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Background: Emotion regulation plays a crucial role in well-being in everyday life. Effective emotion regulation depends upon adaptively matching a given strategy to a given situation. Recent research has begun to explore these interactions in the context of daily reports of perceived stress, affect, and emotion regulation strategy usage. To further understand these differences in strategy efficacy in an ecologically valid context, we examined responses to real world stressors in a young adult sample., Methods: We surveyed a range of emotion regulation strategies, including two forms of cognitive reappraisal (i.e., reinterpretation, which involves cognitively reframing one's emotional responses, and psychological distancing, which involves adopting an objective, impartial perspective). Participants reported strategy usage, momentary perceived stress, and affect in response to multiple ecological momentary assessments over a period of 7 days., Results: Analyses of links between strategy usage and affect revealed that rumination was significantly negatively associated with more positive affect ratings. Further, a significant interaction between momentary perceived stress and reinterpretation usage was observed on affect, such that reinterpretation was more adaptive during situations perceived as less stressful., Conclusion: These results provide further insight into the importance of situational context in determining the effectiveness of particular emotion regulation strategies.

Objectives: To assess the impact on clinical management, potential for peer learning, and referring physician satisfaction with subspecialist reinterpretations of hepatopancreaticobiliary (HPB) imaging examinations., Materials and Methods: HPB CTs and MRIs from outside hospitals were reinterpreted by two subspecialty radiologists between March 2021 and August 2022. Reinterpretation reports were mailed to radiologists that issued primary reports. The electronic record was reviewed to assess for changes in clinical management based on the reinterpretations (yes/no/unavailable). To assess the potential for peer learning, a survey using a 5-point Likert scale was sent to radiologists who issued primary reports. A separate survey was sent to referring physicians to assess satisfaction with reinterpretations., Results: Two hundred fifty imaging examinations (122 CT, 128 MRI) were reinterpreted at the request of 19 referring physicians. Ninety-six radiologists issued primary reports. RADPEER scores 1-3 were assigned to 131/250 (52%), 86/250 (34%), and 33/250 (13%) examinations, respectively. Of 213 reinterpretations with adequate records for assessment, 75/213 (35%) were associated with a change in management; of these, 71/75 (95%) were classified as RADPEER 2 or 3. Most radiologists agreed or strongly agreed with the following: prefer to receive reinterpretations (34/36, 94%); reinterpretations changed practice of reporting HPB imaging examinations (23/36, 64%); and reinterpretations offer opportunities for peer learning (34/36, 94%). Referring physicians agreed or strongly agreed (7/7, 100%) that reinterpretations are valuable and often change or clarify management of patients with complex HPB disease, and offer an opportunity for peer learning., Conclusion: Radiologists and referring physicians strongly agree that HPB imaging reinterpretations help support peer learning and patient management, respectively., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

In recent decades, a substantial volume of work has examined the neural mechanisms of cognitive reappraisal. Distancing and reinterpretation are two frequently used tactics through which reappraisal can be implemented. Theoretical frameworks and prior evidence have suggested that the specific tactic through which one employs reappraisal entails differential neural and psychological mechanisms. Thus, we were motivated to assess the neural mechanisms of this distinction by examining the overlap and differentiation exhibited by the neural correlates of distancing (specifically via objective appraisal) and reinterpretation. We analyzed 32 published functional magnetic resonance imaging (fMRI) studies in healthy adults using multilevel kernel density analysis. Results showed that distancing relative to reinterpretation uniquely recruited right bilateral dorsolateral PFC (DLPFC) and left posterior parietal cortex, previously associated with mentalizing, selective attention and working memory. Reinterpretation relative to distancing uniquely recruited left bilateral ventrolateral PFC (VLPFC), previously associated with response selection and inhibition. Further, distancing relative to reinterpretation was associated with greater prevalence of bilateral amygdala attenuation during reappraisal. Finally, a behavioral meta-analysis showed efficacy for both reappraisal tactics. These results are consistent with prior theoretical models for the functional neural architecture of reappraisal via distancing and reinterpretation and suggest potential future applications in region-of-interest specification and neural network analysis in studies focusing on specific reappraisal tactics., (© The Author(s) 2023. Published by Oxford University Press.)

Background: Second-opinion reads on imaging studies are common for CT and MRI, but many institutions are hesitant to implement a workflow for second read of ultrasound studies performed at other facilities due to quality considerations., Objective: The purpose of this study was to assess discrepancy rates between initial and second-opinion general ultrasound reports METHODS: We reviewed all requests of second-opinion US studies referred to our tertiary care center between 02/01/2020 and 06/23/2022. We evaluated percentage of exams that were interpreted versus archived. Whenever the original report was available (n = 196 studies), we evaluated any discrepancy in findings, interpretation, and potential management change based on second report compared to the initial report as evaluated by consensus agreement of 3 subspecialized radiologists., Results: A total of 586 ultrasound studies for 533 patients were nominated for consult. After excluding 58 studies for technical reasons (e.g., duplicate nomination, images for procedure guidance, modality is not ultrasound) and 282 studies that were archived by the reading radiologist due to various objective (e.g., studies such as echocardiography not interpreted by the abdominal imagers or more recent study available obviating need for consultation) and subjective (e.g., suboptimal image quality, lack of cine clips) reasons, a total of 246 studies were reinterpreted and were further analyzed. Only 21/246 patients (8.5%) got repeat ultrasound of the same body part within 3 months of original study date. The original (first-read) report was available for 196/246 studies, with discrepancy present between the first and second reads in 74/196 (37.8%) studies, with potential management change in 51/196 (26.0%) studies., Conclusion: Second-opinion interpretation of outside ultrasound examinations by subspecialized radiologists can result in recommended management change in 26% of studies indicating potential for added value to reinterpreting ultrasound studies despite the concerns for quality control., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Research has suggested a contradictory effect between detachment and reinterpretation, two distinct tactics of cognitive reappraisal, in the regulation of negative emotion. The reasons for this contradictory effect remain unclear. The present study explored the differences between these tactics in terms of potential early processes and neural mechanisms, comparing psychophysiological differences using event-related potentials (ERPs) in the regulation of negative emotion. Thirty college students were required to perform an emotion regulation task, in which they naturally viewed or applied a given emotion regulation strategy towards negative pictures. The results demonstrated that both tactics reduced emotional experiences (decrease of arousal and increase of valence). Reinterpretation was associated with reductions in the late positive potential (LPP) in the late time window, while detachment was not. Detachment showed a lower amplitude in the N1 and N2 ERP components and a higher P2 amplitude than reinterpretation. The differences in early ERP components (N1, N2, and P2) predicted the reduction of LPP amplitude. These findings reveal the differential effects of these tactics on emotional experience and neural responses and highlight the significance of early processes on emotion across the time course of cognitive reappraisal., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Variant classifications may change over time, driven by emergence of fresh or contradictory evidence or evolution in weighing or combination of evidence items. For variant classifications above the actionability threshold, which is classification of likely pathogenic or pathogenic, clinical actions may be irreversible, such as risk-reducing surgery or prenatal interventions. Variant reclassification up or down across the actionability threshold can therefore have significant clinical consequences. Laboratory approaches to variant reinterpretation and reclassification vary widely., Methods: Cancer Variant Interpretation Group UK is a multidisciplinary network of clinical scientists and genetic clinicians from across the 24 Molecular Diagnostic Laboratories and Clinical Genetics Services of the United Kingdom (NHS) and Republic of Ireland. We undertook surveys, polls, and national meetings of Cancer Variant Interpretation Group UK to evaluate opinions about clinical and laboratory management regarding variant reclassification., Results: We generated a consensus framework on variant reclassification applicable to cancer susceptibility genes and other clinical areas, which provides explicit recommendations for clinical and laboratory management of variant reclassification scenarios on the basis of the nature of the new evidence, the magnitude of evidence shift, and the final classification score., Conclusion: In this framework, clinical and laboratory resources are targeted for maximal clinical effect and minimal patient harm, as appropriate to all resource-constrained health care settings., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Distraction and reinterpretation have been recognized as two different tactics of emotion regulation. As a tactic of attention deployment, distraction involves shifting attention to neutral information or performing a secondary task to distract attention from emotion stimuli of the primary task. Reinterpretation, a representative tactic of cognitive change, was defined as changing the meaning of a situation to enhance or reduce its emotional impact. Thus, there are significant differences between the two processes. We wondered if the neural mechanisms underlying distraction and reinterpretation are different. Even though their neural correlates have been widely studied with functional magnetic resonance imaging (fMRI), few studies were conducted to compare the two tactics directly. Here we conducted an activation likelihood estimation (ALE) meta-analyses to investigate the common or different neural bases of distraction and reinterpretation. Moreover, we also used the meta-analytic connectivity modeling (MACM) to identify the emotion regulation network of distraction and reinterpretation. Overall, we found that the left dorsal lateral prefrontal cortex (DLPFC) was consistently activated during distraction and reinterpretation, whereas the left amygdala and inferior frontal gyrus/ventrolateral prefrontal cortex (VLPFC) were specifically activated during reinterpretation alone. The results indicate that the neural basis of distraction and reinterpretation are similar but not identical. The MACM results showed that distraction and reinterpretation share a common emotion regulation network, including the bilateral DLPFC, the dorsal medial prefrontal cortex, the inferior parietal lobule, the insula, the left (pre) supplementary motor area, the left middle temporal gyrus, and the right superior temporal gyrus. However, that network may subserve different functions when adopting various emotion regulation strategies. In addition, we suggest that the emotion regulation network of the left VLPFC may be a specific regulatory network for reinterpretation., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s). Published by IMR Press.)

Genome-wide sequencing (GWS) is a standard of care for diagnosis of suspected genetic disorders, but the proportion of patients found to have pathogenic or likely pathogenic variants ranges from less than 30% to more than 60% in reported studies. It has been suggested that the diagnostic rate can be improved by interpreting genomic variants in the context of each affected individual's full clinical picture and by regular follow-up and reinterpretation of GWS laboratory results. Trio exome sequencing was performed in 415 families and trio genome sequencing in 85 families in the CAUSES study. The variants observed were interpreted by a multidisciplinary team including laboratory geneticists, bioinformaticians, clinical geneticists, genetic counselors, pediatric subspecialists, and the referring physician, and independently by a clinical laboratory using standard American College of Medical Genetics and Genomics (ACMG) criteria. Individuals were followed for an average of 5.1 years after testing, with clinical reassessment and reinterpretation of the GWS results as necessary. The multidisciplinary team established a diagnosis of genetic disease in 43.0% of the families at the time of initial GWS interpretation, and longitudinal follow-up and reinterpretation of GWS results produced new diagnoses in 17.2% of families whose initial GWS interpretation was uninformative or uncertain. Reinterpretation also resulted in rescinding a diagnosis in four families (1.9%). Of the families studied, 33.6% had ACMG pathogenic or likely pathogenic variants related to the clinical indication. Close collaboration among clinical geneticists, genetic counselors, laboratory geneticists, bioinformaticians, and individuals' primary physicians, with ongoing follow-up, reanalysis, and reinterpretation over time, can improve the clinical value of GWS., Competing Interests: The authors declare no competing interests., (© 2022 The Authors.)

Pharmacogenomic (PGx) evidence for selective serotonin reuptake inhibitors (SSRIs) continues to evolve. For sites offering testing, maintaining up-to-date interpretations and implementing new clinical decision support (CDS) driven by existing results creates practical and technical challenges. Vanderbilt University Medical Center initiated panel testing in 2010, added CYP2D6 testing in 2017, and released CDS for SSRIs in 2020. We systematically reinterpreted historic CYP2C19 and CYP2D6 genotypes to update phenotypes to current nomenclature and to launch provider CDS and patient-oriented content for SSRIs. Chart review was conducted to identify and recontact providers caring for patients with current SSRI therapy and new actionable recommendations. A total of 15,619 patients' PGx results were reprocessed. Of the non-deceased patients reprocessed, 21% ( n = 3278) resulted in CYP2C19 *1/*17 reinterpretations. Among 289 patients with an actionable recommendation and SSRI medication prescription, 31.8% ( n = 92) did not necessitate contact of a clinician, while 43.2% ( n = 125) resulted in clinician contacted, and for 25% ( n = 72) no appropriate clinician was able to be identified. Maintenance of up-to-date interpretations and recommendations for PGx results over the lifetime of a patient requires continuous effort. Reprocessing is a key strategy for maintenance and expansion of PGx content to be periodically considered and implemented.

Reinterpretation and distancing are two cognitive reappraisal tactics, used to regulate one's emotions in response to emotion-eliciting stimuli or situations. Relatively less is known about their (differential) lasting effects on emotional responding and related neural correlates. This functional magnetic resonance imaging study investigated 85 healthy females, participating in a 2-day cognitive emotion regulation experiment. On the first day, participants were instructed to passively look at, reinterpret or distance from repeatedly presented aversive pictures. One week later, they were re-exposed to the same stimuli without regulation instruction, in order to assess lasting effects. The main outcome measures comprised ratings of negative feelings and blood-oxygen-level-dependent responses. Lasting effects for reinterpretation compared with looking at aversive pictures during passive re-exposure 1 week later were reflected in stronger activation of the left amygdala, the ventromedial prefrontal cortex (vmPFC) and reduced negative feelings. Neither distancing compared with looking at aversive pictures nor reinterpretation compared with distancing did result in significant effects during re-exposure. These findings indicate that reinterpretation leads to reduced negative feelings 1 week later, which might be mediated by inhibitory vmPFC activation or stronger positive emotions during re-exposure. However, the missing difference compared with distancing questions the specificity of the results and the mechanisms underlying these two cognitive reappraisal tactics., (© The Author(s) 2020. Published by Oxford University Press.)

The clinical utility of genetic testing for epilepsy has been enhanced with the advancement of next-generation sequencing (NGS) technology along with the rapid updating of publicly available databases. The aim of this study was to evaluate the diagnostic yield of NGS and assess the value of reinterpreting genetic test results in children and adults with epilepsy. We performed genetic testing on 200 patients, including 82 children and 118 adults. The results were classified into three categories: positive, inconclusive, or negative. The reinterpretation of inconclusive results was conducted in April 2020. Overall, we identified disease-causing variants in 12% of the patients in the original analysis, and 14.5% at reinterpretation. The diagnostic yield for adults with epilepsy was similar to that for children (11 vs. 19.5%, p = 0.145). After reinterpretation, 9 of the 86 patients who initially had inconclusive results obtained a clinically significant change in diagnosis. Among these nine revised cases, five obtained positive diagnoses, representing a diagnosis rate of 5.8% (5/86). Manual searches for additional evidence of pathogenicity for candidate variants and updated patient clinical information were the main reasons for diagnostic reclassification. This study emphasizes the diagnostic potential of combining NGS and reinterpretation of inconclusive genetic test reports in children and adults with epilepsy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Jiang, Song, Wang, Zhao, Yang, Gao, Leng, Man and Jiang.)

Background: The accurate interpretation of BRCA1/2 variants becomes increasingly important in breast cancer and other related cancers including ovarian cancer, prostate cancer, pancreatic cancer and so forth. In the past decades, especially before year 2015, limitations of techniques and lack of databases and guidelines have led to possible misinterpretation of the clinical significance of sequence variants of BRCA1/2. A published study reported reclassification of some BRCA1/2 variants previously classified as variants of uncertain significance (VUS) to likely pathogenic in breast or ovarian cancer patients from Korea. However, little is known about the situation in Chinese population., Methods: We retrospectively retrieved 109 publications studying about BRCA1/2 variants of Chinese population from the year 1999 to year 2019 (March). After excluding publications of meta-analysis and publications with missing data, 72 publications were eventually retained for subsequent analysis. In total, 1,351 BRCA variants (673 BRCA1 variants and 678 BRCA2 variants) derived from 42,430 Chinese cancer patients were standardized and reinterpreted using ACMG/AMP 2015 guidelines and China Expert Consensus on BRCA variant interpretation by genetic counselors., Results: Among the 1,351 BRCA variants, the majority of interpretation (91.7%, 1,239/1,351) remained the same as previously published. However, there were 112 (8.3%, 112/1,351) variants (64 BRCA1, 48 BRCA2) reclassified with different categories., Conclusions: Our results demonstrated that clinical significance of not only VUS, but also pathogenic/likely pathogenic variants varied from time to time in the Chinese population. Precise reinterpretation of BRCA1/2 variants is of crucial importance to genetic counseling or clinical decision-making for risk individuals or patients.

Objective: To investigate the utility of a detailed medical history in the interpretation of chromosomal microarray results for pediatric patients with a constitutional disease., Study Design: A retrospective review and reinterpretation of test results from chromosomal microarrays performed from 2011 to 2013. Previously reported genetic variants were reanalyzed after review of the patient's complete electronic medical record (cEMR). A 3-tier system was used for reclassification of variants: pathogenic or likely pathogenic (P/LP); variant of uncertain significance (VUS); or benign or likely benign (B/LB)., Results: Over an 18-month period, 998 patients with chromosomal microarray results were identified. The most common reasons for chromosomal microarray testing were developmental delay (n = 336), autism spectrum disorder (n = 241), and seizures (n = 143). Chromosomal microarray testing identified 1 or more variants in 48% (482 of 998) of patients; 516 patients had a negative report. For the 482 patients with variants, the original interpretations were composed of 19.3% P/LP (93 of 482), 44.8% VUS (216 of 482), and 35.9% B/LB (173 of 482) variants. After review of the cEMR, 34% of patient results (164 of 482) were changed in interpretation. One case changed from B/LB to VUS, 7 VUS were upgraded to P/LP, and 156 VUS were downgraded to B/LB. No P/LP variants had a change in interpretation., Conclusions: Overall, 16.4% (164 of 998) of patients with chromosomal microarray testing had a change in interpretation. Access to the patient's cEMR improves the interpretation of chromosomal microarrays by decreasing the number of uncertain (VUS) interpretations., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Anterior interosseous nerve (AIN) syndrome is a rare disease whose pathophysiology is controversial. Despite efforts to elucidate the pathophysiology of AIN syndrome, it has not yet been resolved. We reinterpret electrodiagnostic studies, magnetic resonance imaging (MRI), and surgical findings to clarify the pathophysiology of AIN syndrome., Materials and Methods: In this retrospective case series, we included surgically treated 20 cases of nontraumatic AIN syndrome. Surgery was performed after a minimum of 12 weeks of conservative treatment. The clinical data and operation records were extracted from the medical records for analysis. All electrodiagnostic tests were reinterpreted by physicians with an American Board Certification in electrodiagnostic medicine. Moreover, every contrast-enhanced MRI performed during the assessment was reviewed by a musculoskeletal radiologist., Results: Of the twenty re-analyzed cases, nine AIN syndromes (45%) showed abnormal electromyography in non-AIN innervated muscles. Sensory nerve conduction studies were normal in all cases. Five magnetic resonance images (46%) showed signal changes in non-AIN-innervated muscles. Only four cases (20%) revealed definitive compression of the AIN during surgery., Conclusions: Electrodiagnostic study and MRI indicated that many patients with AIN syndrome exhibited a diffuse pathologic involvement of the motor component of the median nerve. We conclude that the main pathophysiology of AIN syndrome would be diffuse motor fascicle neuritis of the median nerve in the upper arm., Competing Interests: Conflict of interestThere are no conflicts of interest., (© Indian Orthopaedics Association 2020.)

The evolving evidence base for the interpretation of variants identified in genetic and genomic testing has presented the genetics community with the challenge of variant reinterpretation. In particular, it is unclear whether an ethical duty of periodic reinterpretation should exist, who should bear that duty, and what its dimensions should be. Based on an analysis of the ethical arguments for and against a duty to reinterpret, we conclude that a duty should be recognized. Most importantly, by virtue of ordering and conducting tests likely to produce data on variants that cannot be definitively interpreted today, the health-care system incurs a duty to reinterpret when more reliable data become available. We identify four elements of the proposed ethical duty: data storage, initiation of reinterpretation, conduct of reinterpretation, and patient recontact, and we identify the parties best situated to implement each component. We also consider the reasonable extent and duration of a duty, and the role of the patient's consent in the process, although we acknowledge that some details regarding procedures and funding still need to be addressed. The likelihood of substantial patient benefit from a systematic approach to reinterpretation suggests the importance for the genetics community to reach consensus on this issue.

Background: In recent years, the amount of genomic data produced in clinical genetics services has increased significantly due to the advent of next-generation sequencing. This influx of genomic information leads to continuous changes in knowledge on how genetic variants relate to hereditary disease. These changes can have important consequences for patients who have had genetic testing in the past, as new information may affect their clinical management. When and how patients should be recontacted after new genetic information becomes available has been investigated extensively. However, the issue of how to handle the changing nature of genetic information remains underexplored in a laboratory setting, despite it being the first stage at which changes in genetic data are identified and managed., Methods: The authors organized a 7-day online focus group discussion. Fifteen clinical laboratory geneticists took part. All (nine) Dutch clinical molecular genetics diagnostic laboratories were represented., Results: Laboratories in our study reinterpret genetic variants reactively, e.g. at the request of a clinician or following identification of a previously classified variant in a new patient. Participants currently deemed active, periodic reinterpretation to be unfeasible and opinions differed on whether it is desirable, particularly regarding patient autonomy and the main responsibilities of the laboratory. The efficacy of reinterpretation was questioned in the presence of other strategies, such as reanalysis and resequencing of DNA. Despite absence of formal policy regarding when to issue a new report for clinicians due to reclassified genetic data, participants indicated similar practice across all laboratories. However, practice differed significantly between laboratory geneticists regarding the reporting of VUS reclassifications., Conclusion: Based on the results, the authors formulated five challenges needing to be addressed in future laboratory guidelines: 1. Should active reinterpretation of variants be conducted by the laboratory as a routine practice? 2. How does reinterpretation initiated by the laboratory relate to patient expectations and consent? 3. When should reinterpreted data be considered clinically significant and communicated from laboratory to clinician? 4. Should reinterpretation, reanalysis or a new test be conducted? 5. How are reclassifications perceived and how might this affect laboratory practice?

Cognitive reappraisal and fear extinction learning represent two different approaches to emotion regulation. While their respective neural correlates have been widely studied with functional magnetic resonance imaging (fMRI), few direct comparisons between these processes have been conducted. We conducted a meta-analysis of fMRI studies of reappraisal and fear extinction, with the aim of examining both commonalities and differences in their neural correlates. We also conducted independent analyses that focused on specific reappraisal strategies (reinterpretation, distancing). Overall, we observed that the dorsal anterior cingulate cortex (dACC) and the bilateral anterior insular cortex (AIC) were similarly consistently engaged by reappraisal and extinction. Extinction was more consistently linked to activation of sensory and emotion processing regions, whereas reappraisal was more consistently associated with activation of a dorsal fronto-parietal network. Interestingly, the amygdala was preferentially deactivated by distancing. These results suggest that the dACC and the AIC are involved in domain-general regulatory networks. Differences between extinction and reappraisal could be explained by their relative processing demands on visual perceptual versus higher cognitive neural systems., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In two experiments, we examined the role of gesture in reinterpreting a mental image. In Experiment 1, we found that participants gestured more about a figure they had learned through manual exploration than about a figure they had learned through vision. This supports claims that gestures emerge from the activation of perception-relevant actions during mental imagery. In Experiment 2, we investigated whether such gestures have a causal role in affecting the quality of mental imagery. Participants were randomly assigned to gesture, not gesture, or engage in a manual interference task as they attempted to reinterpret a figure they had learned through manual exploration. We found that manual interference significantly impaired participants' success on the task. Taken together, these results suggest that gestures reflect mental imaginings of interactions with a mental image and that these imaginings are critically important for mental manipulation and reinterpretation of that image. However, our results suggest that enacting the imagined movements in gesture is not critically important on this particular task., (Copyright © 2019. Published by Elsevier B.V.)

Purpose: At our tertiary medical center, multidisciplinary subspecialists meet twice a week during a CME-accredited conference to discuss oncologic and non-oncologic patients with pancreatic diseases at which time a subspecialized abdominal staff radiologist reinterprets the patient's relevant imaging studies. This study assesses the changes in patient management due to imaging reinterpretation during multidisciplinary pancreas conference (MPC)., Materials and Methods: In this retrospective, IRB-approved, HIPAA-compliant study, imaging studies of all patients discussed at MPC between July 1 and December 31, 2015 were assessed for technical adequacy, and original reports analyzed for congruency with reinterpretation. Management measures included change in diagnosis, clinical stage, treatment, or workup. Additional data were obtained on referring services affected and their resultant change in practice. Changes in surgical resectability, surgical approach, or delayed operative dates were noted for surgeons. Changes in chemotherapeutic or radiation oncology regimens as well as decisions for additional imaging, laboratory workup, or histologic evaluation were also recorded., Results: A total of 252 patients were included (54.4% males, 45.6% females, mean age 63.71 years). Relevant imaging consisted of 142 abdominal CT scans, 112 abdominal MRI scans, 1 abdominal ultrasound, and 1 nuclear medicine octreotide study of which 69.4% were performed in-house. Image quality was deemed appropriate in 95.2%. Cases presented included solid pancreatic malignancies (n = 140; 55.6%), cystic pancreatic lesions (n = 41; 16.3%), acute and chronic inflammatory conditions (n = 52; 20.6%), and miscellaneous entities (n = 10; 4.0%); 9 (3.6%) cases were normal. Image reinterpretation was congruent with original reports in 56.7%, with minor, moderate, and major discrepancies occurring in 9.5, 26.2%, and 7.5% of cases, respectively. Incongruent reinterpretation was predominantly due to perceptional errors (false-negative reports due to missed findings) and interpretative errors (false-positive results due to over-reporting or misclassification of diagnoses). Services most commonly affected included surgical oncology, radiology, and gastroenterology at 16.7%, 13.1%, and 12.7% of cases, respectively. Management changes included a change in diagnosis in 8.7%, change in clinical stage in 8.7%, change in treatment in 17.9%, and further workup needed in 19.0% of patients, respectively. No change in management occurred in the remaining 61.5% of cases., Conclusions: Subspecialized abdominal radiologist reinterpretation in the context of more comprehensive patient information heavily impacts the multidisciplinary management of patients with pancreatic disorders. Further efforts are needed to solidify the abdominal radiologist's role in the multidisciplinary clinical setting.

More than 600 molecular crystal structures with correct, incorrect and uncertain space-group symmetry were energy-minimized with dispersion-corrected density functional theory (DFT-D, PBE-D3). For the purpose of determining the correct space-group symmetry the required tolerance on the atomic coordinates of all non-H atoms is established to be 0.2 Å. For 98.5% of 200 molecular crystal structures published with missed symmetry, the correct space group is identified; there are no false positives. Very small, very symmetrical molecules can end up in artificially high space groups upon energy minimization, although this is easily detected through visual inspection. If the space group of a crystal structure determined from powder diffraction data is ambiguous, energy minimization with DFT-D provides a fast and reliable method to select the correct space group.

Emotion regulation comprises all extrinsic and intrinsic control processes whereby people monitor, evaluate and modify the occurrence, intensity and duration of emotional reactions. Here we sought to quantitatively summarize the existing neuroimaging literature to investigate a) whether different emotion regulation strategies are based on different or the same neural networks; b) which brain regions in particular support the up- and down-regulation of emotions, respectively; and c) to which degree the neural networks realising emotion regulation depend on the stimulus material used to elicit emotions. The left ventrolateral prefrontal cortex (VLPFC), the anterior insula and the supplementary motor area were consistently activated independent of the regulation strategy. VLPFC and posterior cingulate cortex were the main regions consistently found to be recruited during the up-regulation as well as the down-regulation of emotion. The down-regulation compared to the up-regulation of emotions was associated with more right-lateralized activity while up-regulating emotions more strongly modulated activity in the ventral striatum. Finally, the process of emotion regulation appeared to be unaffected by stimulus material., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

People are adept at forming impressions of others, but how easily can impressions be updated? Although implicit first impressions have been characterized as difficult to overturn, recent work shows that they can be reversed through reinterpretation of earlier learning. However, such reversal has been demonstrated only in the same experimental session in which the impression formed, suggesting that implicit updating might be possible only within a brief temporal window, before impressions are consolidated and when memory about the initial information is strongest. Implicit impressions may be unable to be revised when reinterpreting details are learned later, due to memory consolidation or forgetting of the details to be reinterpreted. This study tested whether implicit first impressions can be reversed through reinterpretation after a two-day delay following the initial formation. Results showed that implicit revision emerged after the delay, even among those with poor explicit recall or who were not cued to recall. We discuss implications for theory on impression formation and updating.

Emotions are an indispensable part of our mental life. The term emotion regulation refers to those processes that influence the generation, the experience and the expression of emotions. There is a great variety of strategies to regulate emotions efficiently, which are used in daily life and that have been investigated by cognitive neuroscience. Distraction guides attention to a secondary task. Reinterpretation, a variant of cognitive reappraisal, works by changing the meaning of an emotional stimulus. Detachment, another reappraisal strategy, refers to distancing oneself from an emotional stimulus, thereby reducing its personal relevance. Expressive Suppression modifies the behavioral or physiological response to an emotional stimulus. These four strategies are not equally effective in terms of emotion regulation success and have been shown to partly rely on different neuronal systems. Here, we compare for the first time the neural mechanisms of these typical strategies directly in a common functional magnetic resonance imaging (fMRI) paradigm of downregulation of negative emotions. Our results indicate that three of those strategies (Detachment, Expressive Suppression and Distraction) conjointly increase brain activation in a right prefronto-parietal regulation network and significantly reduce activation of the left amygdala. Compared to the other regulation strategies, Reinterpretation specifically recruited a different control network comprising left ventrolateral prefrontal cortex and orbitofrontal gyrus and was not effective in downregulation of the amygdala. We conclude that Detachment, Distraction and Expressive Suppression recruit very similar emotion regulation networks, whereas Reinterpretation is associated with activation of a qualitatively different network, making this regulation strategy a special one. Notably, Reinterpretation also proved to be the least effective strategy in neural terms, as measured by downregulation of amygdala activation., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Semantic ambiguity resolution is an essential and frequent part of speech comprehension because many words map onto multiple meanings (e.g., "bark," "bank"). Neuroimaging research highlights the importance of the left inferior frontal gyrus (LIFG) and the left posterior temporal cortex in this process but the roles they serve in ambiguity resolution are uncertain. One possibility is that both regions are engaged in the processes of semantic reinterpretation that follows incorrect interpretation of an ambiguous word. Here we used fMRI to investigate this hypothesis. 20 native British English monolinguals were scanned whilst listening to sentences that contained an ambiguous word. To induce semantic reinterpretation, the disambiguating information was presented after the ambiguous word and delayed until the end of the sentence (e.g., "the teacher explained that the BARK was going to be very damp"). These sentences were compared to well-matched unambiguous sentences. Supporting the reinterpretation hypothesis, these ambiguous sentences produced more activation in both the LIFG and the left posterior inferior temporal cortex. Importantly, all but one subject showed ambiguity-related peaks within both regions, demonstrating that the group-level results were driven by high inter-subject consistency. Further support came from the finding that activation in both regions was modulated by meaning dominance. Specifically, sentences containing biased ambiguous words, which have one more dominant meaning, produced greater activation than those with balanced ambiguous words, which have two equally frequent meanings. Because the context always supported the less frequent meaning, the biased words require reinterpretation more often than balanced words. This is the first evidence of dominance effects in the spoken modality and provides strong support that frontal and temporal regions support the updating of semantic representations during speech comprehension.