Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification

Anxiety disorders are common and difficult to treat. Some cognitive models of anxiety propose that attention bias to threat causes and maintains anxiety. This view led to the development of a computer-delivered treatment: attention bias modification (ABM) which predominantly trains attention avoidance of threat. However, meta-analyses indicate disappointing effectiveness of ABM-threat-avoidance training in reducing anxiety. This article considers how ABM may be improved, based on a review of key ideas from models of anxiety, attention and cognitive control. These are combined into an integrative framework of cognitive functions which support automatic threat evaluation/detection and goal-directed thought and action, which reciprocally influence each other. It considers roles of bottom-up and top-down processes involved in threat-evaluation, orienting and inhibitory control in different manifestations of attention bias (initial orienting, attention maintenance, threat avoidance, threat-distractor interference) and different ABM methods (e.g., ABM-threat-avoidance, ABM-positive-search). The framework has implications for computer-delivered treatments for anxiety. ABM methods which encourage active goal-focused attention-search for positive/nonthreat information and flexible cognitive control across multiple processes (particularly inhibitory control, which supports a positive goal-engagement mode over processing of minor threat cues) may prove more effective in reducing anxiety than ABM-threat-avoidance training which targets a specific bias in spatial orienting to threat

Nurse Educator Certification: Overview and Evaluation of the Canadian Association of Schools of Nursing Program

The Canadian Association of Schools of Nursing (CASN) has spearheaded an education institute and fostered the growth of an accessible cadre of innovative educational programming that were built on identified national nursing educator competencies. The purpose of this article is to outline the development and structure of the CASN Canadian Nurse Educator Certification Program, share an analysis of one aspect of program evaluation data and summarize the program’s current value to nurse educators. The program offers flexible professional development for Canadian nurse educators through three online modules that prepare participants to sit the national certification exam and attain the designation of Canadian Certified Nurse Educator (CCNE). Part of an ongoing program evaluation conducted by CASN in 2021 sought to provide information on the perception of certification of nurse educators in Canada. A review of the process of module delivery that prepares educators to sit the certification exam and how certification is perceived as valuable or not by nurse educators was the focus. The CCNE program participants’ perspectives on the value of module learnings in terms of academic practice were evaluated using the Perceived Value of Certification Tool for the Nurse Educator. Of the 108 respondents to the survey questions, the findings indicate that most CCNE nurse educators perceived that there is value in nurse educator certification. A key survey finding was that educators perceived intrinsic value more so than extrinsic value in obtaining certification. Overall, the respondents believed that certification was not fully recognized by employers, colleagues, or students and that enhancing others’ perceptions of certification was needed. Despite consistent enrolments in the CASN program modules, the program and CCNE designation appear to require further formal recognition from teaching and academic institutions across the country. With the shortage of qualified nursing faculty, the need to strengthen current academic faculty members’ competencies is imperative. The certification and credentialing of academic nurse educators needs to be recognized. Educators should be provided merit for the acquisition of the specialized knowledge, expertise, and competencies required for the role. Résumé L’Association canadienne des écoles de sciences infirmières (ACESI) a dirigé un institut de formation et favorisé la croissance d’un cadre accessible de programmes éducatifs novateurs fondés sur les compétences nationales identifiées des enseignant(e)s en sciences infirmières. Le but de cet article est de décrire le développement et la structure du Programme canadien de certification pour infirmières et infirmiers enseignant(e)s de l’ACESI, de partager une analyse d’un aspect des données d’évaluation du programme et de résumer la valeur actuelle de ce dernier pour les infirmières et infirmiers enseignant(e)s. Le programme offre un perfectionnement professionnel flexible aux infirmières et infirmiers enseignant(e)s canadien(ne)s grâce à trois modules en ligne qui préparent les participant(e)s à passer l’examen national de certification et à obtenir le titre de Canadian Certified Nurse Educator (infirmière enseignante canadienne certifiée; CCNE). Une partie d’une évaluation de programme en cours, menée par l’ACESI en 2021, visait à fournir des renseignements sur la perception de la certification des infirmières et infirmiers enseignant(e)s au Canada. L’accent a été mis sur l’examen du processus de prestation du module qui prépare les enseignant(e)s à passer l’examen de certification et sur la perception des infirmières et infirmiers enseignant(e)s sur la valeur de la certification. Les points de vue des participant(e)s au programme CCNE sur l’importance des apprentissages au cours du module en matière de pratiques de formation universitaire ont été examinés à l’aide du Perceived Value of Certification Tool for the Nurse Educator (outil de valeur perçue de la certification pour l’infirmière enseignante). Parmi les 108 répondant(e)s aux questions du sondage, les résultats indiquent que la plupart des infirmières et infirmiers enseignant(e)s détenant le titre CCNE perçoivent la valeur de la certification des infirmières enseignantes. L’une des principales conclusions de l’étude était que les enseignant(e)s percevaient davantage la valeur intrinsèque que la valeur extrinsèque dans l’obtention de la certification. Dans l’ensemble, les répondant(e)s estimaient que la certification n’était pas pleinement reconnue par les employeurs, les collègues ou les étudiant(e)s, et qu’il était nécessaire d’améliorer la perception que les autres avaient de la certification. Malgré des inscriptions constantes aux modules du programme de l’ACESI, le programme et la désignation CCNE semblent nécessiter une reconnaissance officielle supplémentaire de la part des établissements d’enseignement universitaire à travers le pays. Avec la pénurie de membres du corps professoral qualifié(e)s en sciences infirmières, la nécessité de renforcer les compétences des membres actuel(le)s du corps professoral universitaire est impérative. La certification et la délivrance de titres et certificats pour les infirmières et infirmiers enseignant(e)s universitaires doivent être reconnues. Les enseignant(e)s devraient recevoir un mérite pour l’acquisition des connaissances spécialisées, de l’expertise et des compétences requises pour le rôle

Genomic Sequence and Phylogenetic Analysis of Culex Flavivirus, an Insect-Specific Flavivirus, Isolated From Culex pipiens (Diptera: Culicidae) in Iowa

Adult mosquitoes (Diptera: Culicidae) were collected in 2007 and tested for specific viruses, including West Nile virus, as part of the ongoing arbovirus surveillance efforts in the state of Iowa. A subset of these mosquitoes (6,061 individuals in 340 pools) was further tested by reverse transcription-polymerase chain reaction (RT-PCR) using flavivirus universal primers. Of the 211 pools of Culex pipiens (L.) tested, 50 were positive. One of 51 pools of Culex tarsalis Coquillet was also positive. The flavivirus minimum infection rates (expressed as the number of positive mosquito pools per 1,000 mosquitoes tested) for Cx. pipiens and Cx. tarsalis were 10.3 and 1.2, respectively. Flavivirus RNA was not detected in Aedes triseriatus (Say) (52 pools), Culex erraticus (Dyar & Knab) (25 pools), or Culex territans Walker (one pool). Sequence analysis of all RT-PCR products revealed that the mosquitoes had been infected with Culex flavivirus (CxFV), an insect-specific virus previously isolated in Japan, Indonesia, Texas, Mexico, Guatemala and Trinidad. The complete genome of one isolate was sequenced, as were the envelope protein genes of eight other isolates. Phylogenetic analysis revealed that CxFV isolates from the United States (Iowa and Texas) are more closely related to CxFV isolates from Asia than those from Mexico, Guatemala, and Trinidad

What academics value: a comparative analysis of research into continuing professional development in four English universities

This conference presentation explored findings from four research projects, undertaken in different institutions. The projects highlighted the influence of the changing character of academic identities and the complexity of CPD in higher education (HE). Within this, the paper considered how institutions can respond to this knowledge, with particular regard to contemporary influences such as the UK Professional Standards Framework (HEA 2006). Comparing four different evaluative approaches, the paper demonstrated how multi-faceted research approaches can bring different dimensions to a research area. Thus, for example, in one institution interviews, focus groups, and a survey to examine the attitudes, engagement and perceived priorities in relation to CPD were administered. A second institution developed case study methodology with action research, collating data at different levels. Another institution has undertaken evaluative analysis of existing provision, with the fourth institution carrying out qualitative, narrative research engaging academics across faculties and disciplinary areas. Following exploration of these distinctive methodological approaches, the paper compared the respective findings, which provided evidence of contrasting perspectives and values related to CPD. Each of the studies emphasised that very different cultures and practices exist across the spectrum of subject, discipline and institutional cultures within HE. The concept of ‘trust’ emerges as a significant underpinning value-set that drives engagement in professional development. Furthermore, whilst academics value CPD, there are different approaches to what CPD actually means. Given the complexities of context and meaning, the relationship between valuing professional development and perceived engagement in activities (Rothwell and Arnold, 2005) is also considered. This affects strategic approaches, including implementation of the Professional Standards Framework (HEA 2006) and the value placed on it by both individual and institution. A ‘one-size-fits-all’ approach is inappropriate if we are to respond to what academics value across the diversity of HE; flexibility to apply to subjects and individuals at local levels, is needed. Finally, the paper concluded that professional development in HE should rightly be subjected to analysis and debate across academic cultures and institutional contexts

Neural Correlates of Treatment in Adolescents with Generalized Anxiety Disorder: A Preliminary Investigation

Objective: Generalized anxiety disorder (GAD) is a prevalent and debilitating psychiatric condition in adolescence. Two effective forms of treatment are cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors. This pilot study examined changes in brain function following each type of treatment in GAD. Method: Subjects were 14 youth with GAD (7 had CBT, 7 received fluoxetine) and 10 age- and gender-matched healthy peers. FMRI scans were acquired before and after treatment for patients, and over two comparable time points for controls. During fMRI acquisition, a probe detection task with emotional (angry, happy) and neutral faces allowed for assessment of neural response to threat. Following previous research, region of interest analyses were performed in the right ventrolateral prefrontal cortex (VLPFC). Results: FMRI results showed increased VLPFC activation, relative to controls, in the medication (t(15) = 3.01, p \u3c 0.01) and CBT (t(15) = 3.22, p \u3c 0.01) groups following treatment. Conclusions: This study shows significant increase in VLPFC activation in response to angry faces following treatment with CBT or fluoxetine for GAD. This is consistent with previous research indicating that the VLPFC may facilitate effective responding to underlying neural correlates of anxiety in other brain regions, such as the amygdala

Prospective Study of Chikungunya Virus Acute Infection in the Island of La Réunion during the 2005–2006 Outbreak

BACKGROUND:Chikungunya virus (CHIKV) is a recently re-emerged arthropod borne virus responsible for a massive outbreak in the Indian Ocean and India, and extended to Southeast Asia as well as Italy. CHIKV has adapted to Aedes albopictus, an anthropophilic mosquito species widely distributed in Asia, Europe, Africa and America. Our objective was to determine the clinical and biological features of patients at the acute phase of CHIKV infection. METHODS AND FINDINGS:A prospective study enrolled 274 consecutive patients with febrile arthralgia recorded at the Emergency Department of the Groupe Hospitalier Sud-Réunion between March and May 2006. Three groups were defined: one group of 180 viremic patients (positive CHIKV RT-PCR), one group of 34 patients with acute post-viremic infection (negative CHIKV RT-PCR, positive anti-CHIKV IgM and negative IgG), and one group of 46 uninfected patients (negative CHIKV RT-PCR, anti-CHIKV IgM and IgG). Bivariate analyses of clinical and biological features between groups were performed. Patients with CHIKV viremia presented typically with asymmetrical bilateral polyarthralgia (96.5%) affecting the lower (98%) and small joints (74.8%), as well as asthenia (88.6%), headache (70%), digestive trouble (63.3%), myalgia (59%), exanthems (47.8%), conjunctival hyperhemia (23%) and adenopathy (8.9%). Vertigo, cutaneous dysesthesia, pharyngitis and haemorrhages were seldom observed. So far unreported symptoms such as chondrocostal arthralgia (20%), entesopathies (1.6%), talalgia (14%) were also noted. Prurit was less frequent during the viremic than post-viremic phase (13.9% vs. 41.2%; p<0.001), whereas lymphopenia was more frequent (87.6% vs. 39.4%; p<0.001). Others biological abnormalities included leukopenia (38.3%), thrombocytopenia (37.3%), increased ASAT and ALAT blood levels (31.6 and 7.3%, respectively) and hypocalcemia (38.7%). Lymphopenia <1,000/mm(3) was very closely associated with viremic patients (Yule coefficient 0.82, positive predictive value 92.3%). Age under 65 was associated with a benign course, as no patients younger than 65 had to be hospitalized (Yule coefficient 0.78). CONCLUSIONS:The diagnosis of CHIKV infection in acute phase is based on commonly accepted clinical criteria (fever and arthralgia), however clinical and biological diffrences exist in acute phase depending on whether or not the patient is within the viremic phase of the infection

IKKα negatively regulates ASC-dependent inflammasome activation.

The inflammasomes are multiprotein complexes that activate caspase-1 in response to infections and stress, resulting in the secretion of pro-inflammatory cytokines. Here we report that IκB kinase α (IKKα) is a critical negative regulator of apoptosis-associated specklike protein containing a C-terminal caspase-activation-andrecruitment (CARD) domain (ASC)-dependent inflammasomes. IKKα controls the inflammasome at the level of the adaptor ASC, which interacts with IKKα in the nucleus of resting macrophages in an IKKα kinase-dependent manner. Loss of IKKα kinase activity results in inflammasome hyperactivation. Mechanistically, the downstream nuclear effector IKK-related kinase (IKKi) facilitates translocation of ASC from the nucleus to the perinuclear area during inflammasome activation. ASC remains under the control of IKKα in the perinuclear area following translocation of the ASC/IKKα complex. Signal 2 of NLRP3 activation leads to inhibition of IKKα kinase activity through the recruitment of PP2A, allowing ASC to participate in NLRP3 inflammasome assembly. Taken together, these findings reveal a IKKi-IKKα-ASC axis that serves as a common regulatory mechanism for ASC-dependent inflammasomes

A two-nuclease pathway involving RNase H1 is required for primer removal at human mitochondrial OriL.

The role of Ribonuclease H1 (RNase H1) during primer removal and ligation at the mitochondrial origin of light-strand DNA synthesis (OriL) is a key, yet poorly understood, step in mitochondrial DNA maintenance. Here, we reconstitute the replication cycle of L-strand synthesis in vitro using recombinant mitochondrial proteins and model OriL substrates. The process begins with initiation of DNA replication at OriL and ends with primer removal and ligation. We find that RNase H1 partially removes the primer, leaving behind the last one to three ribonucleotides. These 5'-end ribonucleotides disturb ligation, a conclusion which is supported by analysis of RNase H1-deficient patient cells. A second nuclease is therefore required to remove the last ribonucleotides and we demonstrate that Flap endonuclease 1 (FEN1) can execute this function in vitro. Removal of RNA primers at OriL thus depends on a two-nuclease model, which in addition to RNase H1 requires FEN1 or a FEN1-like activity. These findings define the role of RNase H1 at OriL and help to explain the pathogenic consequences of disease causing mutations in RNase H1

Amygdala and Ventrolateral Prefrontal Cortex Activation to Masked Angry Faces in Children and Adolescents with Generalized Anxiety Disorder

1. Context. Vigilance to threat is a key feature of generalized anxiety disorder (GAD). The amygdala and ventrolateral prefrontal cortex comprise a neural circuit that is responsible for detection of threats. Disturbed interactions between these structures may underlie pediatric anxiety. To date, no study has selectively examined responses to briefly-presented threats (e.g. less than 50 msec) in GAD or in pediatric anxiety. 2. Objective. To investigate amygdala and ventrolateral prefrontal cortex activation during processing of briefly-presented threats in pediatric GAD. 3. Design. Case-control study. 4. Setting. Government clinical research institute. 5. Participants. Youth volunteers, 17 with GAD and 12 diagnosis-free. 6. Main Outcome Measures. We used functional magnetic resonance imaging to measure blood oxygenation level-dependent signal. During imaging, subjects performed an attention orienting task with rapidly presented (17 msec), masked emotional (angry or happy) and neutral faces. 7. Results. When viewing masked angry faces, GAD youth, relative to comparison subjects, showed greater right amygdala activation that positively correlates with anxiety disorder severity. Moreover, in a functional connectivity (psychophysiological interaction) analysis, right amygdala and right ventrolateral prefrontal cortex showed strong negative coupling specifically to masked angry faces. This negative coupling tended to be weaker in GAD youth than in comparisons. Conclusions. GAD youth have hyper-activation of the amygdala to briefly-presented, masked threats. The presence of threat-related negative connectivity between the right ventrolateral prefrontal cortex and amygdala suggests that the prefrontal cortex modulates amygdala response to threat. In pediatric GAD, hyper-amygdala response occurs in the absence of a compensatory increase in modulation by ventrolateral prefrontal cortex