Anticipatory cognitive stress appraisal and the acute procoagulant stress response in men

OBJECTIVE: Acute mental stress elicits blood hypercoagulability. Following a transactional stress model, we investigated whether individuals who anticipate stress as more threatening, challenging, and as exceeding their coping skills show greater stress reactivity of the coagulation activation marker D-dimer, indicating fibrin generation in plasma. METHODS: Forty-seven men (mean age 44 +/- 14 years; mean blood pressure [MBP] 101 +/- 12 mm Hg; mean body mass index [BMI] 26 +/- 3 kg/m(2)) completed the Primary Appraisal Secondary Appraisal (PASA) scale before undergoing the Trier Social Stress Test (combination of mock job interview and mental arithmetic task). Heart rate, blood pressure, plasma catecholamines, and D-dimer levels were measured before and after stress, and during recovery up to 60 minutes poststress. RESULTS: Hemodynamic measures, catecholamines, and D-dimer changed across all time points (p values <.001). The PASA "Stress Index" (integrated measure of transactional stress perception) correlated with total D-dimer area under the curve (AUC) between rest and 60 minutes poststress (r = 0.30, p = .050) and with D-dimer change from rest to immediately poststress (r = 0.29, p = .046). Primary appraisal (combined "threat" and "challenge") correlated with total D-dimer AUC (r = 0.37, p = .017), D-dimer stress change (r = 0.41, p = .004), and D-dimer recovery (r = 0.32, p = .042). "Challenge" correlated more strongly with D-dimer stress change than "threat" (p = .020). Primary appraisal (DeltaR(2) = 0.098, beta = 0.37, p = .019), and particularly its subscale "challenge" (DeltaR(2) = 0.138, beta = 0.40, p = .005), predicted D-dimer stress change independently of age, BP, BMI, and catecholamine change. CONCLUSIONS: Anticipatory cognitive appraisal determined the extent of coagulation activation to and recovery from stress in men. Particularly individuals who anticipated the stressor as more challenging and also more threatening had a greater fibrin stress response.

Modulation of anticipatory emotion and perception processing by cognitive control.

Strategies of cognitive control are helpful in reducing anxiety experienced during anticipation of unpleasant or potentially unpleasant events. We investigated the associated cerebral information processing underlying the use of a specific cognitive control strategy during the anticipation of affect-laden events. Using functional magnetic resonance imaging, we examined differential brain activity during anticipation of events of unknown and negative emotional valence in a group of eighteen healthy subjects that used a cognitive control strategy, similar to "reality checking" as used in psychotherapy, compared with a group of sixteen subjects that did not exert cognitive control. While expecting unpleasant stimuli, the "cognitive control" group showed higher activity in left medial and dorsolateral prefrontal cortex areas but reduced activity in the left extended amygdala, pulvinar/lateral geniculate nucleus and fusiform gyrus. Cognitive control during the "unknown" expectation was associated with reduced amygdalar activity as well and further with reduced insular and thalamic activity. The amygdala activations associated with cognitive control correlated negatively with the reappraisal scores of an emotion regulation questionnaire. The results indicate that cognitive control of particularly unpleasant emotions is associated with elevated prefrontal cortex activity that may serve to attenuate emotion processing in for instance amygdala, and, notably, in perception related brain areas.

Anticipatory cognitive stress appraisal modulates suppression of wound-induced macrophage activation by acute psychosocial stress

Anticipatory cognitive stress appraisal (ACSA) can affect the stress-induced release of stress hormones, which, in turn, can modulate microbicidal potential of macrophages. This study examines whether ACSA modulates wound-induced activation of macrophage microbicidal potential in 22 acutely stressed compared to 17 nonstressed healthy men. After catheter-induced wound infliction and completing the ACSA questionnaire, the stress group underwent an acute mental stress task, while the nonstressed group did not. Macrophage microbicidal potential and stress hormones were repeatedly measured. In acutely stressed men, but not in nonstressed men, higher scores in ACSA related to lower macrophage microbicidal potential. This association was statistically mediated by the norepinephrine (NE) stress response. Our data suggest that ACSA modulates stress-induced suppression of wound-induced macrophage activation and that the NE stress response underlies this effect.

Anticipatory and reactive forms of blame avoidance: of foxes and lions

Blame avoidance behavior (BAB) encompasses all kinds of integrity-protecting activities by officeholders in the face of potentially blame-attracting events. Although considered essential for a realistic understanding of politics and policymaking, a general understanding of this multi-faceted behavioral phenomenon and its implications has been lacking to date. We argue that this is due to the lack of careful conceptualization of various forms of BAB. Crucially, the difference between anticipatory and reactive forms of BAB is largely neglected in the literature. This paper links anticipatory and reactive forms of BAB as two consecutive decision situations. It exposes dependence relationships between the situations that trigger BAB, the rationalities at work, the resources and strategies applied by blame-avoiding actors, and the various consequences thereof. The paper concludes that anticipatory and reactive BAB are distinct phenomena that require specific research approaches to assess their relevance for the workings of polities.

Momentary stress moderates procoagulant reactivity to a trauma-specific interview in patients with posttraumatic stress disorder caused by myocardial infarction

Hypercoagulability of the blood might partially explain the increased cardiovascular disease risk in posttraumatic stress disorder (PTSD) and is also triggered by anticipatory stress. We hypothesized exaggerated procoagulant reactivity in patients with PTSD in response to a trauma-specific interview that would be moderated by momentary stress levels. We examined 23 patients with interviewer-diagnosed PTSD caused by myocardial infarction (MI) and 21 post-MI patients without PTSD. A second diagnostic (i.e., trauma-specific) interview to assess posttraumatic stress severity was performed after a median follow-up of 26 months (range 12-36). Before that interview patients rated levels of momentary stress (Likert scale 0-10) and had blood collected before and after the interview. The interaction between PTSD diagnostic status at study entry and level of momentary stress before the follow-up interview predicted reactivity of fibrinogen (P=0.036) and d-dimer (P=0.002) to the PTSD interview. Among patients with high momentary stress levels, PTSD patients had greater fibrinogen (P=0.023) and d-dimer (P=0.035) reactivity than non-PTSD patients. Among patients with low momentary stress levels, PTSD patients had less d-dimer reactivity than non-PTSD patients (P=0.024); fibrinogen reactivity did not significantly differ between groups. Momentary stress levels, but not severity of posttraumatic stress, correlated with d-dimer reactivity in PTSD patients (r=0.46, P=0.029). We conclude that momentary stress levels moderated the relationship between PTSD and procoagulant reactivity to a trauma-specific interview. Procoagulant reactivity in post-MI patients with PTSD confronted with their traumatically experienced MI was observed if patients perceived high levels of momentary stress before the interview.

Decision-making in amnesia: do advantageous decisions require conscious knowledge of previous behavioural choices?

Previous work has reported that in the Iowa gambling task (IGT) advantageous decisions may be taken before the advantageous strategy is known [Bechara, A., Damasio, H., Tranel, D., ; Damasio, A. R. (1997). Deciding advantageously before knowing the advantageous strategy. Science, 275, 1293-1295]. In order to test whether explicit memory is essential for the acquisition of a behavioural preference for advantageous choices, we measured behavioural performance and skin conductance responses (SCRs) in five patients with dense amnesia following damage to the basal forebrain and orbitofrontal cortex, six amnesic patients with damage to the medial temporal lobe or the diencephalon, and eight control subjects performing the IGT. Across 100 trials healthy participants acquired a preference for advantageous choices and generated large SCRs to high levels of punishment. In addition, their anticipatory SCRs to disadvantageous choices were larger than to advantageous choices. However, this dissociation occurred much later than the behavioural preference for advantageous alternatives. In contrast, though exhibiting discriminatory autonomic SCRs to different levels of punishment, 9 of 11 amnesic patients performed at chance and did not show differential anticipatory SCRs to advantageous and disadvantageous choices. Further, the magnitude of anticipatory SCRs did not correlate with behavioural performance. These results suggest that the acquisition of a behavioural preference--be it for advantageous or disadvantageous choices--depends on the memory of previous reinforcements encountered in the task, a capacity requiring intact explicit memory.

The effect of natural habituation on coagulation responses to acute mental stress and recovery in men

Blood coagulation activation might be one mechanism linking acute mental stress with coronary events. We investigated the natural habituation of coagulation responses and recovery to short-term mental stress. Three times with one-week intervals, 24 men (mean age 47 +/- 7 years) underwent the same 13-min stressor (preparation, job interview, mental arithmetic). During each visit venous blood was obtained four times (baseline, immediately post-stress, 45 min of recovery, 105 min of recovery). Eight blood coagulation parameters were measured at weeks one and three. Acute stress provoked increases in von Willebrand factor antigen, fibrinogen, clotting factor FVII activity (FVII:C), FVIII:C, FXII:C (p's < or = 0.019), and D-dimer (N.S.). All coagulation parameters experienced full recovery except FVIII:C (p = 0.022). Stress did not significantly affect activated partial thromboplastin time and prothrombin time. At all time points FVIII:C and FXII:C levels were significantly higher at week one compared to week three (p's < or = 0.041). Before catheter insertion, systolic blood pressure (p = 0.001) and heart rate (p = 0.026) were relatively higher at week one. Unlike the magnitude of systolic blood pressure response to stress (p = 0.007) and of cortisol recovery from stress (p = 0.002), the magnitude of all coagulation responses to stress and the recovery from stress were similar in week one and week three. Sympathetic activation with anticipatory stress best explained increased baseline activity in FVIII and FXII at week one. An incapacity of the coagulation system to adapt to stress repeats is perhaps a consequence of evolution, but might also contribute to increased coronary risk in some individuals, particularly in those with cardiovascular diseases.

In your eyes only: deficits in executive functioning after frontal TMS reflect in eye movements

This study investigated the roles of the right and left dorsolateral prefrontal (rDLPFC, lDLPFC) and the medial frontal cortex (MFC) in executive functioning using a theta burst transcranial magnetic stimulation (TMS) approach. Healthy subjects solved two visual search tasks: a number search task with low cognitive demands, and a number and letter search task with high cognitive demands. To observe how subjects solved the tasks, we assessed their behavior with and without TMS using eye movements when subjects were confronted with specific executive demands. To observe executive functions, we were particularly interested in TMS-induced changes in visual exploration strategies found to be associated with good or bad performance in a control condition without TMS stimulation. TMS left processing time unchanged in both tasks. Inhibition of the rDLPFC resulted in a decrease in anticipatory fixations in the number search task, i.e., a decrease in a good strategy in this low demand task. This was paired with a decrease in stimulus fixations. Together, these results point to a role of the rDLPFC in planning and response selection. Inhibition of the lDLPFC and the MFC resulted in an increase in anticipatory fixations in the number and letter search task, i.e., an increase in the application of a good strategy in this task. We interpret these results as a compensatory strategy to account for TMS-induced deficits in attentional switching when faced with high switching demands. After inhibition of the lDLPFC, an increase in regressive fixations was found in the number and letter search task. In the context of high working memory demands, this strategy appears to support TMS-induced working memory deficits. Combining an experimental TMS approach with the recording of eye movements proved sensitive to discrete decrements of executive functions and allows pinpointing the functional organization of the frontal lobes.

Immediate implant placement in mandible and prosthetic rehabilitation by means of all-zirconium oxide restorations: case report of a woman with a history of periodontitis.

Owing to its single surgical intervention, immediate implant placement has the advantage of shortening treatment time, and thus positively affects patient morbidity. According to the bone resorption pattern after tooth extraction, bone loss should be anticipated if immediate implant placement is considered. The present case report aims to present a possible treatment option and to demonstrate that a partially edentulous arch may be rehabilitated esthetically by immediate implant placement and by corresponding anticipatory measures.

Policy Instrument Selection under Uncertainty: The Case of Micropollution Regulation

The paper addresses the question of which factors drive the formation of policy preferences when there are remaining uncertainties about the causes and effects of the problem at stake. To answer this question we examine policy preferences reducing aquatic micropollutants, a specific case of water protection policy and different actor groups (e.g. state, science, target groups). Here, we contrast two types of policy preferences: a) preventive or source-directed policies, which mitigate pollution in order to avoid contact with water; and b) reactive or end-of-pipe policies, which filter water already contaminated by pollutants. In a second step, we analyze the drivers for actors’ policy preferences by focusing on three sets of explanations, i.e. participation, affectedness and international collaborations. The analysis of our survey data, qualitative interviews and regression analysis of the Swiss political elite show that participation in the policy-making process leads to knowledge exchange and reduces uncertainties about the policy problem, which promotes preferences for preventive policies. Likewise, actors who are affected by the consequences of micropollutants, such as consumer or environmental associations, opt for anticipatory policies. Interestingly, we find that uncertainties about the effectiveness of preventive policies can promote preferences for end-of-pipe policies. While preventive measures often rely on (uncertain) behavioral changes of target groups, reactive policies are more reliable when it comes to fulfilling defined policy goals. Finally, we find that in a transboundary water management context, actors with international collaborations prefer policies that produce immediate and reliable outcomes.

Adapting agricultural water governance to climate change: Experiences from Germany, Spain and California

This study describes and discusses initiatives taken by public (water) agencies in the state of Brandenburg in Germany, the state of California in the USA and the Ebro River Basin in Spain in response to the challenges which climate change poses for the agricultural water sector. The drivers and actors and the process of changing agricultural water governance are its particular focus. The assumptions discussed are: (i) the degree of planned and anticipatory top-down implementation processes decreases if actions are more decentralized and are introduced at the regional and local level; (ii) the degree of autonomous and responsive adaptation approaches seems to grow with actions at a lower administrative level. Looking at processes of institutional change, a variety of drivers and actors are at work such as changing perceptions of predicted climate impacts; international obligations which force politicians to take action; socio-economic concerns such as the cost of not taking action; the economic interests of the private sector. Drivers are manifold and often interact and, in many cases, reforms in the sector are driven by and associated with larger reform agendas. The results of the study may serve as a starting point in assisting water agencies in developing countries with the elaboration of coping strategies for tackling climate change-induced risks related to agricultural water management.

Consciousness and choking in visually-guided actions

Choking under pressure describes the phenomenon of people performing well below their expected standard under circumstances where optimal performance is crucial. One of the prevailing explanations for choking is that pressure increases the conscious attention to the underlying processes of the performer's task execution, thereby disrupting what would normally be a relatively automatic process. However, research on choking has focused mainly on the influence of pressure on motor performance, typically overlooking how it might alter the way that vision is controlled when performing these motor actions. In this article we ask whether the visual component of expert motor-skill execution is susceptible to choking much like the motor component is thought to be. To do so, we draw heavily on empirical findings from studies of sporting expertise, in particular focussing on the role of gaze in three types of visually-guided actions: interceptive actions, aiming tasks, and anticipatory skill. For each of these skills we evaluate the nature of the expert advantage, discuss the role of consciousness in their control, examine the potential impact of pressure on task performance, and consider interventions designed to reduce the likelihood of choking when performing these tasks