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Abstract Background Procrastination is common among university students and associated with adverse outcomes such as physical and mental health problems. According to the Temporal motivation theory procrastination may vary over time depending on the temporal proximity to goals and deadlines. Aims To determine if mean procrastination levels among university students varies over an academic year, and if trajectories of procrastination are moderated by gender identity, perfectionistic strivings, and/or perfectionistic concerns. Sample Swedish university students (n = 1410). Methods The cohort was followed with web-surveys at four time-points over one academic year (Late semester, Mid semester, After semester, and Early semester). Generalized Estimating Equations were used to estimate mean levels of self-rated procrastination at the different time-points. Results We found only small fluctuations in mean procrastination levels over the academic year. Participants with high perfectionistic concerns demonstrated higher mean procrastination levels at all time-points, but neither gender identity, perfectionistic concerns nor perfectionistic strivings affected the slope of the mean procrastination trajectories. Conclusions In this cohort of Swedish university students, self-rated procrastination levels were stable over the academic year. Perfectionistic concerns, but not gender identity or perfectionistic strivings, was associated with higher levels of procrastination.

Abstract Background Despite accumulating evidence of an association between air pollution and renal disease, studies on the association between long-term exposure to air pollution and renal function are still contradictory. This study aimed to investigate this association in a large population with relatively low exposure and with improved estimation of renal function as well as renal injury biomarkers. Methods We performed a cross-sectional analysis in the middle-aged general population participating in the Swedish CardioPulmonary bioImaging Study (SCAPIS; n = 30 154). Individual 10-year exposure to total and locally emitted fine particulate matter (PM2.5), inhalable particulate matter (PM10), and nitrogen oxides (NOx) were modelled using high-resolution dispersion models. Linear regression models were used to estimate associations between exposures and estimated glomerular filtration rate (eGFR, combined creatinine and cystatin C) and serum levels of renal injury biomarkers (KIM-1, MCP-1, IL-6, IL-18, MMP-2, MMP-7, MMP-9, FGF-23, and uric acid), with consideration of potential confounders. Results Median long-term PM2.5 exposure was 6.2 µg/m3. Almost all participants had a normal renal function and median eGFR was 99.2 mL/min/1.73 m2. PM2.5 exposure was associated with 1.3% (95% CI 0.6, 2.0) higher eGFR per 2.03 µg/m3 (interquartile range, IQR). PM2.5 exposure was also associated with elevated serum matrix metalloproteinase 2 (MMP-2) concentration, with 7.2% (95% CI 1.9, 12.8) higher MMP-2 per 2.03 µg/m3. There was a tendency towards an association between PM10 and higher levels of uric acid, but no associations were found with the other biomarkers. Associations with other air pollutants were null or inconsistent. Conclusion In this large general population sample at low exposure levels, we found a surprising association between PM2.5 exposure and a higher renal filtration. It seems unlikely that particle function would improve renal function. However, increased filtration is an early sign of renal injury and may be related to the relatively healthy population at comparatively low exposure levels. Furthermore, PM2.5 exposure was associated with higher serum concentrations of MMP-2, an early indicator of renal and cardiovascular pathology.

Abstract Nonhuman great apes have been claimed to be unable to learn human words due to a lack of the necessary neural circuitry. We recovered original footage of two enculturated chimpanzees uttering the word “mama” and subjected recordings to phonetic analysis. Our analyses demonstrate that chimpanzees are capable of syllabic production, achieving consonant-to-vowel phonetic contrasts via the simultaneous recruitment and coupling of voice, jaw and lips. In an online experiment, human listeners naive to the recordings’ origins reliably perceived chimpanzee utterances as syllabic utterances, primarily as “ma-ma”, among foil syllables. Our findings demonstrate that in the absence of direct data-driven examination, great ape vocal production capacities have been underestimated. Chimpanzees possess the neural building blocks necessary for speech.

Abstract Purpose The purpose of this study was to explore changes in symptoms of eating disorders, compulsive exercise, and depression, between two assessments 12 months apart, among elite gymnasts. Method Factors related to the development of mental health symptoms in male and female Swedish national team gymnasts were investigated using baseline and 1-year follow-up scores in two subscales of the Eating Disorders Inventory 3; drive for thinness and body dissatisfaction, two subscales of the Compulsive Exercise Test; avoidance and rule-driven behavior and exercise for weight control, and the Montgomery-Åsberg Depression Rating Scale-Self report (MADRS-S). Linear mixed models were used to investigate the influence of drive for thinness, exercise for weight control, avoidance and rule-driven behavior, and MADRS-S on body dissatisfaction. Results Body dissatisfaction increased from baseline to the follow-up assessment, while drive for thinness and depression remained stable. Symptoms of eating disorders and depression were generally low in this group of elite gymnasts at both assessments. Drive for thinness, exercise for weight control, and symptoms of depression were associated with body dissatisfaction. Discussion Our findings indicate that there were no significant changes over time in eating disorders and depression symptoms but significant associations with body dissatisfaction. Furthermore, we found independent effects of drive for thinness, exercise for weight control and symptoms of depression for body dissatisfaction.

Abstract Background Despite progress understanding the mechanisms underlying tumor spread, metastasis remains a clinical challenge. We identified the choline-producing glycerophosphodiesterase, EDI3 and reported its association with metastasis-free survival in endometrial cancer. We also observed that silencing EDI3 slowed cell migration and other cancer-relevant phenotypes in vitro. Recent work demonstrated high EDI3 expression in ER-HER2+ breast cancer compared to the other molecular subtypes. Silencing EDI3 in ER-HER2+ cells significantly reduced cell survival in vitro and decreased tumor growth in vivo. However, a role for EDI3 in tumor metastasis in this breast cancer subtype was not explored. Therefore, in the present work we investigate whether silencing EDI3 in ER-HER2+ breast cancer cell lines alters phenotypes linked to metastasis in vitro, and metastasis formation in vivo using mouse models of experimental metastasis. Methods To inducibly silence EDI3, luciferase-expressing HCC1954 cells were transduced with lentiviral particles containing shRNA oligos targeting EDI3 under the control of doxycycline. The effect on cell migration, adhesion, colony formation and anoikis was determined in vitro, and significant findings were confirmed in a second ER-HER2+ cell line, SUM190PT. Doxycycline-induced HCC1954-luc shEDI3 cells were injected into the tail vein or peritoneum of immunodeficient mice to generate lung and peritoneal metastases, respectively and monitored using non-invasive bioluminescence imaging. Metabolite levels in cells and tumor tissue were analyzed using targeted mass spectrometry and MALDI mass spectrometry imaging (MALDI-MSI), respectively. Results Inducibly silencing EDI3 reduced cell adhesion and colony formation, as well as increased susceptibility to anoikis in HCC1954-luc cells, which was confirmed in SUM190PT cells. No influence on cell migration was observed. Reduced luminescence was seen in lungs and peritoneum of mice injected with cells expressing less EDI3 after tail vein and intraperitoneal injection, respectively, indicative of reduced metastasis. Importantly, mice injected with EDI3-silenced cells survived longer. Closer analysis of the peritoneal organs revealed that silencing EDI3 had no effect on metastatic organotropism but instead reduced metastatic burden. Finally, metabolic analyses revealed significant changes in choline and glycerophospholipid metabolites in cells and in pancreatic metastases in vivo. Conclusions Reduced metastasis upon silencing supports EDI3’s potential as a treatment target in metastasizing ER-HER2+ breast cancer.

This paper proposes the design of an instructional model, referred to as the universal genre sphere, for teaching academic writing in a manner appropriate to all learners, but developed especially with consideration for the needs of English as additional language students with or without diagnosed learning differences. Despite growing research on, variously, second-language writing, English as an additional language and learning differences, there has been relatively little work that explores approaches to the intersections of these topics. Thus, the proposed universal genre sphere model is founded on the pillars of universal design for learning and the tenets of the genre-based approach, especially the teaching-learning cycle, to create more equitable and inclusive, as well as effective, learning environments. The universal genre sphere balances inclusive design that draws upon students' interests, while breaking learning into manageable and adjustable segments, thus making academic writing more accessible to a greater number of learners. The combination of universal design for learning and the genre-based approach represents an opportunity to create a shift in second-language writing instruction (and, potentially, in L1 writing instruction) that aligns with the principles of inclusive education by reducing barriers in the classroom and providing students with multiple pathways to participate, which could do much to advance knowledge about more inclusive, equitable and effective writing instruction for all learners.

Objectives The inclusion of rock-climbing in the Olympic Games has increased participation in the sport and attention to athletes' health. In sports where the importance of low body weight is considerate, there is an increased risk of developing eating disorders (EDs). There is sparse research on EDs among rock-climbers. The primary aim was to map ED symptoms among rock-climbers compared with controls. The secondary aim was to analyze differences in body dissatisfaction. Comparisons between rock-climbing levels and sexes were performed.Design This is a cross-sectional study in a larger prospective longitudinal study series, CLIMB: Climber’s Longitudinal attitudes towards Injury, Mental health and Body image, using baseline data.Participants Swedish rock-climbers, at an advanced and elite level according to the International Rock Climbing Research Association, participated. Participants were at least 13 years old. 183 rock-climbers partook with a mean age of 29.5 (SD=9.1) with two participants under 15 years old. 180 controls partook with a mean age of 29.0 (SD=8.9). There were no control participants under 15 years of age.Primary and secondary outcome measures Data was gathered through a self-report questionnaire collecting the primary outcome measure, ED symptoms (Eating Disorders Examination Questionnaire (EDE-Q) V.6.0) and the secondary outcome measure, body dissatisfaction (Body Shape Questionnaire-8C).Results There were no differences between rock-climbers and controls regarding ED symptoms. Symptoms were higher among female rock-climbers (26%) than male (5.8%). Regarding body dissatisfaction, the control group reported higher levels compared with rock-climbers. At least a mild concern was observed in 13.3% of male rock-climbers, compared with 47.4% of females.Conclusions Although there was no difference in the EDE-Q V.6.0 between rock-climbers and controls, females reported significantly more symptoms than men. Regarding body dissatisfaction, female rock-climbers exhibited higher levels of dissatisfaction than males. Further, higher levels of dissatisfaction were reported in controls, especially in men, where symptoms were three times higher than rock-climbers.Trial registration number NCT05587270.

Abstract Genome-wide association studies (GWAS) have identified more than 200 common genetic variants independently associated with colorectal cancer (CRC) risk, but the causal variants and target genes are mostly unknown. We sought to fine-map all known CRC risk loci using GWAS data from 100,204 cases and 154,587 controls of East Asian and European ancestry. Our stepwise conditional analyses revealed 238 independent association signals of CRC risk, each with a set of credible causal variants (CCVs), of which 28 signals had a single CCV. Our cis-eQTL/mQTL and colocalization analyses using colorectal tissue-specific transcriptome and methylome data separately from 1299 and 321 individuals, along with functional genomic investigation, uncovered 136 putative CRC susceptibility genes, including 56 genes not previously reported. Analyses of single-cell RNA-seq data from colorectal tissues revealed 17 putative CRC susceptibility genes with distinct expression patterns in specific cell types. Analyses of whole exome sequencing data provided additional support for several target genes identified in this study as CRC susceptibility genes. Enrichment analyses of the 136 genes uncover pathways not previously linked to CRC risk. Our study substantially expanded association signals for CRC and provided additional insight into the biological mechanisms underlying CRC development.

Abstract Prolonged exposure to antibiotics at low concentration can promote processes associated with bacterial biofilm formation, virulence and antibiotic resistance. This can be of high relevance in microbial communities like the oral microbiome, where commensals and pathogens share a common habitat and where the total abundance of antibiotic resistance genes surpasses the abundance in the gut. Here, we used an ex vivo model of human oral biofilms to investigate the impact of ampicillin on biofilm viability. The ecological impact on the microbiome and resistome was investigated using shotgun metagenomics. The results showed that low concentrations promoted significant shifts in microbial taxonomic profile and could enhance biofilm viability by up to 1 to 2-log. For the resistome, low concentrations had no significant impact on antibiotic resistance gene (ARG) diversity, while ARG abundance decreased by up to 84%. A positive correlation was observed between reduced microbial diversity and reduced ARG abundance. The WHO priority pathogens Streptococcus pneumoniae and Staphylococcus aureus were identified in some of the samples, but their abundance was not significantly altered by ampicillin. Most of the antibiotic resistance genes that increased in abundance in the ampicillin group were associated with streptococci, including Streptococcus mitis, a well-known potential donor of ARGs to S. pneumoniae. Overall, the results highlight the potential of using the model to further our understanding of ecological and evolutionary forces driving antimicrobial resistance in oral microbiomes.

Abstract Objectives To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. Methods A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Results A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052–0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). Conclusion The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Abstract Background It is well documented that smokers suffer increased risk of postoperative complications after medical surgery, for example delayed healing and increased risk of infection. It is also known that preoperative smoking cessation can reduce the risk of these complications. Because of this there are guidelines regarding preoperative smoking cessation in non-oral medical surgery. There are however no specific guidelines regarding oral surgical procedures, such as surgical extractions, dentoalveolar surgery, periodontal surgery, or dental implantation. Nevertheless, it is common that dentists and oral surgeons recommend smoking cessation pre to oral surgical procedures. The aim with this systematic review was to see if there are any evidence in the literature, supporting preoperative smoking cessation in oral surgical procedures. Methods A systematic search of the electronic databases PubMed, Scopus, Web of Science, and Cochrane was conducted to identify studies addressing the effect of preoperative smoking cessation in oral surgical procedures. Included publications were subjected to preidentified inclusion criterion. Six examiners performed the eligibility and quality assessment of relevant studies. Risk of bias was assessed using ROBINS-I and RoB 2. Certainty assessment was carried out using GRADE. Results The initial search resulted in 2255 records, and after removal of 148 duplicates, 16 articles met an acceptable level of relevance. These were read in full text, whereof 12 articles were excluded, due to different intervention, outcome, or study design than stated in the review protocol. One study remained with moderate risk of bias and three were excluded due to high risk of bias. Conclusion This systematic review could not determine the effect of smoking cessation pre to oral surgical procedures, in smokers. This indicates lack of knowledge in the effects of smoking cessation. We also conclude a lack of knowledge in how to design smoking cessation in the most effective way.

Aims: Individuals of African ancestry (AA) present with lower insulin sensitivity compared to their European counterparts (EA). Studies show ethnic differences in skeletal muscle fiber type (lower type I fibers in AA), muscle fat oxidation capacity (lower in AA), whilst no differences in total skeletal muscle lipids. However, skeletal muscle lipid subtypes have not been examined in this context. We hypothesize that lower insulin sensitivity in AA is due to a greater proportion of type II (non-oxidative) muscle fibers, and that this would result in an ancestry-specific association between muscle lipid subtypes and peripheral insulin sensitivity. To test this hypothesis, we examined the association between insulin sensitivity and muscle lipids in AA and EA adults, and in an animal model of insulin resistance with muscle-specific fiber types. Methods: In this cross-sectional study, muscle biopsies were obtained from individuals with a BMI ranging from normal to overweight with AA (N = 24) and EA (N = 19). Ancestry was assigned via genetic admixture analysis; peripheral insulin sensitivity via hyperinsulinaemic–euglycemic clamp; and myofiber content via myosin heavy chain immunohistochemistry. Further, muscle types with high (soleus) and low (vastus lateralis) type I fiber content were obtained from high-fat diet-induced insulin resistant F1 mice and littermate controls. Insulin sensitivity in mice was assessed via intraperitoneal glucose tolerance test. Mass spectrometry (MS)-based lipidomics was used to measure skeletal muscle lipid. Results: Compared to EA, AA had lower peripheral insulin sensitivity and lower oxidative type 1 myofiber content, with no differences in total skeletal muscle lipid content. Muscles with lower type I fiber content (AA and vastus from mice) showed lower levels of lipids associated with fat oxidation capacity, i.e., cardiolipins, triacylglycerols with low saturation degree and phospholipids, compared to muscles with a higher type 1 fiber content (EA and soleus from mice). Further, we found that muscle diacylglycerol content was inversely associated with insulin sensitivity in EA, who have more type I fiber, whereas no association was found in AA. Similarly, we found that insulin sensitivity in mice was associated with diacylglycerol content in the soleus (high in type I fiber), not in vastus (low in type I fiber).Conclusions; Our data suggest that the lipid contribution to altered insulin sensitivity differs by ethnicity due to myofiber composition, and that this needs to be considered to increase our understanding of underlying mechanisms of altered insulin sensitivity in different ethnic populations.

Abstract Objective The Mental and Substance Use Disorders Prevalence Study (MDPS) builds upon previous epidemiologic studies to provide estimates of prevalence and treatment rates of mental and substance use disorders among adults aged 18–65 in the U.S. The study background and methods are described. Method The MDPS employed novel techniques such as the inclusion of household, prison, homeless and state psychiatric hospital populations, a semi‐structured clinical interview administered by trained clinical interviewers to assess disorders, the assessment of both past year and lifetime schizophrenia spectrum disorder (SSD) using full Diagnostic and Statistical Manual 5 criteria, as well as other mental and substance use disorders, and video‐based interviewing. Population specific and combined sample weights were developed to estimate nationally representative prevalence and treatment rates. Results Data collection was conducted between October 2020 and October 2022 resulting in 5679 clinical interviews. The statistical weighting and analytic plan are described. Weighted response rates and reasons for non‐response are provided for each study population. Conclusions The MDPS successfully developed and employed novel techniques to estimate the prevalence and treatment rates of mental and substance use disorders in both household and non‐household populations, including some of the most impairing disorders such as SSD.

Background & Aims: Changes in gut microbiota in metabolic dysfunction-associated steatotic liver disease (MASLD) are important drivers of disease progression towards fibrosis. Therefore, reversing microbial alterations could ameliorate MASLD progression. Oat beta-glucan, a non-digestible polysaccharide, has shown promising therapeutic effects on hyperlipidemia associated with MASLD, but its impact on gut microbiota and most importantly MASLD-related fibrosis remains unknown. Methods: We performed detailed metabolic phenotyping, including assessments of body composition, glucose tolerance, and lipid metabolism, as well as comprehensive characterization of the gut-liver axis in a western-style diet (WSD)-induced model of MASLD and assessed the effect of a beta-glucan intervention on early and advanced liver disease. Gut microbiota were modulated using broad-spectrum antibiotic treatment. Results: Oat beta-glucan supplementation did not affect WSD-induced body weight gain or glucose intolerance and the metabolic phenotype remained largely unaffected. Interestingly, oat beta-glucan dampened MASLD-related inflammation, which was associated with significantly reduced monocyte-derived macrophage infiltration and fibroinflammatory gene expression, as well as strongly reduced fibrosis development. Mechanistically, this protective effect was not mediated by changes in bile acid composition or signaling, but was dependent on gut microbiota and was lost upon broad-spectrum antibiotic treatment. Specifically, oat beta-glucan partially reversed unfavorable changes in gut microbiota, resulting in an expansion of protective taxa, including Ruminococcus, and Lactobacillus followed by reduced translocation of Toll-like receptor ligands. Conclusions: Our findings identify oat beta-glucan as a highly efficacious food supplement that dampens inflammation and fibrosis development in diet-induced MASLD. These results, along with its favorable dietary profile, suggest that it may be a cost-effective and well-tolerated approach to preventing MASLD progression and should be assessed in clinical studies. Impact and Implications: Herein, we investigated the effect of oat beta-glucan on the gut-liver axis and fibrosis development in a mouse model of metabolic dysfunction-associated steatotic liver disease (MASLD). Beta-glucan significantly reduced inflammation and fibrosis in the liver, which was associated with favorable shifts in gut microbiota that protected against bacterial translocation and activation of fibroinflammatory pathways. Together, oat beta-glucan may be a cost-effective and well-tolerated approach to prevent MASLD progression and should be assessed in clinical studies.

More than resource allocations, evaluations of funding applications have become central instances for status bestowal in academia. Much attention in past literature has been devoted to grasping the status consequences of prominent funding evaluations. But little attention has been paid to understanding how the status-bestowing momentum of such evaluations is constructed. Throughout this paper, our aim is to develop new knowledge on the role of applicants in constructing certain funding evaluations as events with crucial importance for status bestowal. Using empirical material from retrospective interviews with Sweden-based early-career scientists who, successfully or unsuccessfully, applied for European Research Council (ERC) Starting Grants, our findings show how these scientists interlinked experiences from various practices to construct the ERC's evaluations, in general, and the final-stage appointments at Brussels' Madou Plaza Tower, in particular, as apex-esque, crescendo-like status-bestowing events. We discuss our findings as instructional, preparatory, and demarcative practices that, by extension, distribute responsibility for the construction and reinforcement of high-stakes, career-defining evaluations through which considerable stress and anxiety is generated in academia.

In a clinical psychology training context, there is a need to examine students' theoretical knowledge as well as their professional competence. One promising method to assess students' professional competence is the Objective and Structured Clinical Examination (OSCE). In this report, we describe and discuss the implementation of OSCE on a clinical psychology programme at a university in Sweden, including lesson learned regarding the structure and content for this examination. We also report on preliminary results, in which we explored students' perceived competence and worries, and their supervisors' reports regarding their clinical practicum, in relation to a new curriculum that includes more simulation-based elements (including the OSCE) than the old curriculum. Results showed that students on the new curriculum reported lower levels of perceived competence before the clinical practicum, but increased significantly more over time in comparison to students on the old curriculum. These results are discussed in relation to the potential role of OSCE in clinical psychology students' development of professional competence. Due to methodological limitations, these results should be interpreted with caution and should be viewed as exploratory. All in all, this report can be viewed as a guideline for implementation of OSCE on similar programmes in psychology.

Needle procedures are one of the most common reasons for children to visit hospitals. If unaddressed, negative needle experiences can worsen over time and lead to needle noncompliance, needle fears, and healthcare avoidance. This mixed methods pilot study tested the effect of combined music therapy and standard pharmacological care compared to standard care alone on fear and discomfort in children in connection to a scheduled needle procedure. Children and their parents were also interviewed on their general experience of music therapy and how they regulated fear and discomfort during needle procedures while participating in music therapy. Thirty children aged 0 to 15 and their parents were recruited at the pediatric outpatient unit at The Central Hospital in Karlstad, Sweden. The participants were randomized to an intervention group with music therapy and to a control group that received standard care alone. The children rated their fear and discomfort before, during and after a needle procedure on a child-friendly visual analogue scale. The children and parents who were randomized to the music therapy condition were interviewed about their experiences of music therapy as procedural support. No significant differences between the intervention group and the group with standard care alone were found, indicating that the two groups were equivalent with regard to experienced fear and discomfort. The content analysis of the interviews indicated that the children and their parents considered that the music therapy intervention promoted the participants’ emotion regulation, promoted adaptive coping strategies for both children and the parents, and favorably but also ambivalently affected the context and interactions in the procedural room.