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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.

Migration frequently involves Rac-mediated protrusion of lamellipodia, formed by Arp2/3 complex-dependent branching thought to be crucial for force generation and stability of these networks. The formins FMNL2 and FMNL3 are Cdc42 effectors targeting to the lamellipodium tip and shown here to nucleate and elongate actin filaments with complementary activities in vitro. In migrating B16-F1 melanoma cells, both formins contribute to the velocity of lamellipodium protrusion. Loss of FMNL2/3 function in melanoma cells and fibroblasts reduces lamellipodial width, actin filament density and -bundling, without changing patterns of Arp2/3 complex incorporation. Strikingly, in melanoma cells, FMNL2/3 gene inactivation almost completely abolishes protrusion forces exerted by lamellipodia and modifies their ultrastructural organization. Consistently, CRISPR/Cas-mediated depletion of FMNL2/3 in fibroblasts reduces both migration and capability of cells to move against viscous media. Together, we conclude that force generation in lamellipodia strongly depends on FMNL formin activity, operating in addition to Arp2/3 complex-dependent filament branching., Actin polymerization in lamellipodia of cells is regulated by the Arp2/3 complex and FMNL family formins. Here the authors show that both FMNL2 and FMNL3 contribute to lamellipodium protrusion and structure, and abolishing FMNL2/3 reduces protrusion force generation and migration, without affecting Arp2/3 incorporation.

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 …

Formins are actin polymerization factors that elongate unbranched actin filaments at the barbed end. Rho family GTPases activate Diaphanous-related formins through the relief of an autoregulatory interaction. The crystal structures of the N-terminal domains of human FMNL1 and FMNL2 in complex with active Cdc42 show that Cdc42 mediates contacts with all five armadillo repeats of the formin with specific interactions formed by the Rho-GTPase insert helix. Mutation of three residues within Rac1 results in a gain-of-function mutation for FMNL2 binding and reconstitution of the Cdc42 phenotype in vivo. Dimerization of FMNL1 through a parallel coiled coil segment leads to formation of an umbrella-shaped structure that—together with Cdc42—spans more than 15 nm in diameter. The two interacting FMNL–Cdc42 heterodimers expose six membrane interaction motifs on a convex protein surface, the assembly of which may facilitate actin filament elongation at the leading edge of lamellipodia and filopodia., FMNL formins polymerize actin filaments to generate cellular protrusions such as lamellipodia and filopodia at the leading edge of a cell. Here the authors provide detailed mechanistic insights into the formation of actin-based protrusions through GTPase dependent activation and membrane localization of FMNL1 and FMNL2.