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Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids. Objective: To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference and risk of opioid misuse in chronic pain patients. Methods: Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Pain severity and pain interference were hypothesized to uniquely predict the risk of opioid misuse. Pain severity was hypothesized to predict pain interference. Finally, psychological flexibility was hypothesized as an indirect effect in these relationships. Results: Main findings suggest that pain severity predicts risk of opioid misuse, mediated by psychological flexibly. Pain interference also predicts risk of opioid misuse, mediated by psychological flexibility. Finally, results suggest pain severity predicts pain interference, mediated by psychological flexibility. Discussion: Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain patients seeking prescription opioids.

Suspension is defined as a temporary removal from the educational setting where a child is able to return after a determined period of time, while expulsion is the complete and permanent removal of a child from an entire educational system (Gilliam and Shahar 2006). Preschool children have been found to be both suspended and expelled at higher rates than school-aged children (Cutler and Gilkerson 2002; Gilliam 2005; Gilliam and Shahar 2006). It has been reported that 50,000 preschoolers were suspended at least once; another 17,000 were estimated to have been expelled (Malik 2017). However, much of this information had been collected from public preschool programs. Although many factors contribute to the high suspension and expulsion rates of young children, race has risen to the forefront as a possible contributing correlate to disproportionality (Kunesh and Noltemeyer 2019; U.S. Department of Education Office for Civil Rights 2016a, b). More specifically, children of color have been found to be at increased risk for being suspended and expelled (U.S. Department of Education Office for Civil Rights 2016a, b). In addition to addressing the gap in research by reporting suspension and expulsion data from one state’s community childcare centers, this paper also examines the disproportionality of suspensions and expulsions in these programs. The impact of director race on early childhood suspension and expulsion is also considered as a contributing factor.

In the ancient contemplative practice known as lectio divina, sacred texts were read slowly and carefully while listeners attended to the sounds of the performance. Rather than reading analytically...

Few studies have examined the development or implementation of protocols based on acceptance and commitment therapy (ACT) to enhance sport injury rehabilitation, despite findings that suggest ACT m...

The requirement for vaccination with products under emergency use authorisation is new legal territory, finds Jennifer Block

Alcohol consumption among young adult college students represents a significant public health problem. The presence of alcohol-related cues in drinkers' environments can trigger powerful alcohol cravings, which may influence drinking outcomes. Less is known about how this cue-induced craving influences behavioral economic demand for alcohol. In addition, research has suggested that trait mindfulness may be an important buffer of the effects of internal states of craving on drinking decisions. Based on this literature, we hypothesized that cue-induced cravings would be associated with increased alcohol demand, an effect that would be attenuated among drinkers who have higher levels of mindfulness. Young adult college student drinkers (n = 69) completed a laboratory-based cue-induced craving assessment, a self-report assessment of trait mindfulness, and an alcohol purchase task. Findings revealed that cue-induced craving was related to higher alcohol demand. Consistent with the study hypothesis, acceptance, a component of mindfulness, buffered the effects of cue-induced craving on alcohol demand. Results raise the possibility that mindfulness-based interventions may be useful in helping disrupt the link between internal states of craving and drinking decisions in young adult college student drinkers.

Intake no-show rates for psychotherapy vary from 20% to 57% (Swenson & Pekarik, 1988), and experiential avoidance may be related to failure to attend intake sessions. This pilot study attempted to increase intake attendance at a community mental health center by employing a brief experiential acceptance-based intervention. Those who scheduled intakes were randomly assigned to 1 of 2 groups: orientation letter or acceptance-enhanced orientation letter; rates from these conditions were compared with a retrospective comparison control group. Participants were randomized by way of an online random number generator. Persons assigned to the orientation group did not have a higher show rate than persons within the control group (∼48% compared with ∼52%). Persons assigned to the acceptance group did have higher show rates than persons in the other two groups (∼67% compared with ∼48% and ∼52%, respectively), however this difference was nonsignificant. Results suggest that brief acceptance-based interventions should be further studied for their potential value in maximizing client attendance.

Previous research on Korean-born adoptees suggests that exploring one’s ethnic identity may increase one’s psychological well-being. Existing research also suggests that some adoptees may not engage in ethnic identity exploration because they wish to avoid feeling different because of their adopted status. The current study sought to integrate these findings and investigate associations between experiential acceptance of adoption-related thoughts and feelings, ethnic identity, and psychological well-being in a Korean-born adoptee population ( N = 91). Hierarchical multiple regression analyses revealed that experiential acceptance significantly contributed to both psychological well-being and development of a positive ethnic identity. Clinical implications for therapists and families are discussed.

Mentoring across educational and training programs that prepare behavioral health care providers and related professionals is a critical topic and one that has been relatively neglected empirically. Articles in this special issue summarize extant literature on mentoring across several levels and contexts: undergraduate education, master's level training, doctoral training (both PhD and PsyD), and internship and postdoctoral training. This introductory paper provides an overview of each contribution to the special issue, discusses the intended audience, and presents the issue as part of what should be an ongoing dialogue about best practices in mentoring. Overall, the special issue aims to raise and begin to address a number of significant questions related to where we are going as a field, who is equipped to move us in that direction, and how to mentor the next generations of those who will serve a variety of "clients." Keywords: mentoring; supervision; training; doctoral; master's-level; education "A discipline which critically looks at the evidence for practice should itself be critically examined" (Nabulsi et al., 2007, p. 468). Nabulsi and colleagues review evidence for the impact of education in evidence-based health care (EBHC) on learner, patient, and health system outcomes. This review clearly concludes that existing data is limited and of generally poor quality. The literature on the impact of training methods in psychology (in evidence- based practice and more generally) is similarly sparse (McFall, 2006; Sholomskas et al., 2005; see Rakovshik & McManus, 2010 for a notable exception). As those trained from within scientist-practitioner, practitioner-scholar, and/or clinical science models, we as psychologists engaged in training know well the value of subjecting our clinical methods to empirical scrutiny and actively consuming the research that others within and outside of the field put forth. Yet, if we were to rely as heavily on evidence-based practice in our roles as clinical supervisors, research mentors, and course instructors, we would not get very far! Given that training clearly involves planting and tending to the seeds of tomorrow's professionals, it seems imperative that we at least actively "sit with" questions about why this is the case and consider some attempts to move forward in addressing this neglected set of topics. In his address upon receipt of the APA Award for Distinguished Career Contributions to Education and Training in Psychology, Rex Forehand (2008) speaks of the "art and science of mentoring in Psychology" and aptly summarizes the sparse literature on this topic. Forehand's article is an inspiring call for greater attention to the mentoring process. It is limited for our purposes, however, by its focus on "producing the next generation of scholars" (p. 744); this review clearly pertains to practices related to training students in PhD programs poised for positions in academic institutions. Although much of the literature that Forehand presents may be relevant to working with trainees with more diverse aspirations, this in and of itself involves a host of empirical questions. Furthermore, with the growth of PsyD programs with various emphases, the reality that master's-level practitioners currently provide a high percentage of psychotherapeutic services, and the fact that training in ways of thinking about evidence-based practice can begin during undergraduate years and span through internship and postdoctoral training (and beyond; see Kazdin, 2008), it seems that exploration of these topics by individuals who are involved in training across various types of programs and levels of training is warranted. Mentoring: A Privilege and Responsibility Williams-Nickelson (2009) offers a definition of mentoring that is useful for our purposes. It emphasizes a mentor as an individual who is in the mentee's chosen profession, who actively works to integrate that person into a professional role, and who feels a sense of responsibility for the development of the mentee's career. …

Although mammography can aid in the early detection and prevention of breast cancer, many women do not receive annual mammograms. It remains unclear whether anxiety about breast cancer inhibits or promotes mammography rates. The way in which women regulate their anxiety (ie, level of experiential avoidance) may play a role in predicting mammography adherence. A community sample of women (N = 84) completed a questionnaire which assessed mammography rates, experiential avoidance, and breast cancer anxiety. The results suggest that, while controlling for breast cancer anxiety, experiential avoidance (β = .31, p.01) significantly predicted mammography rates. When examining experiential avoidance as a moderator, a multiple regression analysis approached significance (R2 Δ = .04, p = .07), suggesting that a woman's level of experiential avoidance influences the relationship between anxiety and mammography. These findings will help enable health care practitioners to better identify women at risk of non-adherence to mammography recommendations.

Experiential acceptance, which involves “having,” or “allowing” private experiences, has recently gained much attention in the cognitive-behavioral literature. Acceptance, however, may be considered a common factor among psychotherapeutic traditions. The purposes of this paper are to examine the historical roots of acceptance and to discuss the forms of and theoretical rationales for which the concept of acceptance has been recently introduced into the cognitive-behavioral literature, with an emphasis on acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999 ). It is hoped that clarification of the theoretical basis underlying acceptance-based approaches, as well as a comparison of various forms of psychotherapy with regard to their emphasis on acceptance, will promote heightened understanding and stimulate more rigorous exploration of treatment efficacy.

Cell migration is initiated by lamellipodia-membrane-enclosed sheets of cytoplasm containing densely packed actin filament networks. Although the molecular details of network turnover remain obscure, recent work points towards key roles in filament nucleation for Arp2/3 complex and its activator WAVE complex. Here, we combine fluorescence recovery after photobleaching (FRAP) of different lamellipodial components with a new method of data analysis to shed light on the dynamics of actin assembly/disassembly. We show that Arp2/3 complex is incorporated into the network exclusively at the lamellipodium tip, like actin, at sites coincident with WAVE complex accumulation. Capping protein likewise showed a turnover similar to actin and Arp2/3 complex, but was confined to the tip. In contrast, cortactin-another prominent Arp2/3 complex regulator-and ADF/cofilin-previously implicated in driving both filament nucleation and disassembly-were rapidly exchanged throughout the lamellipodium. These results suggest that Arp2/3- and WAVE complex-driven actin filament nucleation at the lamellipodium tip is uncoupled from the activities of both cortactin and cofilin. Network turnover is additionally regulated by the spatially segregated activities of capping protein at the tip and cofilin throughout the mesh.

A quasi-experimental design was used to compare the effectiveness of group (game-based cognitive behavioral) therapy to group-plus-individual therapy for child sexual abuse. The sample consisted predominantly of children from economically disadvantaged, African-American or Latino backgrounds. Pretreatment scores were examined in order to determine which factors influence treatment referral decisions. Results suggest that children who were referred for individual therapy in addition to group therapy report higher pretreatment levels of sexualized behavior. Posttreatment differences were also compared across therapy conditions. Results suggest that individual therapy is needed to address the sexual concerns of survivors but that it may not be needed to augment the effects of group therapy for other symptoms. Implications for treatment are discussed.

SummaryMitochondrial outer- and inner-membrane fusion events are coupled in vivo but separable and mechanistically distinct in vitro, indicating that separate fusion machines exist in each membrane. Outer-membrane fusion requires trans interactions of the dynamin-related GTPase Fzo1, GTP hydrolysis, and an intact inner-membrane proton gradient. Inner-membrane fusion also requires GTP hydrolysis but distinctly requires an inner-membrane electrical potential. The protein machinery responsible for inner-membrane fusion is unknown. Here, we show that the conserved intermembrane-space dynamin-related GTPase Mgm1 is required to tether and fuse mitochondrial inner membranes. We observe an additional role of Mgm1 in inner-membrane dynamics, specifically in the maintenance of crista structures. We present evidence that trans Mgm1 interactions on opposing inner membranes function similarly to tether and fuse inner membranes as well as maintain crista structures and propose a model for how the mitochondrial dynamins function to facilitate fusion.

Despite the efficacy of standard immunotherapy, a subset of myasthenia gravis (MG) patients remains medically refractory. Muscle-specific kinase autoantibody positive (MuSK+) patients, in particular, do not respond well to treatment, exhibit more bulbar symptoms and have more frequent exacerbations as compared to acetylcholine receptor antibody positive (AChR+) patients.1 ,2 Autoreactive B cells are appropriate candidates for targeted drug therapy as they play an important role in the pathogenesis of MG.2–4 Rituximab, a chimeric monoclonal antibody that targets the CD20 antigen on B lymphocytes, is the only B cell–directed biologic currently approved for clinical use. Several groups, including our own, have observed the benefits of rituximab in both AChR+ and MuSK+ patients.2–7 The durability of this positive response has varied among different reports. One group reported sustained benefit after a mean follow-up of 31 months in the combined AChR+ and MuSK+ cohort and 40 months in the MuSK+ subpopulation.3 Here, we report our experience with the sustained effects of rituximab in nine refractory MuSK+ patients in a follow-up period ranging from 2 to 5.5 years. A retrospective study was performed of generalised MuSK+ MG patients referred to our neuromuscular clinic from 2003 to 2011. Nine MuSK+ patients were identified with refractory disease and treated with rituximab. The group consisted of eight females and one male with a median age of 40. Patients were defined as refractory when they: (1) could not lower …

In this article, the authors wish to summarize the effect a network such as OhioLINK has had on the traditional ILL department at Miami University? In an increasingly networked environment, patrons will be offered a growing number of avenues for document access? Traditional interlibrary loan increasingly will occupy merely one niche and will not (necessarily) compete with other niches or document supply mechanismes. They discuss OhioLINK as part of over-all resource sharing at our intisution and to a lesser degreee among the OhioLINK memeber institutions

Although researchers have not yet examined the applicability of mindfulness for weight-gain prevention, mindfulness training has the potential to increase an individual's awareness of factors that enable an individual to avoid weight gain caused by overconsumption.The study intended to examine the effects of 1 h of mindfulness training on state mindfulness and food consumption.The research team performed a pilot study.The study occurred at an urban, northeastern, Catholic university.Participants were 26 undergraduate, English-speaking students who were at least 18 y old (77% female, 73% Caucasian). Students with food allergies, an inability to fast, or a current or past diagnosis of an eating disorder were ineligible.Participants fasted for 4 h. Between the third and fourth hours, they attended a 1-h session of mindfulness training that integrated three experiential mindfulness exercises with group discussion. Following training, they applied the skills they learned during a silent lunch.The Toronto Mindfulness Scale (TMS), the Awareness subscale of the Philadelphia Mindfulness Scale (PHLMS-AW), and a modified version of the Acting with Awareness subscale of the Five-Facet Mindfulness Questionnaire (FFMQ-AW) were used preand posttraining to assess changes in state mindfulness, present-moment awareness, and mealtime awareness, respectively. A postmeal, subjective hunger/fullness Likert scale was used to assess food consumption (healthy vs unhealthy consumption).The study found a statistically significant increase in state mindfulness (P=.002). Eighty-six percent of participants engaged in healthy food consumption. No statistically significant changes occurred in either present-moment awareness (P=.617) or mealtime awareness (P=.483).Preliminary results suggest promising benefits for use of mindfulness training on weight-gain prevention in healthy individuals. More research is needed to understand the impact that mindfulness may have on long-term, weight-gain prevention.

The Bush administration's obsession with abstinence-only approaches to AIDS prevention is leading to attacks on the notion of safe sex, manipulation of educational materials, loss of funding and other assaults on HIV-prevention organizations, and manipulation of scientific research itself. The Centers for Disease Control and Prevention, once a partner to HIV experts, has become a case study in the pitched battle between science and ideology.

We report 10 years’ follow-up of the previously described family with a novel mutation of the KCNA1 gene. The family consisted of 3 affected boys (first seen at ages 3, 11, and 12) and their affected mother and asymptomatic father and sister. They clinically presented with diffuse myokymia, muscle cramps, and lower limb spasticity without ataxia, but episodic ataxia developed later during adolescence and early adulthood. Long-term follow-ups of families with known KCNA1 gene mutation are rarely mentioned in the literature. Treatment with carbamazepine, 600 to 800 mg daily resulted in cessation of muscle cramps and marked improvement of lower leg symptoms. In the youngest child, after 2 years carbamazepine had to be changed to oxcarbazepine because of side effects. Carbamazepine and oxcarbazepine are both effective in treatment of symptoms related to KCNA1 gene mutation. Symptoms will reoccur if treatment is stopped and there is variability of symptom severity between family members.

OBJECTIVE To determine the relationship between mean sensor glucose concentrations and hemoglobin A1c (HbA1c) values measured in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications laboratory at the University of Minnesota in a cohort of subjects with type 1 diabetes from the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial. RESEARCH DESIGN AND METHODS Near-continuous glucose sensor data (≥4 days/week) were collected for 3 months before a central laboratory–measured HbA1c was performed for 252 subjects aged 8–74 years, the majority of whom had stable HbA1c values (77% within ±0.4% of the patient mean). RESULTS The slope (95% CI) for mean sensor glucose concentration (area under the curve) versus a centrally measured HbA1c was 24.4 mg/dL (22.0–26.7) for each 1% change in HbA1c, with an intercept of −16.2 mg/dL (−32.9 to 0.6). Although the slope did not vary with age or sex, there was substantial individual variability, with mean sensor glucose concentrations ranging from 128 to 187 mg/dL for an HbA1c of 6.9–7.1%. The root mean square of the errors between the actual mean sensor glucose concentration versus the value calculated using the regression equation was 14.3 mg/dL, whereas the median absolute difference was 10.1 mg/dL. CONCLUSIONS There is substantial individual variability between the measured versus calculated mean glucose concentrations. Consequently, estimated average glucose concentrations calculated from measured HbA1c values should be used with caution.

Olanzapine is an atypical antipsychotic drug that infrequently has been reported to cause seizures and myoclonus despite a small proconvulsant risk. This is the first report of generalized myoclonus induced in a patient who had been maintained on low dose olanzapine for over seven years without any change in her dose. Olanzapine was discontinued, and the myoclonic jerks completely resolved within 48 h.

Filopodia are rod-shaped cell surface protrusions composed of a parallel bundle of actin filaments. Since filopodia frequently emanate from lamellipodia, it has been proposed that they form exclusively by the convergence and elongation of actin filaments generated in lamellipodia networks. However, filopodia form without Arp2/3-complex, which is essential for lamellipodia formation, indicating that actin filaments in filopodia may be generated by other nucleators. Here we analyzed the effects of ectopic expression of GFP-tagged full length or a constitutively active variant of the human formin mDia2/Drf3. By contrast to the full-length molecule, which did not affect cell behaviour and was entirely cytosolic, active Drf3 lacking the C-terminal regulatory region (Drf3DeltaDAD) induced the formation of filopodia and accumulated at their tips. Low expression of Drf3DeltaDAD induced rod-shaped or tapered filopodia, whereas over-expression resulted in multiple, club-shaped filopodia. The clubs were filled with densely bundled actin filaments, whose number but not packing density decreased further away from the tip. Interestingly, clubs frequently increased in width after protrusion beyond the cell periphery, which correlated with increased amounts of Drf3DeltaDAD at their tips. These data suggest Drf3-induced filopodia form and extend by de novo nucleation of actin filaments instead of convergent elongation. Finally, Drf3DeltaDAD also induced the formation of unusual, lamellipodia-like structures, which contained both lamellipodial markers and the prominent filopodial protein fascin. Microarray analyses revealed highly variable Drf3 expression levels in different commonly used cell lines, reflecting the need for more detailed analyses of the functions of distinct formins in actin cytoskeleton turnover and different cell types.

Empathic responding, most notably perspective-taking and empathic concern, has important implications for interpersonal functioning. While empathy training approaches have received some support for a variety of populations, few extant interventions have targeted empathic responding in couples. Mindfulness- and acceptance-based behavioral approaches, for couples as a unit and/or for individual family members/partners, are proposed as an adjunct to empathy training interventions. Preliminary findings suggest that the viability of these interventions for increasing empathic responding should be further investigated, and specific suggestions for this line of research are offered.

The Guest House, a poem by Rumi (translated by Barks & Moyne, 1997) that has been utilized in mindfulness-based therapeutic approaches (e.g., Roemer & Orsillo, 2002; Segal, Williams, & Teasdale, 2002), conveys the essence of mindfulnessandexperiential acceptance. Such a “stance” stands in sharp contrast to the approach that many of us take toward our thoughts, feelings, and bodily sensations, particularly those that we label “unwanted.” Bringing mindfulness and/or acceptance to our private experiences may fundamentally alter our relationship to these phenomena. How would we know if an individual was willing to “welcome and entertain them all” (Segal, 2003)? What might it look like to “meet them at the door laughing”? How might we measure this critical shift via self-report or experimental designs?

Anxiety disorders are the most commonly experienced mental health problems in the United States. Narrow, Rae, Robins, and Regier (2002), combining data from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS), conservatively estimated the one-year prevalence for any anxiety disorder to be 13.1% for adults aged 18–54. These conditions tend to be chronic. Three year remission rates range from 16 to 23% for social phobia, generalized anxiety disorder, agoraphobia, and panic disorder with agoraphobia (Keller, 2000, in Barlow, 2002). In one longitudinal study, within the first 22 months following the onset of an episode, only 18% of individuals diagnosed with panic disorder and agoraphobia and about 43% of those with panic disorder without agoraphobia had recovered in comparison to approximately 80% of those with major depressive disorder (Hirschfeld, 1996). Functional status of patients with anxiety disorders is diminished as evidenced by higher rates of financial dependence, unemployment (e.g., Leon, Portera and Weissman, 1995), poorer quality of life (Massion, Warshaw, & Keller, 1993), and increased risk for completed suicide (Allgulander, 1994).

Childbirth educators and doulas express frustration that the vast majority of women choose standard obstetric care for labor and birth, even though the evidence shows that this care increases the likelihood that they will experience unnecessary intervention and morbidity. Women are preparing for childbirth by reading and taking classes, but they are unprepared for this reality. What responsibility do doulas and childbirth educators have in alerting women of the risk?

The actin cytoskeleton is continuously remodeled through cycles of actin filament assembly and disassembly. Filaments are born through nucleation and shaped into supramolecular structures with various essential functions. These range from contractile and protrusive assemblies in muscle and non-muscle cells to actin filament comets propelling vesicles or pathogens through the cytosol. Although nucleation has been extensively studied using purified proteins in vitro, dissection of the process in cells is complicated by the abundance and molecular complexity of actin filament arrays. We here describe the ectopic nucleation of actin filaments on the surface of microtubules, free of endogenous actin and interfering membrane or lipid. All major mechanisms of actin filament nucleation were recapitulated, including filament assembly induced by Arp2/3 complex, formin and Spir. This novel approach allows systematic dissection of actin nucleation in the cytosol of live cells, its genetic re-engineering as well as screening for new modifiers of the process.