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Background: Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States. Objective: This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans. Methods: A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged >= 50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates. Results: Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks. Conclusion: IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy. Refereed/Peer-reviewed

Research suggests that when dealing with personal setbacks, secondary control (SC) adjustment and acceptance beliefs can foster psychological wellbeing. However, little research has examined these beliefs, in combination, and how they impact students in their academic development. We conducted secondary analysis using an eight-month longitudinal study design over a two-semester introductory course on a sample of university students (

Individual differences in sociodemographic characteristics and trait-like perceptions of opportunities and constraints may shape responses to adversities such as the onset of the COVID-19 pandemic. However, little is known about how these factors combine to form multifaceted profiles of developmental opportunity and constraint or the implications of such profiles for longitudinal well-being following major life stressors. Using a national sample of U.S. adults (n = 293), we used latent profile analysis to identify profiles based on relevant sociodemographic characteristics (age, SES, chronic conditions, functional status) and trait-like perceptions of opportunity and constraints (perceived mastery, perceived constraints). Results showed that three common profiles emerged at pandemic onset (veridical opportunity, perceived constraints, perceived opportunity). Subsequent latent growth models showed that, despite reporting more sociodemographic constraints, the perceived opportunity profile exhibited better 1-year emotional well-being (positive and negative affect) during the pandemic than the perceived constraints profile. Findings advance the literature by identifying multifaceted individual differences in profiles of developmental opportunity and constraint and by showing these profiles have consequences for longitudinal well-being following the pandemic onset.

Knowledge tests used to evaluate child protection training program effectiveness for early childhood education providers may suffer from threats to construct validity given the contextual variability inherent within state-specific regulations around mandated reporting requirements. Unfortunately, guidance on instrument revision that accounts for such state-specific mandated reporting requirements is lacking across research on evaluation practices. This study, therefore, explored how collection and integration of validity evidence using a mixed methods framework can guide the instrument revision process to arrive at a more valid program outcome measure.

PurposeIf an individual has been blind since birth due to a treatable eye condition, ocular treatment is urgent. Even a brief period of visual deprivation can alter the development of the visual system. The goal of our structured scoping review was to understand how we might better support children with delayed access to ocular treatment for blinding conditions.MethodWe searched MEDLINE, Embase and Global Health for peer-reviewed publications that described the impact of early (within the first year) and extended (lasting at least 2 years) bilateral visual deprivation.ResultsOf 551 reports independently screened by two authors, 42 studies met our inclusion criteria. Synthesizing extracted data revealed several trends. The data suggests persistent deficits in visual acuity, contrast sensitivity, global motion, and visual-motor integration, and suspected concerns for understanding complex objects and faces. There is evidence for resilience in color perception, understanding of simple shapes, discriminating between a face and non-face, and the perception of biological motion. There is currently insufficient data about specific (re)habilitation strategies to update low vision services, but there are several insights to guide future research in this domain.ConclusionThis summary will help guide the research and services provision to help children learn to see after early and extended blindness.

Older adults make up the largest portion of the population of physically inactive individuals. Health challenges, and psychological barriers (e.g., maladaptive causal attributions), contribute to reduced activity engagement and low perceived control. This pilot study tested an attributional retraining (AR) intervention designed to increase control-related outcomes in a physical activity context for older adults with compromised health. Using a randomized treatment design, we examined treatment effects on a sample of older adults attending a day hospital (N = 37, Mage = 80). We employed ANCOVAs, controlling for age, sex, and morbidity, to assess differences in post-treatment outcomes between AR and No-AR conditions. AR recipients (vs. No-AR) reported lower post-treatment helplessness and more perceived control over their health. Our study offers evidence for AR to increase control-related outcomes and lays the groundwork for further research into supporting older adult populations with compromised health.

AIM This study aimed to investigate the variability by ethnicity, socio-economic status and location in coverage and testability of the universal B4 School Check vision screening in children aged 4-5 years in New Zealand. METHODS Aggregated data from 1 July 2011 to 30 June 2015 were sourced from the Statistics New Zealand Integrated Data Infrastructure. Sourced data were attendance at vision screening and record of visual acuity measurement stratified by ethnicity, socio-economic status and region. Children who attended screening were compared with the eligible population (n = 252 279) to calculate coverage. Testability was determined by comparing the children with a recorded visual acuity measurement in each eye with those who attended screening. RESULTS Overall vision screening coverage was 89.5% and testability was 97.8%. Ethnic differences were evident for coverage (85.7% in Pacific children, 92.5% in European children) and testability (96.4% in Māori children, 98.4% in European children). Socio-economic differences were also observed for coverage (86.4% in most deprived areas, 92.4% in least deprived), testability (most deprived 96.3%, least deprived 98.7%) and by region (coverage range of 80.4-96.4% and testability range of 93.2-99.3%). CONCLUSIONS Significant disparities exist in vision screening coverage and testability for New Zealand pre-school children. Equity-focused initiatives are required to improve outcomes for children from Māori and Pacific families, and those from households in lower socio-economic areas. Understanding region-specific challenges and successes could support more equitable access to vision screening between regions. Further research is required to determine sources of inequities and to investigate interactions between ethnicity, socio-economic status and location.

This study used latent transition analysis (LTA) to examine stability and change in the emotion profiles of university students during a two-semester course. Three positive emotions (i.e., hope, pride, and happiness) and five negative emotions (i.e., guilt, helplessness, anger, shame, and regret) derived from Weiner’s attribution theory of emotion (1985, 2007, 2018a, 2018b) were used to identify the emotion profiles of university students at the beginning (Time 1) and end (Time 2) of a two-semester course. We also examined changes in emotion profile memberships over time. Results showed 81% of participants remained in their Time 1 profiles at Time 2, with the majority classified in profiles defined by stable positive emotions or mixed emotions. ANCOVAs indicated that students in the stable positive emotion profile achieved better overall course performance than those with a stable mixed profile or a stable negative emotion profile. An ascending emotion transition profile (Time 1 mixed-to-Time 2 positive) performed better than a stable mixed emotion profile. The present findings extend our current understanding of multifaceted profiles of student emotion that can change over time.

Considerable evidence shows that cell phone use (CPU) is detrimental to students’ academic achievement. However, researchers have yet to consider whether or not perceived academic control (PAC) and anxiety can mediate this effect. In this two-semester study, we examined the role of PAC and learning-related anxiety in affecting the relationship between students’ daily CPU and their final grades in a university course. The study used a series of multiple regressions supplemented by the Hayes’ mediation procedures with a sample of first-year undergraduate students (N = 931) in a research-1 university. The results showed that PAC partially reduced the negative effects of CPU on the grades of the female students while the effects of CPU and PAC were virtually independent for the male students. Anxiety, in turn, did not mediate between CPU and the students’ academic performance for either females or males.

During the COVID‐19 pandemic, one of the major changes that has occurred in emergency medicine is the evolution of telemedicine. With relaxation of regulatory and administrative barriers, the use of this already available technology has rapidly expanded. Telemedicine provides opportunity to markedly decrease personal protective equipment (PPE) and reduce healthcare worker exposures. Moreover, with the convenience and availability of access to medical care via telemedicine, a more fundamental change in healthcare delivery in the United States is likely. The implementation of telemedicine in the emergency department (ED) in particular has great potential to prevent the iatrogenic spread of COVID‐19 and protect health care workers. Challenges to widespread adoption of telemedicine include privacy concerns, limitation of physical examination, and concerns of patient experience. In this clinical review, we discuss ED telemedicine applications, logistics, and challenges in the COVID‐19 era as well as recent regulatory and legal changes. In addition, examples of telemedicine use are described from 2 institutions. Examples of future applications of telemedicine within the realm of emergency medicine are also discussed.

On the basis of recent findings in the context of the Social Online Self-Regulation Theory it is assumed that intensity of social Facebook use (i.e., a higher intensity and more time spend on Facebook focusing on social activities) serves the purpose of self-regulation. A priming of unfulfilled goals was used to increase participants’ intensity of social Facebook use in order to regulate the negative emotions and the self-discrepancy which should be caused by the priming. High social comparison orientation as well as difficulties in emotion regulation were assumed to moderate that effect. 355 people took part in an online survey. As expected, difficulties in emotion regulation as well as social comparison orientation were positively correlated with intensity of social Facebook use. However, the priming effect was moderated by difficulties in emotion regulation. Our research follows propositions derived from self-regulation theory and is, therefore, integrated into a broader theoretical approach focusing on the goal-setting of the self. Finally, possible applications of this research on the explanation of dysfunctional social Facebook use are outlined.

Despite increased emphasis on educating students in science, technology, engineering, and mathematics (STEM) disciplines, nearly half of U.S. college students who enroll in these programs fail to graduate with STEM degrees. Using archival data from the Motivation and Academic Achievement Database, we tested whether a motivation intervention to reframe causal attributions for academic setbacks improved graduation rates for college students in STEM disciplines ( N = 496). Results showed that the intervention increased the odds of 8-year graduation for students who were at risk of college dropout. Findings highlight the potential of theory-informed psychological interventions to increase persistence to graduation for at-risk students in STEM fields.

Background Comprehensive vision screening programmes for children are an important part of public health strategy, but do not exist in many countries, including Tonga. This project set out to assess: (1) the functional vision of children attending primary schools in Tonga and (2) how a new recognition acuity test (The Auckland Optotypes displayed on a tablet computer) compares to use of a standardised eye chart in this setting. Methods Children from three Tongan primary schools were invited to participate. Acuity testing was conducted using a standardised recognition acuity chart (Lea symbols) and the tablet test displaying two formats of The Auckland Optotypes. Measures of ocular alignment, stereo acuity and non-cycloplegic photorefraction were also taken. Results Parents of 249 children consented to participate. One child was untestable. Only 2.8 per cent of testable children achieved visual acuity worse than 0.3 logMAR in the weaker eye. Results from the Spot Photoscreener suggested that no children had myopia or hyperopia, but that some children had astigmatism. The tablet test was practical in a community setting, and showed ±0.2 logMAR limits of agreement with the Lea symbols chart. Conclusion The sample of children in Tongan primary schools had good functional vision. A modified version of the tablet acuity test is a promising option for vision screening in this context.

Summary: Background: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. Funding: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. Translations: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

Background: Older adults with a cognitive impairment, including those not yet diagnosed, may have deficits in their physical function. Objective: We sought to determine the associations of cognitive impairment consistent with dementia (CICD) diagnosis status on handgrip strength, gait speed, and functional disability in older adults. Methods: The analytical sample included 8,383 adults aged ≥65-years without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010–2016 waves of the Health and Retirement Study. A handgrip dynamometer measured handgrip strength. Men with handgrip strength

Goal adjustment capacities (i.e., goal disengagement and goal reengagement) are core self-regulatory resources theorized to buffer psychological well-being during intractable life circumstances. However, research has yet to examine whether these capacities protect well-being for individuals who encounter uncontrollable losses in their ability to pursue important life goals due to the COVID-19 pandemic. Using a nationally-representative sample of American adults aged 18-80 (n = 292), the present longitudinal study examined the influence of goal disengagement and reengagement on levels and change in psychological well-being for individuals who differed in perceived control over their goals early in the pandemic. Results from multilevel growth models showed that goal reengagement, but not goal disengagement, capacities predicted higher levels of well-being (lower perceived stress, depressive symptoms; higher life satisfaction, meaning in life) for individuals who reported pandemic-induced declines in control over their goals. Findings inform theories of motivation and self-regulation and point to the adaptive value of goal reengagement capacities during uncontrollable life circumstances.

Childhood visual impairment has a life-long impact that, with early access to eyecare, is largely avoidable. We aimed to understand visual impairment and its correction among Pacific youth in Aotearoa New Zealand.The Pacific Islands Families Study is a birth cohort study that tracks an original sample of 1,398 Pacific children born at Middlemore Hospital (Auckland). This analysis focuses on assessed visual acuity (at 9- and 18-years, using 0.3logMAR or 6/12 as the cut-off for visual impairment) and participants' self-reports about accessing eyecare services.Less than a fifth of children (111/729, 15.2%) and teens (86/457, 18.8%) reported having sought eyecare. The percentage of participants with refractive correction was 3.6% (32/887) at 9-years and 14.3% (66/463) at 18-years. At 9-years, 1.9% of children (16/853) had visual impairment in one eye only, and 0.9% (8/853) had visual impairment impacting both eyes. By 18-years these values increased to 7.9% (36/456) and 4.2% (19/456), respectively. Among those with visual impairment, most children (15/24, 62.5%) and teens (32/55, 58.2%) reported they did not have refractive correction.Although prevalence of visual impairment is relatively low compared to non-Pacific youth, much of the reported impairment appears to be avoidable with improved eyecare.

Recognition acuity-the minimum size of a high-contrast object that allows us to recognize it-is limited by optical and neural elements of the eye and by processing within the visual cortex. The perceived size of objects can be changed by motion-adaptation. Viewing receding or looming motion makes subsequently viewed stimuli appear to grow or shrink, respectively. It has been reported that resulting changes in perceived size impact recognition acuity. We set out to determine if such acuity changes are reliable and what drives this phenomenon. We measured the effect of adaptation to receding and looming motion on acuity for crowded tumbling-T stimuli (). We quantified the role of crowding, individuals' susceptibility to motion-adaptation, and potentially confounding effects of pupil size and eye movements. Adaptation to receding motion made targets appear larger and improved acuity (-0.037 logMAR). Although adaptation to looming motion made targets appear smaller, it induced not the expected decrease in acuity but a modest acuity improvement (-0.018 logMAR). Further, each observer's magnitude of acuity change was not correlated with their individual perceived-size change following adaptation. Finally, we found no evidence that adaptation-induced acuity gains were related to crowding, fixation stability, or pupil size. Adaptation to motion modestly enhances visual acuity, but unintuitively, this is dissociated from perceived size. Ruling out fixation and pupillary behavior, we suggest that motion adaptation may improve acuity via incidental effects on sensitivity-akin to those arising from blur adaptation-which shift sensitivity to higher spatial frequency-tuned channels.

BACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010–2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%−93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1–90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1–91.4%). DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.

PurposePeople who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries.MethodsWe searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis.ResultsWe screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success.ConclusionAlthough research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.

Student-athletes in their first-year transition to university experience many psychological and social stressors as they balance multiple commitments. Our study examined whether a student-athlete social identity affected psychosocial adjustment as students transition to postsecondary, and whether it acted by reducing stress to foster academic adjustment. Student-athletes enrolled in an introductory psychology course at a Canadian university (n = 331) were recruited. We assessed whether a relationship existed between student-athlete social identity and key academic indicators of psychosocial adjustment (perceived control, perceived stress, learning-related anxiety); and whether ratings of perceived stress mediated the relationship between student-athlete social identity and psychosocial adjustment measures five-months later. Our findings revealed that student-athlete social identity (a) predicted psychosocial adjustment later in the course; and (b) indirectly enhanced academic control and lowered negative emotions via reductions in perceived stress. This study offers insights on how social identities may promote positive adjustment during the critical transition to university.

BackgroundChronic lower back pain (CLBP) is a major health care burden and often results in workplace absenteeism. It is a priority for appropriate management of CLBP to get individuals back to work as early as possible. Interventions informed by the flags approach, which integrates cognitive and behavioral approaches via identification of biopsychosocial barriers to recovery, have resulted in reduced pain-related work absences and increased return to work for individuals with CLBP. However, research indicates that physicians’ adherence to biopsychosocial guidelines is low.ObjectiveThe current study examined the effects of a flags approach–based educational intervention on clinical judgments of medical students and general practitioner (GP) trainees regarding the risk of future disability of CLBP patients.DesignRandomized controlled trial (trial registration number: ISRCTN53670726).SettingUniversity classroom.SubjectsMedical students and GP trainees.MethodsUsing 40 fictional CLBP cases, differences in clinical judgment accuracy, weighting, and speed (experimental N = 32) were examined pre- and postintervention, as were flags approach knowledge, pain attitudes and beliefs, and empathy, in comparison with a no-intervention control group (control N = 31).ResultsResults revealed positive effects of the educational intervention on flags approach knowledge, pain-related attitudes and beliefs, and judgment weighting of psychologically based cues; results are discussed in light of existing theory and research.ConclusionsShort flags approach–based educational video interventions on clinical judgment-making regarding the risk of future disability of CLBP patients may provide opportunities to gain biopsychosocial knowledge, overcome associated attitude barriers, and facilitate development of clinical judgment-making more aligned with psychological cues.

Preeclampsia is a prevalent pregnancy complication characterized by new-onset maternal hypertension and inflammation, with placental ischemia as the initiating event. Studies of others have provided evidence for the importance of lymphocytes in placental ischemia-induced hypertension; however, the contributions of B1 versus B2 lymphocytes are unknown. We hypothesized that peritoneal B1 lymphocytes are important for placental ischemia-induced hypertension. As an initial test of this hypothesis, the effect of anti-CD20 depletion on both B-cell populations was determined in a reduced utero-placental perfusion pressure (RUPP) model of preeclampsia. Anti-murine CD20 monoclonal antibody (5 mg/kg, Clone 5D2) or corresponding mu IgG2a isotype control was administered intraperitoneally to timed pregnant Sprague-Dawley rats on gestation day (GD)10 and 13. RUPP or sham control surgeries were performed on GD14, and mean arterial pressure (MAP) was measured on GD19 from a carotid catheter. As anticipated, RUPP surgery increased MAP and heart rate and decreased mean fetal and placental weight. However, anti-CD20 treatment did not affect these responses. On GD19, B-cell populations were enumerated in the blood, peritoneal cavity, spleen, and placenta with flow cytometry. B1 and B2 cells were not significantly increased following RUPP. Anti-CD20 depleted B1 and B2 cells in peritoneum and circulation but depleted only B2 lymphocytes in spleen and placenta, with no effect on circulating or peritoneal IgM. Overall, these data do not exclude a role for antibodies produced by B cells before depletion but indicate the presence of B lymphocytes in the last trimester of pregnancy is not critical for placental ischemia-induced hypertension.NEW & NOTEWORTHY The adaptive and innate immune systems are implicated in hypertension, including the pregnancy-specific hypertensive condition preeclampsia. However, the mechanism of immune system dysfunction leading to pregnancy-induced hypertension is unresolved. In contrast to previous reports, this study reveals that the presence of classic B2 lymphocytes and peritoneal and circulating B1 lymphocytes is not required for development of hypertension following third trimester placental ischemia in a rat model of pregnancy-induced hypertension.

Using a life-span theoretical perspective, the present study examined how subjective age relates to perceived control and motivational investment in the work domain. Data from the Midlife in the United States National Study of Health and Well-Being (MIDUS I, II, and III; 1995–2013; n = 2,395) were analyzed using parallel process growth curve modeling. Our analyses used a mediation framework and focused on how changes in subjective age relate to changes in work-specific perceived control and motivational investment over time. Results suggested that feeling progressively younger than one’s actual age predicted increased levels of perceived control over and motivational investment in one’s work situation, as mediated by domain-general perceived control capacity and selective primary control striving, respectively. Results are discussed within the motivational theory of life-span development, specifically, how subjective age operates as a secondary control strategy that enhances or diminishes motivational investment and perceived control in work during midlife.

We investigated motivational regulation involving adjustment of recovery goals in post-stroke rehabilitation via standard in-clinic physiotherapy and in-home telerehabilitation (TR). We used a secondary dataset collected at 11 US sites as part of a clinical trial using video games and game control pads designed to induce certain arm movements required for recovery (n = 124; Mage = 61.44, SD = 13.30). Participants were randomly assigned to either the TR or in-clinic condition and underwent 36 therapy sessions, reporting on their activity-inherent enjoyment for 6-8 weeks. Compared with the in-clinic patients and TR patients with high game performance, TR patients with lower game performance reported lower activity-inherent enjoyment, which is an important motivational resource for successful recovery. The results suggest that these differences occur because TR patients become discouraged by low game score feedback, which may have signaled a poor prospect for recovery. However, the results also suggest that low game performers who successfully adjusted their recovery goals were resilient to the impact of low game score feedback on their motivational resources and satisfaction with therapy. The findings suggest that goal adjustment may be particularly beneficial when patients are discouraged by feedback indicating suboptimal recovery prospects.

While the major drivers of melanoma initiation, including activation of NRAS/BRAF and loss of PTEN or CDKN2A, have been identified, the role of key transcription factors that impose altered transcriptional states in response to deregulated signaling is not well understood. The POU domain transcription factor BRN2 is a key regulator of melanoma invasion, yet its role in melanoma initiation remains unknown. Here, we show that BRN2 haplo-insufficiency is sufficient to promote melanoma initiation and metastasis, acting as a non-canonical tumor suppressor. Mechanistically, BRN2 directly modulates PTEN expression, and PI3K signaling, to drive tumor initiation and progression. Collectively our results reveal that somatic deletion of one BRN2 allele elicits melanoma initiation and progression.SIGNIFICANCEHere, we report frequent mono-allelic loss of the transcription factor BRN2 in human cutaneous melanoma metastases. We developed a mouse model for Brn2-deficient melanoma based on the most common alterations (BrafV600E and Pten loss) in human melanoma and established the role of Brn2 as a functional regulator of tumor initiation, tumor growth, and the formation of metastases in vivo. Mechanistically, BRN2 loss increases PI3K-signaling through PTEN repression, either via MITF induction or not. Overall, we describe a novel tumor suppressor of high prevalence in human melanoma that regulates several steps of in vivo melanomagenesis through two previously unknown molecular mechanisms.

Control-value theory (CVT) posits that cognitive appraisals and emotions govern motivation and learning in achievement settings. Within this framework, we used latent profile analysis to identify multifaceted motivation profiles involving academic control and value appraisals and achievement emotions (boredom, anxiety, enjoyment). Three motivation profiles were identified that comprised co-occurring appraisals and emotions at the start of a two-semester online university course: high control-enjoyment, low control-boredom, low value-boredom. These motivation profiles related to achievement perceptions and performance on six tests over the two-semester introductory psychology course. High control-enjoyment students reported greater success and expected better grades than low control-boredom and low value-boredom students, and outperformed low control-boredom students on all tests. These findings document the nature of adaptive (vs. maladaptive) CVT-related motivation profiles that predict academic attainment in an online course.

e12511 Background: Triple-negative breast cancer (TNBC) has been associated with poorer long-term outcomes compared to other breast cancer subtypes. Due to the lack of targeted therapies, the use of adjuvant chemotherapy is the mainstay of treatment, and its efficacy has demonstrated to be correlated with tumor size. Currently, different national guidelines exist regarding chemotherapy in early stage I TNBC. This study aims to examine the outcomes of the use of adjuvant chemotherapy in stage I TNBC stratified by tumor size and treated in Ontario, using the ICES database. Methods: Records of stage I TNBC patients diagnosed in 2012 to 2014 were collected from the ICES database and analysed. Kaplan-Meier curves and log-rank tests were used to compared differences in overall survival (OS) between groups. Stage I TNBC cancer patients were analyzed by tumor size: T1a (< 0.5 cm), T1b (> 0.5 cm and < 1.0 cm) and T1c (>1.0 cm and < 2.0 cm). A Cox proportional hazard model was used to determine significance of variables. Results: Of the 610 stage I TNBC patients, 183 had tumor sizes ≤ 1cm, representing stages T1aN0M0 and T1bN0M0, and 427 had tumor sizes > 1cm to 2cm, representing stage T1cN0M0. Patients with tumor sizes ≤ 1cm who received adjuvant chemotherapy did not have a significant difference in OS compared to those who did not receive adjuvant chemotherapy (p = 0.41, hazard ratio (HR) = 0.40, 95% confidence interval (CI) 0.021-2.5). However, patients with tumor sizes > 1cm to 2cm who received adjuvant chemotherapy demonstrated a significantly better OS compared to those without (p = 0.023, HR = 0.40, 95% CI 0.16-0.86). Conclusions: Patients with TNBC stage T1cN0M0 should receive adjuvant chemotherapy for better OS. For stages T1aN0M0 and T1bN0M0, patients may be overtreated and avoidance of adjuvant chemotherapy can be considered at this time. Prospective studies should investigate the efficacy of adjuvant chemotherapy in TNBC patients with stage T1aN0M0 and T1bN0M0.