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Invasive fungal infections (IFI) are challenging to predict, diagnose and treat, and are associated with a particularly high mortality among patients with hematological malignancies. They are relatively uncommon in patients with lymphoma, compared with those with acute leukemia or undergoing allogeneic transplantation. We present a patient, autografted for recurrent lymphoma, with fever and refractory diarrhea persisting post engraftment, eventually attributable to disseminated mucor infection. This case illustrates the challenge of timely diagnosis and initiation of treatment for IFI in lymphoma patients, who do not routinely receive antifungal prophylaxis, and the importance of aggressive investigation and symptom-directed tissue sampling for evidence of IFI in febrile immunocompromised hosts not responding to broad-spectrum antibiotics.

Understanding how the public views harm reduction strategies may help inform researchers on how to reduce related stigma and barriers to help-seeking. The current study explored whether stigma towards those who use opioids was affected by gender and type of harm reduction strategy used. Undergraduate students (N = 328) were randomly assigned to read one of six vignettes varying by gender and the type of harm reduction strategy: no harm reduction, opioid agonist therapy (OAT), or safe consumption sites (SCSs). Results demonstrated that participants were less stigmatizing towards the character who engaged in OAT compared to the character with no harm reduction. There was also a pattern demonstrating that SCSs may be perceived more negatively than OAT, although these differences only met conventional significance, not adjusted/corrected alphas. There were no significant effects for gender. Qualitative results revealed that participants held misconceptions about harm reduction. Implications and future directions are discussed.

The objective of the study is to assess the efficacy and tolerability of penicillins compared to anti-staphylococcal beta-lactams for treatment of penicillin-susceptible Staphylococcus aureus bloodstream infections (PSSA BSI). A retrospective cohort study was conducted of 140 sequential PSSA BSI presenting to a local health district (90 cases included). Penicillin susceptibility was confirmed by disc diffusion, Vitek® and Nitrocefin beta-lactamase methods. Clinical information regarding comorbidities and infection complexity was recorded. Antibiotic choice, dosage and duration were reviewed. Outcomes were compared according to the definitive treatment with either penicillin or ASBLs. The primary outcome was 30-day mortality. Secondary outcomes included renal injury, microbiological relapse and treatment tolerability. Ninety patients met inclusion criteria and were included in subsequent analysis. Of PSSA BSI, 69% were community acquired. Eighty-two percent had complex PSSA infections. The average duration of bacteraemia was 2.8 days (SD = 1.8 days). Sixty-six patients received definitive penicillin treatment, with a mean of 3.5 days of empiric antibiotics prior to penicillin. Twenty-four patients received definitive ASBL treatment (11 cefazolin, 13 flucloxacillin). There was no difference in 30-day mortality between groups (p = 1). There was no difference in renal injury (p > 0.5), hospital length of stay (p = 0.59) or microbiological relapse within 1 year (p = 0.17). Penicillin treatment was well tolerated. Our data supports penicillin as a suitable and well-tolerated alternative to ASBL in managing complex PSSA BSI.

The purpose of this study was to explore benefits of interacting with a canine on anxiety, stress, depression, and wellbeing in Higher Education (HE) students. Sixty participants took part in a randomized controlled trial. Assigned to either the canine-assisted intervention (CAI) or control group, the CAI group interacted with a canine whereas the control group watched an unrelated slideshow. Anxiety, depression, stress, and wellbeing measures were completed pre- and post-intervention and demonstrated there was a significant decrease in anxiety and stress in the CAI group. Due to group differences pre-intervention, findings for depression measures were uninterpretable and there was no significant effect found for general wellbeing. Overall, this study uses a CAI and control group and explores the use of a singular, brief CAI session in HE students demonstrating CAI to be an effective means of supporting mental health by decreasing levels of anxiety and stress in the treatment group.

A 63-year-old woman born in Vietnam was diagnosed with IgG Kappa Myeloma after presenting with severe back pain and pathological fracture of L5. Her medical history was notable for essential hypert...

A 21-year-old female with a history of systemic lupus erythematosus (SLE) presented to the emergency department with septic shock. She had been maintained on 5 mg prednisolone daily and hydroxychloroquine 400 mg once daily and been investigated three years prior for recurrent left upper quadrant chest pain. Her previous SLE complications included pericardial effusion and high-risk pregnancy. Intensive care support was required due to septic shock, and a diagnosis of primary invasive S

Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.

The objective of the study is to assess the efficacy and tolerability of penicillins compared to anti-staphylococcal beta-lactams for treatment of penicillin-susceptible Staphylococcus aureus bloodstream infections (PSSA BSI). A retrospective cohort study was conducted of 140 sequential PSSA BSI presenting to a local health district (90 cases included). Penicillin susceptibility was confirmed by disc diffusion, Vitek® and Nitrocefin beta-lactamase methods. Clinical information regarding comorbidities and infection complexity was recorded. Antibiotic choice, dosage and duration were reviewed. Outcomes were compared according to the definitive treatment with either penicillin or ASBLs. The primary outcome was 30-day mortality. Secondary outcomes included renal injury, microbiological relapse and treatment tolerability. Ninety patients met inclusion criteria and were included in subsequent analysis. Of PSSA BSI, 69% were community acquired. Eighty-two percent had complex PSSA infections. The average duration of bacteraemia was 2.8 days (SD = 1.8 days). Sixty-six patients received definitive penicillin treatment, with a mean of 3.5 days of empiric antibiotics prior to penicillin. Twenty-four patients received definitive ASBL treatment (11 cefazolin, 13 flucloxacillin). There was no difference in 30-day mortality between groups (p = 1). There was no difference in renal injury (p 0.5), hospital length of stay (p = 0.59) or microbiological relapse within 1 year (p = 0.17). Penicillin treatment was well tolerated. Our data supports penicillin as a suitable and well-tolerated alternative to ASBL in managing complex PSSA BSI.

Disgust, as a food-related emotion, or distaste (thought to be a precursor to disgust) has often been studied within an associative learning framework. However, it is only within the last few decades that disgust, as a basic emotion, has been considered from a conditioning perspective. This chapter aims to explore the theoretical perspectives that consider the development and acquisition of disgust as resulting from direct and indirect associative learning mechanisms. It will also briefly explore the contribution of indirect disgust-related learning experiences to the promotion of fear.

Contention surrounds how best to screen patients for latent and undiagnosed infection prior to cancer treatment. Early treatment and prophylaxis against reactivation may improve infection-associated morbidity. This study sought to examine rates of screening and prevalence of latent infection in overseas-born patients receiving cancer therapies.A single-centre retrospective audit of 952 overseas-born patients receiving chemotherapy, targeted agents and immunotherapy between January 1 and December 31 2019 was undertaken at Peter MacCallum Cancer Centre. Pre-treatment screening for hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), latent tuberculosis (LTBI), toxoplasmosis and strongyloidiasis was audited.Approximately half of our overseas-born patients were screened for HBV (58.9%) and HCV (50.7%). Fewer patients were screened for HIV (30.5%), LTBI (18.3%), strongyloidiasis (8.6%) or toxoplasmosis (8.1%). Although 59.7% of our patients were born in countries with high epidemiological risk for latent infection, according to World Health Organization data, 35% were not screened for any infection prior to commencement of therapy.The prevalence of latent infections amongst overseas-born patients with cancer, and complexities associated with risk-based screening, likely supports universal latent infection screening amongst this higher-risk cohort.

Frei et al. in the current issue present a large retrospective case-control study of invasive fungal infections (IFI) amongst chronic lymphocytic leukemia (CLL) patients treated with ibrutinib [1]....

This study aimed to review the neurobiological and neuropsychological correlates of paranoid (persecutory delusions) and misidentification (misidentification delusions and/or hallucinations) subtypes of psychosis in dementia, to establish if they represent distinct subphenotypes. Nine studies were eligible, all included patients with Alzheimer’s disease. Greater global cognitive deficits and an accelerated global cognitive decline were observed in the misidentification subtype. Neuroimaging studies showed more marked volume loss in multiple regions in patients with the misidentification subtype, including those involved in object recognition and the processing of information on spatial and temporal context. A single study found greater impairment in visual sustained attention and object recognition in the misidentification subtype. The small number of studies and methodological heterogeneity limit interpretation of the findings. Nevertheless, these findings would tentatively suggest that there may be additional or accelerated pathological change in functional networks involved in visuoperceptual processing in the misidentification subtype. This should be further explored in prospective studies and the investigation extended to other forms of dementia, to gain a transdiagnostic perspective.

The phenomenon whereby behavior becomes controlled by one aspect of the environment at the expense of other aspects of the environment (stimulus overselectivity) is widespread across many intellectual and developmental disabilities. However, the theoretical mechanisms underpinning overselectivity are not understood. Given similarities between overselectivity and overshadowing, exploring overselectivity using associative learning paradigms might allow better theoretical understanding of the phenomenon. Three experiments explored overselectivity using a simultaneous discrimination task with typically developing participants undergoing a cognitively demanding task. Experiment 1 investigated whether stimulus duration effects found within the overshadowing literature also occurred in an overselectivity paradigm, and demonstrated that greater overselectivity was observed when stimuli were presented for short durations (2s and 5s) compared with longer durations (10s). Experiment 2 demonstrated that a posttraining revaluation procedure resulted in retrospective revaluation for stimuli presented at shorter durations (2s) and mediated extinction for stimuli presented at longer durations (10s). Such results replicate findings from the overshadowing literature that have been interpreted in terms of within-compound associations while also supporting assumptions made by an extended comparator hypothesis. Experiment 3 uses an additional control condition to further demonstrate that the retrospective revaluation is a genuine revaluation effect. Additionally, the experiment provides further evidence for the within-compound association explanation of the results through manipulating the consistency with which elements of a compound were paired during training. Taken together, the findings highlight the necessity to consider the role of within-compound associations in overselectivity, allowing for a better understanding of overselectivity effects. (PsycINFO Database Record

Objectives The objective of this study was to evaluate the effect of tumour necrosis factor‐alpha inhibitors (TNF‐αI) on Alzheimer's disease‐associated pathology. Design A literature search of PubMed, Embase, PsychINFO, Web of Science, Scopus, and the Cochrane Library databases for human and animal studies that evaluated the use of TNF‐αI was performed on 26 October 2016. Results The main outcomes assessed were cognition and behaviour, reduction in brain tissue mass, presence of plaques and tangles, and synaptic function. Risk of bias was assessed regarding blinding, statistical model, outcome reporting, and other biases. Sixteen studies were included, 13 of which were animal studies and 3 of which were human. All animal studies found that treatment with TNF‐αI leads to an improvement in cognition and behaviour. None of the studies measured change in brain tissue mass. The majority of studies documented a beneficial effect in other areas, including the presence of plaques and tangles and synaptic function. The amount of data from human studies was limited. Two out of 3 studies concluded that TNF‐αI are beneficial in Alzheimer's disease patients, with one being an observational study and the latter being a small pilot study, with a high risk of bias. Conclusion It was concluded that a large‐scale randomized controlled trial assessing the effectiveness of TNF‐αI on humans is warranted.

A substantial body of research demonstrates the importance of sleep for emotional processing and learning as well as the association between sleep problems and heightened anxiety. However, there is currently no research exploring the impact of sleepiness on vicariously learned fear responses. Experiment 1 (N = 38) first demonstrated no effect of trait or state sleepiness on children’s (7–11 years of age) subjective ratings of fear. Experiment 2 (N = 42) and Experiment 3 (N = 46) used an established vicarious learning paradigm to demonstrate that trait sleepiness facilitated vicariously acquired avoidance preferences for animals paired with fearful faces (fear-paired animals), whereas state sleepiness facilitated children’s fear cognitions and attentional bias toward fear-paired animals. This study is the first to demonstrate the role of state and trait sleepiness in moderating vicarious fear learning in children.

Research with children has demonstrated that both positive vicarious learning (modelling) and positive verbal information can reduce children’s acquired fear responses for a particular stimulus. However, this fear reduction appears to be more effective when the intervention pathway matches the initial fear learning pathway. That is, positive verbal information is a more effective intervention than positive modelling when fear is originally acquired via negative verbal information. Research has yet to explore whether fear reduction pathways are also important for fears acquired via vicarious learning. To test this, an experiment compared the effectiveness of positive verbal information and positive vicarious learning interventions for reducing vicariously acquired fears in children (7-9 years). Both vicarious and informational fear reduction interventions were found to be equally effective at reducing vicariously acquired fears, suggesting that acquisition and intervention pathways do not need to match for successful fear reduction. This has significant implications for parents and those working with children because it suggests that providing children with positive information or positive vicarious learning immediately after a negative modelling event may prevent more serious fears developing.

BACKGROUND Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. METHODS A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. RESULTS Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. CONCLUSION Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.

In this paper we explored the effects of exposure to images of the suffering and vulnerability\ud of others on altruistic, trust-based, and reciprocated incentivized economic decisions,\ud accounting for differences in participants’ dispositional empathy and reported in-group trust\ud for their recipient(s). This was done using a pictorial priming task, framed as a memory test,\ud and a triadic economic game design. Using the largest experimental sample to date to\ud explore this issue, our integrated analysis of two online experiments (total N = 519), found\ud statistically consistent evidence that exposure to images of suffering and vulnerability (vs.\ud neutral images) increased altruistic in-group giving as measured by the “triple dictator\ud game”, and that the manipulation was significantly more effective in those who reported\ud lower trust for their recipients. The experimental manipulation also significantly increased\ud altruistic giving in the standard “dictator game” and trust-based giving in the “investment\ud game”, but only in those who were lower in in-group trust and also high in affective or cognitive\ud empathy. Complementary qualitative evidence revealed the strongest motivations\ud associated with increased giving in the experimental condition were greater assumed reciprocation\ud and a lower aversion to risk. However, no consistent effects of the experimental\ud manipulation on participants’ reciprocated decisions were observed. These findings suggest\ud that, as well as altruistic decision-making in the “triple dictator game”, collaboratively witnessing\ud the suffering of others may heighten trust-based in-group giving in the “investment\ud game” for some people, but the effects are heterogeneous and sensitive to context.

Background Predictor analyses of late-life depression can be used to identify variables associated with outcomes of treatments, and hence ways of tailoring specific treatments to patients. The aim of this review was to systematically identify, review and meta-analyse predictors of outcomes of any type of treatment for late-life depression.Methods Pubmed, Embase, CINAHL, Web of Science and PsycINFO were searched for studies published up to December 2016. Primary and secondary studies reported treatment predictors from randomised controlled trials of any treatment for patients with major depressive disorder aged over 60 were included. Treatment outcomes included response, remission and change in depression score.ResultsSixty-seven studies met the inclusion criteria. Of 65 identified statistically significant predictors, only 7 were reported in at least 3 studies. Of these, 5 were included in meta-analyses, and only 3 were statistically significant. Most studies were rated as being of moderate to strong quality and satisfied key quality criteria for predictor analyses.LimitationsThe searches were limited to randomised controlled trials and most of the included studies were secondary analyses.ConclusionsBaseline depression severity, co-morbid anxiety, executive dysfunction, current episode duration, early improvement, physical illnesses and age were reported as statistically significant predictors of treatment outcomes. Only the first three were significant in meta-analyses. Subgroup analyses showed differences in predictor effect between biological and psychosocial treatment. However, high heterogeneity and small study numbers suggest a cautious interpretation of results. These predictors were associated with various mechanisms including brain pathophysiology, perceived social support and proposed distinct types of depressive disorder. Further investigation of the clinical utility of these predictors is suggested.

Vicarious fear learning refers to the acquisition of fear via observation of the fearful responses of others. The present study aims to extend current knowledge by exploring whether second-order vicarious fear learning can be demonstrated in children. That is, whether vicariously learnt fear responses for one stimulus can be elicited in a second stimulus associated with that initial stimulus. Results demonstrated that children's (5-11 years) fear responses for marsupials and caterpillars increased when they were seen with fearful faces compared to no faces. Additionally, the results indicated a second-order effect in which fear-related learning occurred for other animals seen together with the fear-paired animal, even though the animals were never observed with fearful faces themselves. Overall, the findings indicate that for children in this age group vicariously learnt fear-related responses for one stimulus can subsequently be observed for a second stimulus without it being experienced in a fear-related vicarious learning event. These findings may help to explain why some individuals do not recall involvement of a traumatic learning episode in the development of their fear of a specific stimulus.

Fear and anxiety symptoms can be acquired through (1) a direct traumatic experience, (2) the transmission of verbal information, and (3) vicarious (observational) learning. All three pathways have gained empirical support, and all appear to conform to predictions made by theories of Pavlovian associative learning. Consequently, a number of integrated models of fear learning based on associative learning principles have been proposed. Field and Purkis’ (Anxiety disorders in children and adolescents: Research, assessment and intervention, 2011) model suggests that learning experiences evoke links between a neutral stimulus (CS) and threat-related US. Therefore, a single mechanism underlies all three fear learning pathways, and thus the pathways can have additive and multiplicative effects on the strength of the CS-US link. Crucially, the model acknowledges the role of individual differences in learning. This chapter will discuss the evidence demonstrating the influence of two temperamental constructs, behavioral inhibition (the tendency to react to a novel or unfamiliar situation with excessive apprehension and avoidance) and the behavioral inhibition system (a neurological system, which is linked to behavioral inhibition, that controls the experience of anxiety in response to anxiety-relevant cues). In particular, the chapter will explore the effect of behavioral inhibition and the behavioral inhibition system on both the strength of the CS-US link formed during a learning episode, as well as post-learning processes. Taken together, it is clear that behavioral inhibition interacts with the associative learning of fear to facilitate fear learning.

Superior learning for fear-relevant stimuli is typically indicated in the laboratory by faster acquisition of fear responses, greater learned fear, and enhanced resistance to extinction. Three experiments investigated the speed, magnitude, and robustness of UK children's (6-10 years; N = 290; 122 boys, 168 girls) vicariously learned fear responses for three types of stimuli. In two experiments, children were presented with pictures of novel animals (Australian marsupials) and flowers (fear-irrelevant stimuli) alone (control) or together with faces expressing fear or happiness. To determine learning speed the number of stimulus-face pairings seen by children was varied (1, 10, or 30 trials). Robustness of learning was examined via repeated extinction procedures over 3 weeks. A third experiment compared the magnitude and robustness of vicarious fear learning for snakes and marsupials. Significant increases in fear responses were found for snakes, marsupials and flowers. There was no indication that vicarious learning for marsupials was faster than for flowers. Moreover, vicariously learned fear was neither greater nor more robust for snakes compared to marsupials, or for marsupials compared to flowers. These findings suggest that for this age group stimulus fear relevance may have little influence on vicarious fear learning.

Research with children has shown that vicarious learning can result in changes to 2 of Lang's (1968) 3 anxiety response systems: subjective report and behavioral avoidance. The current study extended this research by exploring the effect of vicarious learning on physiological responses (Lang's final response system) and attentional bias. The study used Askew and Field's (2007) vicarious learning procedure and demonstrated fear-related increases in children's cognitive, behavioral, and physiological responses. Cognitive and behavioral changes were retested 1 week and 1 month later, and remained elevated. In addition, a visual search task demonstrated that fear-related vicarious learning creates an attentional bias for novel animals, which is moderated by increases in fear beliefs during learning. The findings demonstrate that vicarious learning leads to lasting changes in all 3 of Lang's anxiety response systems and is sufficient to create attentional bias to threat in children.

One of the challenges to conditioning models of fear acquisition is to explain how different individuals can experience similar learning events and only some of them subsequently develop fear. Understanding factors moderating the impact of learning events on fear acquisition is key to understanding the etiology and prevention of fear in childhood. This study investigates these moderators in the context of vicarious (observational) learning. Two experiments tested predictions that the acquisition or inhibition of fear via vicarious learning is driven by associative learning mechanisms similar to direct conditioning. In Experiment 1, 3 groups of children aged 7 to 9 years received 1 of 3 inhibitive information interventions—psychoeducation, factual information, or no information (control)—prior to taking part in a vicarious fear learning procedure. In Experiment 2, 3 groups of children aged 7 to 10 years received 1 of 3 observational learning interventions—positive modeling (immunization), observational familiarity (latent inhibition), or no prevention (control)—before vicarious fear learning. Results indicated that observationally delivered manipulations inhibited vicarious fear learning, while preventions presented via written information did not. These findings confirm that vicarious learning shares some of the characteristics of direct conditioning and can explain why not all individuals will develop fear following a vicarious learning event. They also suggest that the modality of inhibitive learning is important and should match the fear learning pathway for increased chances of inhibition. Finally, the results demonstrate that positive modeling is likely to be a particularly effective method for preventing fear-related observational learning in children., The studies demonstrate that positive modeling and prior exposure to a stimulus are effective methods to prevent vicarious fear learning in 7 to 10-year-olds. This confirms that positive modeling is a useful part of prevention programs and that associative learning mechanisms underpin its effectiveness. The findings also explain why not everyone develops fear following a negative vicarious learning event.

Stimulus overselectivity occurs when only one of potentially many aspects of the environment controls behaviour. In four experiments, human participants were trained and tested on a trial-and-error simultaneous discrimination task involving two two-element compound stimuli. Overselectivity emerged in all experiments (i.e., one element from the reinforced compound controlled behaviour at the expense of the other). Following revaluation (extinction) of the previously overselected stimulus, behavioural control by the underselected stimulus element emerged without any direct training of that stimulus element. However, while a series of extinction manipulations targeting the revaluation of the overselected stimulus produced differential extinction of that stimulus, they did not result in differential emergence of the previously underselected stimuli. The results are discussed with respect to the theoretical implications for attention-based accounts of overselectivity.

Vicarious learning has become an established indirect pathway to fear acquisition. It is generally accepted that associative learning processes underlie vicarious learning; however, whether this association is a form of conditioned stimulus-unconditioned stimulus (CS-US) learning or stimulus–response (CS-CR) learning remains unclear. Traditionally, these types of learning can be dissociated in a US revaluation procedure. The current study explored the effects of post-vicarious learning US revaluation on acquired fear responses. Ninety-four children (46 males and 48 females) aged 6 to 10 years first viewed either a fear vicarious learning video or a neutral vicarious learning video followed by random allocation to one of three US revaluation conditions: inflation; deflation; or control. Inflation group children were presented with still images of the adults in the video and told that the accompanying sound and image of a very fast heart rate monitor belonged to the adult. The deflation group were shown the same images but with the sound and image of a normal heart rate. The control group received no US revaluation. Results indicated that inflating how scared the models appeared to be did not result in significant increases in children’s fear beliefs, avoidance preferences, avoidance behavior or heart rate for animals above increases caused by vicarious learning. In contrast, US devaluation resulted in significant decreases in fear beliefs and avoidance preferences. Thus, the findings provide evidence that CS-US associations underpin vicarious learning and suggest that US devaluation may be a successful method for preventing children from developing fear beliefs following a\ud traumatic vicarious learning episode with a stimulus.

Disgust is a protective emotion associated with certain types of animal fears. Given that a primary function of disgust is to protect against harm, increasing children’s disgust-related beliefs for animals may affect how threatening they think animals are and their avoidance of them. One way that children’s disgust beliefs for animals might change is via vicarious learning: by observing others responding to the animal with disgust. In Experiment 1, children (ages 7–10 years) were presented with images of novel animals together with adult faces expressing disgust. Children’s fear beliefs and avoidance preferences increased for these disgust-paired animals compared with unpaired control animals. Experiment 2 used the same procedure and compared disgust vicarious learning with vicarious learning with fear faces. Children’s fear beliefs and avoidance preferences for animals again increased as a result of disgust vicarious learning, and animals seen with disgust or fear faces were also rated more disgusting than control animals. The relationship between increased fear beliefs and avoidance preferences for animals was mediated by disgust for the animals. The experiments demonstrate that children can learn to believe that animals are disgusting and threatening after observing an adult responding with disgust toward them. The findings also suggest a bidirectional relationship between fear and disgust with fear-related vicarious learning leading to increased disgust for animals and disgust-related vicarious learning leading to increased fear and avoidance.

Objective Patients with chronic fatigue syndrome (CFS) are frequently diagnosed with comorbid postural orthostatic tachycardia syndrome (POTS), suggesting a shared pathogenesis. The aim of this study was to examine the relationship between demographic characteristics, autonomic functioning and fatigue levels amongst CFS patients with and without comorbid POTS. Design and setting All patients presenting to the CFS Discovery Clinic between 2009 and 2012 completed a 20-min standing task as part of their initial assessment. Heart rate and pulse pressure were recorded at baseline, at 2-min intervals poststanding, at the end of the task and following a recovery period. Average heart rate and pulse pressure variability were calculated from this data. Age, gender, length of illness and self-reported fatigue scores were also recorded. POTS patients were diagnosed by an orthostatic increase in heart rate >30 beats per min, concomitant symptoms of orthostatic intolerance and no orthostatic hypotension. Differences in autonomic functioning between POTS and CFS patients were compared using independent samples t-tests, whilst logistic and linear regressions were performed to examine the contribution of autonomic functioning to task completion and perceived fatigue, respectively. Results Comorbidity of CFS and POTS (CFS-POTS) was observed in 11% (33/306) of patients. CFS-POTS patients were significantly younger (P < 0.001), had a shorter length of illness (P = 0.034), experienced greater task difficulty (P = 0.002) and were able to stand for significantly shorter periods compared to the CFS-only patients (P < 0.001). CFS-POTS patients experienced significantly lower baseline diastolic blood pressure (P = 0.002), significantly higher heart rate and lower pulse pressures at each standing measurement. Early heart rate changes (P = 0.002) and overall heart rate change (P < 0.001) were significant predictors of completion status, whereas heart rate variability (P < 0.001) and female gender (P < 0.001) were significant predictors of increased perceived task difficulty. Conclusions Haemodynamic and demographic differences between CFS-POTS and CFS-only patients suggest that the former group reflects a distinct subgroup of the CFS population. The findings highlight the utility of screening younger patients with fatigue for POTS, and identified heart rate variability as an important marker of fatigue for CFS patients in general.

Enhanced fear learning for fear-relevant stimuli has been demonstrated in procedures with adults in the laboratory. Three experiments investigated the effect of stimulus fear-relevance on vicarious fear learning in children (aged 6-11 years). Pictures of stimuli with different levels of fear-relevance (flowers, caterpillars, snakes, worms, and Australian marsupials) were presented alone or together with scared faces. In line with previous studies, children's fear beliefs and avoidance preferences increased for stimuli they had seen with scared faces. However, in contrast to evidence with adults, learning was mostly similar for all stimulus types irrespective of fear-relevance. The results support a proposal that stimulus preparedness is bypassed when children observationally learn threat-related information from adults.

Stimulus over-selectivity refers to the phenomenon whereby behavior is controlled by a subset of elements in the environment at the expense of other equally salient aspects of the environment. The experiments explored whether this cue interference effect was reduced following a surprising downward shift in reinforcer value. Experiment 1 revealed that a downward shift in reinforcer value reduced over-selectivity in non-clinical adults under-taking a concurrent cognitive task. Experiments 2 and 3 ruled out a generalization decrement account of this effect; through manipulating the color of the stimuli across phases, we failed to find a reduction in over-selectivity, except for when the nature of the stimuli in one task changed in the context of another one that remained the same. Experiment 4 explored whether a reduction in over-selectivity is a function of the reinforcer and not the stimuli and failed to find a differential effect of reinforcer quality. Taken together, the results extend earlier findings of an attenuation of blocking following a surprise downward shift in reinforcer value to an over-selectivity paradigm in human subjects. Such work has important implications for remediation of over-selectivity.

Stimulus over-selectivity refers to behavior being controlled by one element of the environment at the expense of other equally salient aspects of the environment. This is a common problem for many individuals, including those with autism spectrum disorders, and learning difficulties, and presents a considerable problem for information processing in many important situations involving complex cues and environments. Three experiments explored the strength and generality of the over-selectivity effect in non-clinical adults undertaking a cognitively demanding task, by training and testing participants on a two-component trial-and-error discrimination learning task. The over-selectivity effect was found in a variety of test conditions, including when the comparison test stimulus was neutral (Experiment 1), novel (Experiment 2), neutral with no conditioning history (Experiment 3), or when punished during training (Experiments 1, 2 and 3). Such results provide ubiquity to the phenomenon, making it important to investigate further.

Stimulus over-selectivity refers to behavior being controlled by one element of the environment at the expense of other equally salient aspects of the environment. Four experiments trained and tested non-clinical participants on a two-component trial-and-error discrimination task to explore the effects of different training regimes on over-selectivity. Experiments 1 and 2 revealed no differentiation between partial reinforcement (PR) and continuous reinforcement (CRF) on over-selectivity. Experiments 3 and 4 both found that a change in reinforcement (from CRF to PR in Experiment 3, and from PR to CRF in Experiment 4) did not reduce levels of over-selectivity, but rather continuing training with the same contingency (either CRF or PR) did reduce over-selectivity. The results support assumptions made by the comparator hypothesis, extending the growing body of literature explaining over-selectivity as a post-acquisition, rather than attention, failure.