A double-blind,sham-controlled,trial of home-administered rhythmic 10-Hz median nerve stimulation for the reduction of tics,and suppression of the urge-to-tic,in individuals with Tourette syndrome and chronic tic disorder

Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home-administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable ‘watch-like’ device worn at the wrist. We conducted a UK-wide parallel double-blind sham-controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1–19 mA) electrical stimulation to the median nerve for a pre-determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the ‘offline’ or treatment effect of stimulation was the Yale Global Tic Severity Scale–Total Tic Severity Score (YGTSS–TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the ‘online’ effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4-week stimulation, tic severity (YGTSS-TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS–TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = −.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (−15.6 TPM) during active stimulation compared to sham stimulation (−7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home-administered rhythmic MNS delivered through a wearable wrist-worn device has the potential to be an effective community-based treatment for tic disorders.     

Why do Managers Engage in Trustworthy Behavior? A Multilevel Cross‐Cultural Study in 18 Countries

Drawing on theories of generalized exchange and the norm of indirect reciprocity, we conceptualize subordinates’ organizational citizenship behavior directed toward the organization (OCBO) and directed toward peers (OCBI) as antecedents of managerial trustworthy behavior and examine how managers’ affective trust in subordinates mediates this relationship. We also investigate the extent to which this mediation is moderated by the level of collectivism in a society. Data were collected from 741 managers and 2,111 subordinates in 18 countries representing all major cultural regions of the world. We find support for our hypothesized moderated mediation in that managers’ affective trust in subordinates mediates the relationships between both subordinates’ OCBO and managerial trustworthy behavior, and subordinates’ OCBI and managerial trustworthy behavior across the different countries studied. Further, managers’ affective trust in subordinates only mediates the relationships between both types of citizenship behavior and managerial trustworthy behavior when collectivism is low to medium but not when it is high. Implications for research on cross‐cultural psychology, trust, and organizational citizenship behavior are discussed.     

The role of body mass index,weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models

Objectives: This study was undertaken to ascertain whether or not the body mass index (BMI) of urban disadvantaged children indirectly affects their health-related quality of life (HRQoL) through weight change desires and depressive symptoms and whether such mediation is conditional upon age and gender.

Design: A total of 255 children aged 7–12 years (50% male) were recruited from 7 schools in urban disadvantaged districts in Ireland using consecutive sampling. A prospective longitudinal design was employed whereby children completed, at two time points, the Kidscreen-27, the Children’s Depression Inventory, and the Health Related Behaviour Questionnaire, and had their BMI measured. The analyses involved multiple-, half-longitudinal- and moderated-mediation.

Results: Results showed that the depressive symptoms of children wanting to change their weight may have lead, in large part, to poorer HRQoL (specifically psychological well-being when considering longitudinal data) rather than weight status per se. The mediation effect of weight change desires occurred regardless of age or gender.

Conclusions: Childhood obesity programmes that traditionally focus on the negatives of obesity and the need to control weight may need to take a more positive approach to health and well-being by, for example promoting intuitive eating, an active lifestyle, body acceptance and good mental health.     

The Accuracy of Causal Learning Over Long Timeframes: An Ecological Momentary Experiment Approach

The ability to learn cause–effect relations from experience is critical for humans to behave adaptively — to choose causes that bring about desired effects. However, traditional experiments on experience-based learning involve events that are artificially compressed in time so that all learning occurs over the course of minutes. These paradigms therefore exclusively rely upon working memory. In contrast, in real-world situations we need to be able to learn cause–effect relations over days and weeks, which necessitates long-term memory. 413 participants completed a smartphone study, which compared learning a cause–effect relation one trial per day for 24 days versus the traditional paradigm of 24 trials back- to- back. Surprisingly, we found few differences between the short versus long timeframes. Subjects were able to accurately detect generative and preventive causal relations, and they exhibited illusory correlations in both the short and long timeframe tasks. These results provide initial evidence that experience-based learning over long timeframes exhibits similar strengths and weaknesses as in short timeframes. However, learning over long timeframes may become more impaired with more complex tasks.     

Coping with an insecure employment environment: The differing roles of protean and boundaryless career orientations

In this paper, we utilize a sample of working adults (N = 362) in the context of the recent economic recession to explore the coping mechanisms associated with different career attitudes and their subsequent impact on important individual work outcomes. Results of structural equation modeling (SEM) demonstrated that boundaryless mindset and self-directed protean career attitudes were differentially correlated with external support seeking, active coping, and identity awareness, which in turn were differentially correlated with individual work outcomes of job search behavior, performance, career success, and psychological well-being. Evidence for both full and partial mediation within the model tested is presented, as well as the potential implications of these findings and suggested avenues for future research.     

Under High Perceptual Load,Observers Look but Do Not See

High perceptual load reduces distractor processing and increases inattentional blindness for unexpected stimuli. We reported previously that high perceptual load reduces memory accuracy and impairs eyewitness identification. Here, we used eye tracking to investigate whether memory impairments under load are due to inattentional blindness or a failure to visually inspect stimuli. Seventy‐two participants viewed high or low load versions of a video depicting a theft and identified characters in the video from photographic line‐ups. High perceptual load impaired participants' ability to identify the peripheral character (witness) but not the central character (thief). There was no effect of perceptual load on number of ocular fixations on the witness, time to first fixation or total visit duration. We conclude that memory impairments under load are due to attentional failures rather than differences in visual search behaviour. These findings suggest that high perceptual load scenes may hamper eyewitnesses' ability to encode easily visible stimuli. Copyright © 2017 John Wiley & Sons, Ltd.     

MOVERS AND SHAKERS: HOW AND WHY WOMEN BECOME AND REMAIN ENGAGED IN COMMUNITY LEADERSHIP

This research examines women's narratives regarding the experiences that lead to becoming, sustaining, and challenging active community leaders. Seventeen women neighborhood leaders, age 28 to 73 years, completed in-depth interviews. Qualitative thematic content analyses identified prominent themes in participants' responses that were subsequently linked to a generativity framework. Analyses revealed that leaders reported circuitous rather than linear paths of emerging community participation and growing up among others who demonstrated an ethos of care in informal as well as formal community practices. Women's initial community engagement was most often in response to invitations to address community needs. Both communal and agentic rewards and challenges to community involvement were identified. Based upon the findings, strategies for promoting and sustaining women's community leadership are identified.     

A Comparison of “Direct” Versus “Derived” Extinction of Avoidance Responding

The Psychological Record - To establish a series of derived relations between arbitrary stimuli, 20 subjects were exposed to nonarbitrary and arbitrary relational training and testing procedures....     

The interplay of boundaryless and protean careers: Combinations and implications

The boundaryless and protean career concepts are compared in this article. It is suggested that the theories can be more finely delineated to produce more effective theory and research. The boundaryless career concept is profiled according to Sullivan and Arthur’s (this issue) categories of psychological and physical boundarylessness. The protean career concept is discussed based upon the degree of self-directed and values driven career orientations a career actor demonstrates. We join these respective boundaryless and protean delineations to produce eight likely career profiles based upon combinations of the boundaryless and protean career orientations. These eight profiles are examined in terms of challenges to career actors and those who assist them in their career development.     

Dynamic states in working memory modulate guidance of visual attention: Evidence from an n-back paradigm

Items held in working memory (WM) can automatically bias attention when they reappear in visual displays. Recent evidence, however, suggests that WM biases of attention may be reduced under certain conditions, for example with increasing memory load. We employed a dual task paradigm to investigate how WM biases are affected by dynamic updating of memory contents. 1-back and 2-back versions of a memory task with colour stimuli were interrupted at intervals by an unrelated visual search task. Reappearance in the search display of the item that was currently active in WM guided attention, while suppressed or inactive items did not. We conclude that the rapid updating of memory contents facilitates the shifting of memory representations into different activity states on a moment-to-moment basis. The finding is consistent with models that propose that only one item can be “active” in WM at any one time to guide attention.