum volumes (left: d = 0.129, pFWE = 0.006; right: d = 0.099, pFWE = 0.046) were detected in adult SAD patients relative to controls, but no volumetric differences were apparent in adolescent SAD patients relative to controls. Comorbid anxiety disorders and age of SAD onset were additional determinants of SAD-related volumetric differences in subcortical regions. To conclude, subtle volumetric alterations in subcortical regions in SAD were detected. Heterogeneity in age and clinical characteristics may partly explain inconsistencies in previous findings. The association between alterations in subcortical volumes and SAD illness progression deserves further investigation, especially from adolescence into adulthood.

Association Between Serum MicroRNAs and Abdominal Aortic Aneurysm Diagnosis and Growth

This study aimed to examine the association between serum microRNAs (miRNAs) and diagnosis and growth of abdominal aortic aneurysm (AAA), and to test their diagnostic and prognostic value. The expression levels of 800 miRNA tags were assessed in 108 patients with AAA, 12 age and sex matched healthy controls (HCs), and 12 patients with peripheral artery disease (PAD) using NanoString technology. Findings were assessed in an independent sample of 66 patients with AAA and 29 age and sex matched HCs by reverse transcriptase polymerase chain reaction. AAA growth was assessed by a median of three (interquartile range [IQR] 2, 3) repeat ultrasound scans over a median follow up of 1.1 (IQR 1.0, 2.0) years. The association between the miRNA and AAA diagnosis and growth was examined by regression and linear mixed effects analyses. The diagnostic and prognostic potential of the miRNAs were examined using area under the receiver operator characteristic curve (AUC), net re-classification index (NRI), and Cox hazard analyses. In comparison with HCs, a model combining clinical risk factors, let-7b-5p and miR-548n had an AUC of 98.0% (95% confidence interval [CI] 95.6 - 100.0; p= .003) for diagnosing AAA, which was a significant improvement over clinical risk factors alone (NRI 1.74; 95% CI 1.61 - 1.87; p < .001). Compared with PAD, a model combining clinical risk factors and miR-548n had an AUC of 99.6% (95% CI 98.9 - 100.0, p= .037) for diagnosing AAA, which was a significant improvement over clinical risk factors alone (NRI 1.79, 95% CI 1.68 - 1.91; p < .001). In the longitudinal cohort, none of the miRNAs were able to predict the likelihood of reaching surgical threshold diameter better than clinical risk factors alone. Serum let-7b-5p and miR548n significantly improved the ability to diagnose AAA. None of the miRNAs had independent prognosis value in predicting AAA growth.

Orthographic Processing of Proper Names: A Proposal to Investigate the Orthographic Cue for Second Language Readers

A standard treatment of proper names in second language (L2) vocabulary analyses is to categorize them as known items. This treatment is often supported by the assumption that the form of the proper name (i.e., the initial capital letter) and the context will indicate to the L2 reader that the item is a proper name. The aim of this work-in-progress report is to propose a methodological approach for investigating the claim that form facilitates proper name recognition for L2 readers, in particular for those whose first language (L1) employs a different orthography and writing system than English. While previous research has looked at the orthographic processing of proper names for L1 users, a gap exists in the literature for L2 readers. The assumption that L2 readers are skilled at identifying proper names from the initial capital warrants investigation as there are implications for the processing load in both pedagogical and testing situations. A proposed method to investigate the initial capital letter as a cue for L2 English proper name recognition is a name decision task, a variation on a lexical decision task, using English proper names and common nouns that are familiar to Japanese participants. Reaction times and error percentages to proper names with case type as a factor (i.e., initial capital letter or all lowercase) will be submitted to a linear mixed effects analysis.

A Self-Help Manual for Psychological Distress and Quality of Life During a Haemopoietic Stem-Cell Transplant: An Effectiveness and Acceptability Pilot.

Haemopoietic stem-cell transplantation (HSCT) can be a highly distressing procedure that negatively impacts quality of life (QoL). Self-help interventions can help improve psychopathology and wellbeing in patients with physical illness, but have rarely been trialled with HSCT recipients. This study aimed to pilot the utility of a self-help manual intervention during the acute phase of HSCT. Forty autologous and allogeneic HSCT candidates were randomly assigned to a self-help manual intervention or treatment as usual (TAU). Psychological distress (BSI-18) and QoL (FACT-BMT-Vs4) were measured pre-, 2-3weeks and 3months post-HSCT. Linear mixed-effects analyses showed no significant group-time interaction for global QoL (p = .199) or global distress (p = .624). However, highlighting a protective role during admission, manual participants showed minimal QoL or somatic distress change at 2-3weeks post-transplant compared with moderate-large effects for reduced QoL (d = 0.62) and increased somatic distress (d = -0.81) for TAU patients. Thematic analysis suggests the manual helped prepare patients for transplant and provided strategies to improve distress and QoL. This pilot provides preliminary evidence for the benefit of a self-help manual during hospitalisation for a HSCT. More intensive, recovery-focussed care, however, may be needed to improve psychological health in the post-hospital period. Retrospectively registered trial (ANZCTR No. 12620001165976, 6th November 2020).

Ordinal Pattern Analysis: A Tutorial on Assessing the Fit of Hypotheses to Individual Repeated Measures Data.

This article provides a tutorial introduction to ordinal pattern analysis, a statistical analysis method designed to quantify the extent to which hypotheses of relative change across experimental conditions match observed data at the level of individuals. This method may be a useful addition to familiar parametric statistical methods including repeated measures analysis of variance and generalized linear mixed-effects models, particularly when analyzing inherently individual characteristics, such as perceptual processes, and where experimental effects are usefully modeled in relative rather than absolute terms. Three analyses of increasing complexity are demonstrated using ordinal pattern analysis. An initial analysis of a very small data set is designed to explicate the simple mathematical calculations that make up ordinal pattern analysis, which can be performed without the aid of a computer. Analyses of slightly larger data sets are used to demonstrate familiar concepts, including comparison of competing hypotheses, handling missing data, group comparisons, and pairwise tests. All analyses can be reproduced using provided code and data. Ordinal pattern analysis results are presented, along with an analogous linear mixed-effects analysis, to illustrate the similarities and differences in information provided by ordinal pattern analysis in comparison to familiar parametric methods. Although ordinal pattern analysis does not produce familiar numerical effect sizes, it does provide highly interpretable results in terms of the proportion of individuals whose results are consistent with a hypothesis, along with individual and group-level statistics, which quantify hypothesis performance.

Using change in predicted adult height during GnRH agonist treatment for individualized treatment decisions in girls with central precocious puberty.

It is important to understand what variables influence change in predicted adult height (PAH) throughout GnRHa treatment for central precocious puberty (CPP) to individualize treatment decisions and optimize care. Changes in PAH, chronological age (CA), bone age (BA), BA/CA, and height velocity (HV) were evaluated in girls with CPP throughout treatment with leuprolide acetate (n=77). A second analysis focused on changes in the 3years preceding the first observed BA of≥12years. Relationships were characterized using plot inspection andlinear mixed-effects analyses. Association between treatment duration and last assessed PAH was examined using multiple linear regression models. BA/CA and HV showed a nonlinear change during treatment, with the largest changes and improvement in PAH observed in the first 6-18months. Rate of BA advancement tended to decrease more slowly in girls initiating treatment at a younger BA. On-treatment change in PAH was predicted by concurrent BA/CA change, HV, and BA, as well as CA at treatment initiation. Last assessed PAH was positively associated with longer treatment durations (primary/exploratory models cut-offs of≥33/≥55months). These findings support individualized monitoring during GnRHa treatment. Initial response should be interpreted with caution until 6-18months after treatment initiation and failure should not be assumed based on continued bone maturation in girls starting therapy at a younger age. Treatment cessation should not be automatically based on a diminishing change in PAH or HV, as ongoing treatment may result in continued increase or maintenance of PAH.

Appealing dish names to nudge diners to more sustainable food choices: a quasi-experimental study

BackgroundPromoting plant-rich diets, i.e., diets with significantly reduced amounts of animal products, including vegan and vegetarian, is a promising strategy to help address the dual environmental and health crises that we currently face. Appealing dish names could boost interest in plant-rich dishes by attracting diners’ attention to them. In this study, a systematic approach to naming plant-rich dishes with appealing descriptors was tested with a quasi-experimental design in four workplace, self-service, buffet-style cafeterias in Chicago, Sydney, São Paulo and Singapore.MethodsThree different plant-rich dishes were tested at each site. Appealing names were generated systematically through a workshop and emphasized the dish ingredients, origin, flavor and/or the eating experience. Each test dish appeared once in a four-week menu cycle where menu options changed on a daily basis. The cycle was then repeated four times (six times in Chicago) with the total number of showings for each dish to be four (six in Chicago). The dish names alternated between basic and appealing across dish repetitions. For each dish, the food taken per plate was estimated by weighing the overall food taken and dividing it by the plate count in the cafeteria. Data was analysed as percentage change from baseline (i.e., the first showing of each dish that always had a basic name) with linear mixed effects analysis using the lme4 package in R.ResultsOverall, appealing dish names significantly increased the amount of food taken per plate by 43.9% relative to baseline compared to basic dish names (54.5% vs. 10.6% increase for appealing vs. basic names, respectively, p = .002). This increase corresponded to a 7% increase in actual grams of food taken per plate. Secondary analysis showed that the effect was site-specific to English-speaking countries only and that there was no substitution effect between plant-rich and meat dishes.ConclusionsThe study tested an approach to creating appealing dish names in a systematic way and indicates that, in some settings, appealing dish titles are a relatively easy, scalable, cost-effective strategy that the food services sector can adopt to shift food choices towards more plant-rich, sustainable ones.

Moderate and transient impact of antibiotic use on the gut microbiota in a rural Vietnamese cohort

The human gut microbiota has been shown to be significantly perturbed by antibiotic use, while recovering to the pre-treatment state several weeks after short antibiotic exposure. The effects of antibiotics on the gut microbiota have however been mainly documented in high-income settings with lower levels of antibiotic resistance as compared to lower and middle income countries (LMIC). This study aimed to examine the long-term consequences of repeated exposure to commonly use antibiotics on the fecal microbiota of residents living in a low income setting with high prevalence of antibiotic resistance. Fecal samples from household individuals (n = 63) participating in a rural cohort in northern Vietnam were collected monthly for a period of 6 months. Using 16S V4 rRNA gene region amplicon sequencing and linear mixed-effects models analysis, we observed only a minor and transient effect of antibiotics on the microbial richness (ß = − 31.3, 95%CI = − 55.3, − 7.3, p = 0.011), while the microbial diversity was even less affected (ß = − 0.298, 95%CI − 0.686, 0.090, p = 0.132). Principal Component Analyses (PCA) did not reveal separation of samples into distinct microbiota-based clusters by antibiotics use, suggesting the microbiota composition was not affected by the antibiotics commonly used in this population. Additionally, the fecal microbial diversity of the subjects in our study cohort was lower when compared to that of healthy Dutch adults (median 3.95 (IQR 3.72–4.13) vs median 3.69 (IQR3.31–4.11), p = 0.028, despite the higher dietary fiber content in the Vietnamese as compared to western diet. Our findings support the hypothesis that frequent antibiotic exposure may push the microbiota to a different steady state that is less diverse but more resilient to disruption by subsequent antibiotic use.

New multimodal intervention to reduce irritable bowel syndrome (IBS) severity symptoms-Pilot study with a 12 month follow-up.

Irritable bowel syndrome (IBS) is characterized by patients' high level of suffering. Up to 60% of patients with IBS have symptoms of anxiety or depression and only little attention has been paid to their specific requirements. Anthroposophical multimodal therapy (AMT) has been shown to significantly improve health-related quality of life of patients with high symptomatic burden. The aim of this pilot study was to find out whether AMT meets the needs of IBS patients and the interactions of AMT with IBS, depression and anxiety. Patients with diagnosed IBS were included in a feasibility study and received 12 sessions of AMT over 8 weeks (drks.de, DRKS00016890). The primary endpoint was the change of the IBS severity score (IBS-SSS) and changes were calculated by linear mixed effects analyses. The secondary endpoints were changes of self-reported PHQ-9 and GAD-7 for mental comorbidity as well as self-valued effectiveness and satisfaction of AMT. Thirty-six patients, 89% female, were included in the study. AMT was successfully applied to IBS patients (-45 points in the IBS-SSS, p < .05). AMT had a large positive effect (-84 points in IBS-SSS, p < .003) on patients without anxiety or depression. Over time, patients with higher anxiety scores worsened with regard to their IBS compared to patients with depression and without mental comorbidity. The AMT effect was maintained at a 12 month follow up and both mentally affected and unaffected patients, had even lower IBS severity than shortly after AMT. AMT modules were rated by IBS patients as very effective. Our findings suggest that an 8-week program of AMT improves the severity of IBS with an ongoing effect at a 12 month follow-up. Especially for patients without psychological comorbidities, AMT is very successful. Future IBS therapies should incorporate a modified multimodal concept with stronger psychological therapy modules in parallel for patients with depression and anxiety.

Validation of liver quantitative susceptibility mapping across imaging parameters at 1.5 T and 3.0 T using SQUID susceptometry as reference.

To validate QSM-based biomagnetic liver susceptometry (BLS) to measure liver iron overload at 1.5 T and 3.0 T using superconducting quantum interference devices (SQUID)-based BLS as reference. Subjects with known or suspected iron overload were recruited for QSM-BLS at 1.5 T and 3.0 T using eight different protocols. SQUID-BLS was also obtained in each subject to provide susceptibility reference. A recent QSM method based on data-adaptive regularization was used to obtain susceptibility and maps. Measurements of susceptibility and were obtained in the right liver lobe. Linear mixed-effects analysis was used to estimate the contribution of specific acquisition parameters to QSM-BLS. Linear regression and Bland-Altman analyses were used to assess the relationship between QSM-BLS and SQUID-BLS/ . Susceptibility maps showed high subjective quality for each acquisition protocol across different iron levels. High linear correlation was observed between QSM-BLS and SQUID-BLS at 1.5 T (r2 range, [0.82, 0.84]) and 3.0 T (r2 range, [0.77, 0.85]) across different acquisition protocols. QSM-BLS and were highly correlated at both field strengths (r2 range at 1.5 T, [0.94, 0.99]; 3.0 T, [0.93, 0.99]). High correlation (r2 =0.99) between 1.5 T and 3.0 T QSM-BLS, with narrow reproducibility coefficients (range, [0.13, 0.21] ppm) were observed for each protocol. This work evaluated the feasibility and performance of liver QSM-BLS across iron levels and acquisition protocols at 1.5 T and 3.0 T. High correlation and reproducibility were observed between QSM-BLS and SQUID-BLS across protocols and field strengths. In summary, QSM-BLS may enable reliable and reproducible quantification of liver iron concentration.

Relationship between intrinsic network connectivity and psychiatric symptom severity in functional seizures

BackgroundTraumatic brain injury (TBI) may precipitate the onset of functional seizures (FSs). Many patients with FS report at least one prior TBI, and these patients typically present with more severe...

Prosodic Development During the Early School-Age Years.

This study used a cross-sequential design to identify developmental changes in narrative speech rhythm and intonation. The aim was to provide a robust, clinically relevant characterization of normative changes in speech prosody across the early school-age years. Structured spontaneous narratives were elicited annually from 60 children over a 3-year period. Children were aged 5-7 years at study outset and then were aged 7-9 years at study offset. Articulation rate, prominence spacing, and intonational phrase length and duration were calculated for each narrative to index speech rhythm; measures of pitch variability and pitch range indexed intonation. Linear mixed-effects (LME) models tested for cohort-based and within-subject longitudinal change on the prosodic measures; linear regression was used to test for the simple effect of age-in-months within year on the measures. The LME analyses indicated systematic longitudinal changes in speech rhythm across all measures except phrase duration; there were no longitudinal changes in pitch variability or pitch range across the school-age years. Linear regression results showed an increase in articulation rate with age; there were no systematic differences between age cohorts across years in the study. The results indicate that speech rhythm continues to develop during the school-age years. The results also underscore the very strong relationship between the rate and rhythm characteristics of speech and so suggest an important influence of speech motor skills on rhythm production. Finally, the results on pitch variability and pitch range are interpreted to suggest that these are inadequate measures of typical intonation development during the school-age years.

Adolescent Substance Use Is Associated With Altered Brain Response During Processing of Negative Emotional Stimuli.

Substance misuse is often associated with emotional dysregulation. Understanding the neurobiology of emotional responsivity and regulation as it relates to substance use in adolescence may be beneficial for preventing future use. The present study used a community sample, ages 11-21 years old (N = 130, Mage = 17), to investigate the effects of alcohol and marijuana use on emotional reactivity and regulation using an Emotional Go-NoGo task during functional magnetic resonance imaging. The task consisted of three conditions, where target (Go) stimuli were either happy, scared, or calm faces. Self-report lifetime (and past-90-day) drinking and marijuana use days were provided at all visits. Substance use was not differentially related to task performance based on condition. Whole-brain linear mixed-effects analyses (controlling for age and sex) found that more lifetime drinking occasions was associated with greater neural emotional processing (Go trials) in the right middle cingulate cortex during scared versus calm conditions. In addition, more marijuana use occasions were associated with less neural emotional processing during scared versus calm conditions in the right middle cingulate cortex and right middle and inferior frontal gyri. Substance use was not associated with brain activation during inhibition (NoGo trials). These findings demonstrate that substance use-related alterations in brain circuitry are important for attention allocation and the integration of emotional processing and motor response when viewing negative emotional stimuli.

Subjective Fear in Virtual Reality: A Linear Mixed-Effects Analysis of Skin Conductance

The investigation of the physiological and pathological processes involved in fear perception is complicated due to the difficulties in reliably eliciting and measuring the complex construct of fear. This study proposes a novel approach to induce and measure subjective fear and its physiological correlates combining virtual reality (VR) with a mixed-effects model based on skin conductance (SC). Specifically, we developed a new VR scenario applying specific guidelines derived from horror movies and video games. Such a VR environment was used to induce fear in eighteen volunteers in an experimental protocol, including two relaxation scenarios and a neutral virtual environment. The SC signal was acquired throughout the experiment, and after each virtual scenario, the emotional state and fear perception level were assessed using psychometric scales. We statistically evaluated the greatest sympathetic activation induced by the fearful scenario compared to the others, showing significant results for most SC-derived features. Finally, we developed a rigorous mixed-effects model to explain the perceived fear as a function of the SC features. Model-fitting results showed a significant relationship between the fear perception scores and a combination of features extracted from both fast- and slow-varying SC components, proposing a novel solution for a more objective fear assessment.

Quality of Life Changes in Early-Onset Multiple Sclerosis: A 4-Year Follow-Up Study.

This study investigates longitudinal changes in health-related quality of life (HRQoL) in early-onset multiple sclerosis (MS) patients and explores the impact of disease activity (relapses) on such changes. People with MS (PwMS) onset between 12 and 25 years of age were followed longitudinally. At baseline and at year 4, patients were asked to fill the Paediatric Quality of life inventory (PedsQL). Demographic and clinical features were collected at both time points. Longitudinal within-group comparison of HRQoL total score and sub-scores was performed via paired samples t-test. The effect of relapses on the HRQoL changes over time was explored via linear mixed-effects analysis. No longitudinal changes were observed in the overall PedsQL score, nor in the physical, school and psychological functioning. An increase in the social functioning subscale (p < 0.001) and a decrease in the emotional subscale (p = 0.006) were observed. The change in social functioning, but not the one in the emotional subscale, was affected by the occurrence of relapses (p = 0.044). In conclusion, stimulating the patients to accept their emotional responses to health-related limitations, while preserving their social and relational resources seems key to the preservation of an adequate QoL over time in juvenile-onset MS.

Effects of acute aerobic exercise on mnemonic discrimination performance in older adults.

Ample evidence suggests exercise is beneficial for hippocampal function. Furthermore, a single session of aerobic exercise provides immediate benefits to mnemonic discrimination performance, a highly hippocampal-specific memory process, in healthy younger adults. However, it is unknown if a single session of aerobic exercise alters mnemonic discrimination in older adults, who generally exhibit greater hippocampal deterioration and deficits in mnemonic discrimination performance. We conducted a within subject acute exercise study in 30 cognitively healthy and physically active older adults who underwent baseline testing and then completed two experimental visits in which they performed a mnemonic discrimination task before and after either 30min of cycling exercise or 30min of seated rest. Linear mixed-effects analyses were conducted in which condition order and age were controlled, time (pre vs. post) and condition (exercise vs. rest) were modeled as fixed effects, and subject as a random effect. No significant time by condition interaction effect was found for object recognition (p=.254, η2=.01), while a significant reduction in interference was found for mnemonic discrimination performance following the exercise condition (p=.012, η2=.07). A post-intervention only analysis indicated that there was no difference between condition for object recognition (p=.186, η2=.06), but that participants had better mnemonic discrimination performance (p<.001, η2=.22) following the exercise. Our results suggest a single session of moderate-intensity aerobic exercise may reduce interference and elicit better mnemonic discrimination performance in healthy older adults, suggesting benefits for hippocampal-specific memory function.