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Background Alexithymia is a key transdiagnostic risk factor for emotion-based psychopathologies. Conceptual models specify that this is because alexithymia impairs emotion regulation. However, the extent of these putative emotion regulation impairments remains underexplored. Our aim in this study was to begin to address this gap by examining whether people with high, average, or low levels of alexithymia differ in the types of emotion regulation strategies they typically use. Method General community adults from the United States (N = 501) completed a battery of alexithymia and emotion regulation measures. Participants were grouped into high, average, and low alexithymia quantiles. Results After controlling for demographics and current levels of distress, the high, average, and low alexithymia groups differed in their use of cognitive and behavioral emotion regulation strategies. Compared to the other groups, the high alexithymia group reported lesser use of generally adaptive regulation strategies (cognitive reappraisal, approaching problems, and seeking social support) and greater use of generally maladaptive regulation strategies (expressive suppression, behavioral withdrawal, ignoring). Limitations Our data were cross-sectional and from self-report questionnaires. Future work in other cultural groups would be beneficial. Conclusions Our results support the view that alexithymia is associated with impaired emotion regulation. In particular, people with high alexithymia seem to exhibit a less adaptive profile of emotion regulation strategies. Direct targeting of these emotion regulation patterns in psychotherapy may therefore be a useful pathway for the treatment of emotional disorder symptoms in people with high alexithymia. Available online 23 December 2022

Emotion dysregulation (ED) is a common clinical feature of attention-deficit/hyperactivity disorder (ADHD). The present study examined the role of cognitive reappraisal (CR) and expressive suppression (ES) in adults with ADHD. In addition, resting-state fMRI (rs-fMRI) data were analyzed to identify neural substrates of CR/ES-ED relationships.A total of 309 adults with ADHD and 163 healthy controls were recruited. ED was assessed using the 'emotional control' (EC) subscale from Behavior Rating Inventory of Executive Function-Adult Version. The Emotion Regulation Questionnaire was used to measure CR and ES. The functional connectivities (FCs) with the amygdala as Region of Interest, were analyzed in a subsample to explore their association with CR, ES and EC, respectively.Higher EC scores (indicative of lesser emotional control), as well as lower CR and higher ES utilization were detected in adults with ADHD compared with healthy controls. CR and ES were both negatively correlated with EC in adults with ADHD. Mediation analysis detected a potential effect of ADHD diagnosis on EC via CR. In addition, a unique significant mediation effect was found between ES-related FC of the right amygdala-prefrontal cortex and ED expression in adults with ADHD, confirming the '↑ES → ↓FCsOnly self-reported scales and rs-fMRI data were included in these analyses.Our findings provide preliminary evidence that in adults with ADHD, less frequent use of CR accounts for ED expression, while more frequent use of ES may play a unique compensatory role in emotion regulation.

For the past 50 years, cognitive scientists have assumed that training attention and self-control must be effortful. However, growing evidence suggests promising effects of effortless training approaches such as nature exposure, flow experience, and effortless practice on attention and self-control. This opinion article focuses on effortless training of attention and self-control. We begin by introducing our definitions of effortful and effortless training and reviewing the growing literature on these two different forms of training. We then discuss the similarities and differences in their respective behavioral outcomes and neural correlates. Finally, we propose a putative neural mechanism of effortless training. We conclude by highlighting promising directions for research, development, and application of effortless training.

Specific phobia is characterized by elevated early attention to the phobic object, negative emotion, and avoidance. Typically, phobic objects are biologically relevant, such as potentially threatening snakes or spiders, or potentially contaminating needles or rodents. It is unclear whether the same early attention, emotion, and avoidance responses can be observed in phobia for uncommon, nonbiologically relevant objects, such as buttons (koumpounophobia). In an experimental case study, we measured early attention (detection rates to briefly presented images before a backward mask), emotion, and avoidance to clothing buttons in a button-phobic participant. We compared these responses to nonphobic objects (zippers), and to well-matched control participants. We observed elevated early attention, fear, and disgust to buttons, which did not generalize to nonphobic emotional stimuli. In addition, we observed elevated avoidance of buttons, which did generalize to normatively fearful and disgusting pictures. If replicated, our results indicate that nonbiologically prepared phobic objects elicit similar elevated early attention, emotion, and avoidance as biologically prepared phobic objects. The finding that avoidance was the only response that generalized to nonphobic objects may have treatment implications—namely, that therapeutic attempts to reduce avoidance might consider including a variety of objects, not just the phobic object.

People form a variety of beliefs about themselves that often carry positive or negative valence (e.g. being confident versus awkward). We suggest that, like other complex systems, the self can be modeled as a network composed of nodes (self-beliefs) and connections between them. We describe how self-network organization may vary between individuals and within individuals over time, and highlight the implications of this variation for affective experience. We further articulate how the self-network emerges from dynamic interactions between large-scale brain networks including the default mode network, valuation network, and frontoparietal control network. Finally, we discuss how a network perspective on the self may provide new insights into the mechanisms that underlie cognitive behavioral therapy and mindfulness-based approaches to affective disorders.

Background . Cognitive-behavioral therapy and mindfulness-based stress reduction (MBSR) are two prominent evidence-based treatments for social anxiety disorder (SAD). It is not clear, however, whether outcomes of these two treatments are moderated by similar factors. For example, whereas anger suppression and anger expression each predict outcomes in cognitive- behavioral group therapy (CBGT), it is unknown whether they differentially influence outcomes in CBGT versus MBSR. Methods . One hundred eight participants with SAD were randomized to CBGT, MBSR or Waitlist (WL). WL participants were later randomized to CBGT or MBSR, and their data were combined with data from those originally randomized to CBGT or MBSR. Anger suppression and anger expression were assessed at pre-treatment, and social anxiety was assessed at pre-treatment, post-treatment, and every 3 months throughout a 12-month follow-up period. Results . From pre- to post-treatment, higher anger suppression was associated with significantly greater reduction in social anxiety in CBGT compared with MBSR. From post-treatment through follow-up, higher anger expression was associated lesser reduction in social anxiety in MBSR but not in CBGT. Limitations . Data are limited by sole reliance on self-report and it is unclear whether these findings generalize beyond group-based interventions. Conclusions . Individuals with SAD who are higher in anger suppression and/or expression might be better suited to CBGT than MBSR.

The NLRP3 inflammasome is an important player in innate immunity and pathogenic inflammation. Numerous studies have implicated it in sensing endogenous danger signals, yet the precise mechanisms remain unknown. Here, we review the current knowledge on the organismal and cellular metabolic triggers engaging NLRP3, and the mechanisms involved in integrating the diverse signals.

This study examined whether expressive suppression (ES), a maladaptive regulation strategy, was more strongly associated with PTSD diagnosis and symptom clusters in veterans than cognitive reappraisal (CR), an adaptive regulation strategy.In a cohort study, 746 participants recruited from VHA facilities completed Clinician Administered PTSD Scale-IV, Emotion Regulation Questionnaire, and Patient Health Questionnaire. Participants were categorized into groups: Current, Remitted/Lifetime, and Never PTSD.One-way ANOVA revealed significant differences between Current PTSD and both Remitted and Never PTSD for ES, but not CR. The Remitted and Never PTSD groups did not vary significantly from each other and were collapsed into one group for regressions. Adjusting for sex, race, employment, and comorbid depression, binary logistic regression showed ES, but not CR, was associated with increased likelihood of Current PTSD (p.001, OR: 1.43). ES was also significantly associated with increased odds of meeting criteria for all symptom clusters (ps0.001). CR was not significantly associated with meeting criteria for Current PTSD or any symptom cluster.Cross-sectional design and use of self-report limit causality inferences that can be drawn.ES is associated with increased odds of Current PTSD diagnosis and symptom clusters. Veterans in the Remitted and Never PTSD groups did not differ significantly. Greater suppression of emotional expression is more strongly linked with PTSD criteria in veterans than decreased cognitive reappraisal.

The lymph node ratio (LNR), which represents the proportion of metastatic lymph nodes resected, has been found to be a prognostic variable in several cancers, but data for Medullary thyroid carcinoma (MTC) are sparse. The aim of this study was to determine the value of the LNR in predicting outcome in patients with MTC.A retrospective multicenter study design of 107 patients with MTC who underwent total thyroidectomy with neck dissection between 1984 and 2016. The association of LNR with patient and tumor characteristics and prognostic factors was evaluated.Study population consisted of 53.3% female, mean age at diagnosis was 50.3 ± 18.4 years; 16.8% had inherited MTC. LNR was positively correlated with tumor size (p = 0.018) and inversely correlated with age at diagnosis (p = 0.024). A higher LNR was associated with extrathyroidal extension (p 0.001), multifocality (p = 0.001), bilateral tumor (p = 0.002), distant metastases (p 0.001), and tumor recurrence (OR = 14.7, p 0.001). LNR was also correlated to postoperative calcitonin levels (p 0.001) and carcinoembryonic antigen (p = 0.011). LNR0.1 was associated with shorter disease-specific survival in patients at risk: tumor larger than 20 mm at diagnosis (p = 0.013), sporadic MTC (p = 0.01), and age above 40 years at diagnosis (p = 0.004). Cox multivariate survival analysis revealed LNR as the only significant independent factor for disease free survival (p = 0.005).This study showed that LNR correlates well with patient and tumor characteristics and prognostic variables. We suggest that LNR should be considered an important parameter for predicting outcome in MTC.

Objective Von Hippel-Lindau (VHL) syndrome is a rare and complex disease. We described in 1996 a three generation VHL 2A kindred with 11 mutation carriers. We aim to share our experience regarding the long-term follow-up of this family and the management of all our other VHL patients focusing on frequently encountered neuroendocrine tumors: pheochromocytoma/paraganglioma and pancreatic neuroendocrine neoplasms (PNEN). Methods All VHL patients in follow-up at our tertiary center from 1980 to 2019 were identified. Clinical, laboratory, imaging and therapeutic characteristics were retrospectively analyzed. Results We identified 32 VHL patients in 16 different families, 7/16 were classified as VHL 2 subtype. In the previously described family, the 4 initially asymptomatic carriers developed a neuroendocrine tumor; 7 new children were born, 3 of them being mutation carriers; 2 patients died, one due to metastatic PNEN-related liver failure. Pheochromocytoma was frequent (22/32), bilateral (13/22;59%), often diagnosed in early childhood when active screening was timely performed, associated with paraganglioma in 5/22, rarely malignant (1/22) and recurred after surgery in some cases after more than 20 years. PNEN occurred in 8/32 patients (25%), and was metastatic in three. Surgery and palliative therapy allowed relatively satisfactory outcomes. Severe disabling morbidities due to central-nervous system and ophthalmologic hemangiomas, and other rare tumors as chondrosarcoma in 2 patients and polycythemia in 1 patient were observed. Conclusions Multidisciplinary approach and long-term follow-up is mandatory in VHL patients to manage the multiple debilitating morbidities and delay mortality in these complex patients.

Synovial chondromatosis (SC) is an infrequent, benign condition of unknown etiology affecting the synovium within articular joints. Often considered a metaplastic process, multiple cartilaginous nodules develop in the confines of the synovial membrane. In time, these cartilage nodules develop into fragments, sometimes detaching from the synovium and, thus, become loose in an adjacent synovial cavity. The temporomandibular joint (TMJ) is an unusual site of involvement, with the extracapsular compromise of the cranial base exceedingly rare. A 68-year-old woman presented with a tender mass to the left TMJ that later proved to be SC. Computed tomography illustrated a rare extension of the lesion into the middle cranial fossa. The multidisciplinary effort to remove the mass in its entirety included both oral and maxillofacial surgical and neurosurgical teams. We have reviewed the presentation, diagnosis, surgical treatment, and outcomes of the present case, with diagnostic images and photomicrographs of the lesion included. We also briefly reviewed the reported studies.

Objective Our goal was to identify aspects of residency applications predictive of subsequent performance during pediatric internship. Methods We conducted a retrospective cohort study of graduates of US medical schools who began pediatric internship in a large pediatric residency program in the summers of 2013 to 2017. The primary outcome was the weighted average of subjects’ Accreditation Council for Graduate Medical Education pediatric Milestone scores at the end of pediatric internship. To determine factors independently associated with performance, we conducted multivariate linear mixed-effects models controlling for match year and Milestone grading committee as random effects and the following application factors as fixed effects: letter of recommendation strength, clerkship grades, medical school reputation, master's or PhD degrees, gender, US Medical Licensing Examination Step 1 score, Alpha Omega Alpha membership, private medical school, and interview score. Results Our study population included 195 interns. In multivariate analyses, the aspects of applications significantly associated with composite Milestone scores at the end of internship were letter of recommendation strength (estimate 0.09, 95% confidence intervals [CI]: 0.04, 0.15), numbers of clerkship honors (est. 0.05, 95% CI: 0.01–0.09), medical school ranking (est. 0.04, 95% CI: 0.08–0.01), having a master's degree (est. 0.19, 95% CI: 0.03–0.36), and not having a PhD (est. 0.14, 95% CI: 0.02–0.26). Overall, the final model explained 18% of the variance in milestone scoring. Conclusions Letter of recommendation strength, clerkship grades, medical school ranking, and having obtained a Master's degree were significantly associated with higher clinical performance during pediatric internship.

Background An estimated 38% of US adults are obese. Obesity is associated with socioeconomic disparities and increased rates of comorbidities, and is a known risk factor for development of pancreatic cancer. As a fourth leading cause of death in the United States, pancreatic cancer is commonly treated with a pancreatico-duodenectomy (PD), or Whipple procedure. Data regarding the effects of obesity on post-operative complication rate primarily comes from specialized centers, however the results are mixed. Our aim is to elucidate the effects that obesity has on outcomes after PD for pancreatic head cancer using a national prospectively maintained clinical database. Method The 2010–2015 American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Files (PUF) were used as the data source. We identified cases in which PD was performed (CPT code 48150) in the setting of a postoperative diagnosis of pancreatic cancer (ICD9 code 157.0). We excluded cases that had emergency admissions, BMI ≤18.5 kg/m2, intraoperative wound classification of III or IV, and disseminated cancer. Cases with missing BMI, preoperative albumin, operative time, LOS data were also excluded. Multiple imputation for missing sex, race, functional status, and ASA classification using chained equations was performed.16 Patients that had BMI ≥30 kg/m2 were considered obese, and patients with BMI Results 3484 patients underwent pancreaticoduodenectomy for pancreatic cancer. 860 patients were identified as obese. Propensity score analysis was performed matching age, sex, race, functional status, presence of dyspnea, diabetes, hypertension, acute renal failure, dialysis dependence, ascites, steroid use, bleeding disorders, history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), weight loss, American Society of Anesthesiologists (ASA) classification, and preoperative albumin levels. After matching, obese patients had higher risk of 30-day postoperative complications compared to control, including organ space wound infections (OR 1.38, 95% CI 1.07–1.79, p = 0.0128), returning to the operating room (OR 1.39, 95% CI 1.01–1.91, p = 0.0461), failure to extubate for greater than 48 h (OR 1.60, 95% CI 1.09–2.34, p = 0.0153), death (OR 1.68, 95% CI 1.01–2.78, p = 0.0453), septic shock (OR 2.22, 95% CI 1.46–3.38, p = 0.0002), pulmonary embolism (OR 2.42, 95% CI 1.07–5.45, p = 0.0332), renal insufficiency (OR 2.67, 95% CI 1.33–5.38, p = 0.0058). Sensitivity analysis yielded similar results with the exception of risk for return to the operating room, death, and pulmonary embolism, P > .05. Conclusion In this large observational study using a national clinical database, obese patients undergoing PD for head of pancreas cancer had increased risk of postoperative complications and mortality in comparison to controls.

Emotion regulation (ER) strategies are thought to contribute to mental as well as physical health outcomes. Two common ER strategies include expressive suppression, or inhibition of emotional expression, and cognitive reappraisal, which involves changing how to think about an emotion-eliciting event in order to change its emotional impact. Recent reports have hypothesized that one potential way in which ER may be linked to health outcomes is via the immune system. However, information on this putative link is scarce. The present study aims to explore whether peripheral inflammatory biomarkers are associated with individual differences in ER-strategy use. Participants (n = 117) from the Midlife in the United States II (MIDUS II) study completed the Emotion Regulation Questionnaire (ERQ), and provided a blood sample for immune biomarker extraction including interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), E-selectin, Intercellular Adhesion Molecule-1 (ICAM-1), and fibrinogen. Results showed higher levels of expressive suppression were associated with decreased IL-10, TNF-α, and ICAM-1 levels (controlling for age, sex, BMI, total prescribed medications, and depressive symptoms). Consistent with these findings, hierarchical regression results identified TNF-α as a significant predictor of expressive suppression use. In contrast, no inflammatory markers were associated with predicted use of cognitive reappraisal. Our findings suggest a link between inflammation and specific ER-strategy use. Future research should consider the effects of pro-vs. anti-inflammatory cytokines on adaptive ER and subsequent mental and physical health.

We consider two cantilevered beams undergoing frictional impacts at the free end. The beams are designed to be of similar geometry so that they have distinct but close natural frequencies. Under harmonic base excitation near the primary resonance with the higher-frequency fundamental bending mode, the system shows a strongly modulated non-periodic response. The purpose of this work is to analyze to what extent the non-periodic vibro-impact dynamics can be predicted. To this end, we use a recently developed modeling and simulation approach. The approach relies on component mode synthesis, the massless boundary concept and an appropriate time stepping scheme. Unilateral contact and dry friction are modeled as set-valued laws and imposed locally within the spatially resolved contact area. A linear model updating is carried out based on the natural frequencies and damping ratios identified in the regime without impacts. The nonlinear simulation of the steady-state response to forward and backward stepped sine excitation is compared against measurements. The results are in very good agreement, especially in the light of the uncertainty associated with the observed material loss in the contact region and the nonlinear behavior of the clamping.

Compared to the general population, individuals with multiple sclerosis (MS) report higher levels of insomnia, depression, fatigue, and paresthesia, and lower levels of emotional competencies (understanding emotions in self and others). Available treatments are limited, and novel approaches to reducing symptoms and enhancing emotional competencies in MS are needed. Two potentially beneficial treatments are Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR). The aim of the present study was to investigate the impact of ACT and MBSR on symptoms and emotional competencies in patients with MS.A total of 76 individuals with MS (81.6% females; mean age: 38.88 years; EDSS median: 2; range: 0-5) were randomly assigned to an 8-week ACT treatment, an 8-week MBSR treatment, or a wait-list control condition. At baseline and study-end (week 8), participants completed a series of questionnaires covering symptoms and emotional competencies. At mid-term (week 4), participants rated their insomnia and depression.Over time, symptoms of MS decreased (medium effect size for insomnia, fatigue, and paresthesia, and large effect size for depression) and emotional competencies improved (large effect size), but more so in the MBSR and ACT conditions, compared with the control condition. At study-end, the outcome improvement did not differ between the ACT and MBSR conditions.Both ACT and MBSR led to reduced symptoms and enhanced emotional competencies. Psychotherapeutic interventions such as these should be considered as a means of decreasing symptoms and increasing emotional competencies among individuals with MS.

Treatment of lower urinary tract symptoms secondary to benign prostatic obstruction may affect ejaculatory function. However, preservation of ejaculation via minimally invasive surgical therapies might impair the long-term durability of voiding improvement.

Social anxiety disorder (SAD) has been shown to be associated with difficulty in the ability to vicariously share others' positive emotions (positive affective empathy). Mixed evidence also suggests potentially impaired recognition of the positive and negative emotions of others (cognitive empathy) and impaired or enhanced sharing of the negative emotions of others (negative affective empathy). Therefore, we examined whether two efficacious treatments for SAD, cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR), improve empathy in SAD relative to a wait-list condition and whether improvements in empathy mediate improvements in social anxiety. In the context of a randomized controlled trial, participants with SAD completed an empathy task at baseline, posttreatment/wait-list (N = 81), and 1-year follow-up (N = 37). Relative to both MBSR and wait-list, CBGT resulted in significant improvements in positive affective empathy. CBGT-related changes in positive affective empathy also mediated improvements in social anxiety at both posttreatment/wait-list and at 1-year follow-up. Other indices of empathy did not change differentially across the three conditions. Therefore, one way in which CBGT may specifically confer benefits to individuals with SAD is through increasing their ability or willingness to share in the positive emotions of others.

Progress in and better understanding of cancer biology causes a shift in cancer drug development: away from the evaluation of drugs in large tumour histology defined patient populations towards targeted agents in increasingly heterogeneous molecularly defined subpopulations. This requires novel approaches in clinical trial design by academia and industry, and development of new assessment tools by regulatory authorities. Pharmaceutical industry is developing new targeted agents generating many clinical studies, including target combinations. This requires improved operational efficiency by development of innovative trial designs, strategies for early-stage decision making and early selection of candidate drugs with a high likelihood of success. In addition, patient awareness and ethical considerations necessitate that agents will be rapidly available to patients. Regulatory Authorities such as the European Medicine Agency and national agencies recognise that these changes require a different attitude towards benefit-risk analysis for drug approval. The gold standard of randomised confirmatory Phase III trials is not always ethical or feasible when developing drugs for treatment of small cancer populations. Alternative strategies comprise accelerated approval via conditional marketing approval, which can be granted in the EU based on small non-randomised Phase II trials. The paper describes innovative trial designs with their pros and cons and efforts of pharmaceutical industry and regulatory authorities to deal with the paradigm shift. Furthermore, all stakeholders should continue to share their experiences and discuss problems in order to understand the position and concerns of the other stakeholders to learn from each other and to progress the field of novel oncology clinical trial design.

Recent advances in additive manufacturing at small scales has revealed the exceptional mechanical properties that can be achieved by truss-lattice materials. This study investigates the response of four topologically distinct truss-lattice architectures to the inclusion of defects in order to elucidate how defects influence the elastic properties of these materials. Numerical results from finite element models of periodic beam networks with missing building blocks are compared to both analytical continuum models with a micromechanical basis and to experiments with characteristic feature sizes on the nano and micro scales. Notably, this comparison reveals that the elastic properties of highly connected lattice-truss materials respond to defects in the same manner as homogeneous materials.

Background The prescribing practices of dental professionals may play an important role in the opioid epidemic. The authors performed a scoping review of the current original research literature on dental professionals’ prescribing practices for opioid analgesics published from 2000 through 2017. Types of Studies Reviewed With the use of a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, the inclusion criteria entailed published articles written in English that had an opioid focus, had a dental health care professional prescriber, entailed a US setting, were peer reviewed, had an identified data source, were not review articles, and were not opinion articles. Five databases were searched to identify relevant literature. Results Of 221 articles, 18 met the inclusion criteria. Eight distinct and mutually exclusive themes emerged from these studies: impact of patient demographic characteristics on opioid prescribing, comparison of opioid prescribing by different provider type, quantity of opioids prescribed and consumed, types of opioids prescribed by dental professionals, assessment of self-reported opioid prescribing, opioid prescriptions by procedure, impact of pharmacy integration into dental practice, and implementation of risk mitigation strategies. Conclusions and Practical Implications There is a surprising paucity of research that investigated the prescribing patterns of dentists. Available research suggests that dental practice does not always align with proposed guidelines for opioid prescribing. Some studies that explored interventions found changes in prescribing, suggesting the potential benefit of developing practical strategies targeted to dental providers who prescribed opioids.

Purpose/Objective(s) The International Prostate Symptom Score (I-PSS) is a widely used tool for the evaluation of patient-reported lower urinary tract symptoms (LUTS). Urologists and Radiation Oncologists frequently use the I-PSS to help determine a prostate cancer patient's eligibility for a type of treatment, and to follow up quality-of-life outcomes after treatment. I-PSS is also used to define clinical trial eligibility criteria, and is a common means of comparing patient-reported outcomes between studies. The I-PSS is almost 30 years old and has not been modified in the light of contemporary understandings of patient communication. We sought to assess the degree of patient understanding of I-PSS questions by nursing verification at the time of the patient visit. Materials/Methods Men with prostate cancer self-completed an online I-PSS questionnaire approximately one week prior to their visit with the physician. On the day of the visit, a nurse reviewed each I-PSS question with the patient to ensure they understood it, and then verified patient answers. Patient initial scores and nurse-verified scores were recorded, and the results analyzed for discrepancies. Results I-PSS scores were recorded for 105 men. Complete concordance between patient and nursing scores on all questions was reported for 62 men (59%; 95% C.I. 49%, 69%). The frequency of discordance was highest for urgency (20%), incomplete emptying (22%) and frequency (21%), with lower rates for intermittency (17%), nocturia (15%), weak stream (12%) and straining (7.6%). There was evidence that patients overstated scores compared to nurses for frequency (P = 0.010), weak stream (P = 0.036) and incomplete emptying (P = 0.012); for other domains, there was no evidence for either nurse or patient scores being higher (P≥0.3 for all). For incomplete emptying, nurse scores were lower for 19 men, 15 of whom had a score reduced to zero; for frequency, scores were lower for 14, with 7 reduced to zero. Conclusion Patient I-PSS scores were moderately concordant with scores obtained after nursing review and verification. Some men appear to have had a poorer understanding of the questionnaire, particularly with respect to items concerning incomplete emptying and frequency. Consideration should be given to rewording the I-PSS to improve patient understanding.

Advances in additive manufacturing have enabled a new generation of materials with advantageous properties inherent to their architecture. Recently, architected materials with periodic arrangements of plates, called plate-lattice materials, have been developed to reach theoretical least upper bounds for stiffness and strength of isotropic materials. This work investigates the buckling behavior of several plate-lattice architectures with relative densities between 0.5% to 25% when subjected to uniaxial compression. Finite element unit cell models with shell elements and periodic boundary conditions are used to simulate the buckling and post-buckling behavior of plate-lattices made from an elastic-perfectly plastic parent material. Five plate-lattice architectures with cubic symmetry are investigated - three anisotropic architectures (simple cubic, body-centered cubic, face-centered cubic) and two isotropic architectures (simple cubic and body-centered cubic combination, simple cubic and face-centered cubic combination). Geometric imperfections of varying amplitude are applied to determine the imperfection sensitivity of these plate-lattice materials, and to calculate their buckling knockdown factors. Consistent with the behavior of the elastic-plastic plate building blocks that comprise the lattice, this investigation reveals that plate-lattice materials are generally imperfection insensitive when their constituent plates become thinner and first bifurcation occurs in the elastic range away from the yield stress. When this occurs, the initial post-buckling behavior is stable and the ultimate strength can be many times higher than the initial buckling stress. (C) 2021 Published by Elsevier Ltd.

Purpose Reproducibility of quantitative perfusion analysis of DCE requires a standardized AIF acquisition. However, there are many different approaches for AIF assessment so that the absolute values of perfusion parameters may vary depending on the used method. This study analyzes the influence of the method of AIF determination on quantitative DCE-MRI. Methods In this retrospective, single-center, cohort study three different methods of AIF determination in 50 consecutive patients with multiparametric MRI of the prostate were conducted. As a reference, AIF was selected manually by defining a region of interest in an artery manually (AIFm). The second method (AIFa), based on an automated algorithm and the third, population-derived AIFp where then compared. Primary endpoint were differences in the performance of the perfusion parameters Ktrans, ve and kep regarding the AIF acquisition methods, secondary endpoints consisted of the evaluation of differences in the peripheral and transition zone of the prostate (PZ, TZ). Results In all three methods, Ktrans, ve, and kep were significantly higher in PZ than in TZ with Ktrans showing least overlapping. There were no significant differences for Ktrans determined with AIFm and AIFa (0.3 ± 0.2 min−1 for PZ for both and 0.5 ± 0.3 min−1 for TZ in AIFm and 0.4 ± 0.3 min−1 in AIFa), while there were great differences between AIFa and AIFp and AIFm and AIFp (0.1 ± 0.03 min−1 for TZ and PZ in AIFp). Spearman test demonstrated good correlation of values for Ktrans and kep in all 3 methods (ρ ≥ 0.76). AIFa showed a success rate of 98% in finding the artery. Conclusion AIFa is a recommendable user-independent automatical method to determine quantitative perfusion parameters allowing an objective measurement and saving interactive time for the radiologist. AIFp may be applied as second alternative method.

Middle-aged and older adults constitute a high suicide risk group. Among adults aged 50 years old and older, suicide rates increased and suicide deaths almost doubled during the period from 2000 to 2015. Suicide rates are elevated for patients hospitalized for suicidality (i.e. active suicidal ideation or suicide attempt) and the three months post-hospitalization is the time of the highest suicide risk. Psychosocial interventions for middle-aged and older adults hospitalized for suicidality are sparse. In this article, we present the main aspects, stages, techniques and a clinical case study of Cognitive Reappraisal Intervention for Suicide Prevention (CRISP), a psychosocial intervention targeting cognitive reappraisal to reduce suicide risk in middle-aged and older adults who have been recently hospitalized for suicidal ideation or suicide attempt. CRISP is based on the theory that hospitalization for suicidality is preceded by an emotional crisis (“perfect storm”); this emotional crisis is related to personalized (patient- and situation-specific) triggers; and identifying these personalized triggers and the associated negative emotions and providing strategies for an adaptive response to these triggers and negative emotions will reduce suicidal ideation and improve suicide prevention. CRISP therapists identify these triggers of negative emotions and employ cognitive reappraisal techniques to reduce these negative emotions. The cognitive reappraisal techniques have been selected from different psychosocial interventions and the affective neuroscience literature and have been simplified for use with middle-aged and older adults. CRISP may fill a treatment need for the post-discharge high risk period for middle-aged and older adults hospitalized for suicidality.

We examined (1) differences between controls and patients with social anxiety disorder (SAD) in emotional clarity and attention to emotions; (2) changes in emotional clarity and attention to emotions associated with cognitive-behavioral group therapy (CBGT), mindfulness-based stress reduction (MBSR), or a waitlist (WL) condition; and (3) whether emotional clarity and attention to emotions moderated changes in social anxiety across treatment. Participants were healthy controls (n = 37) and patients with SAD (n = 108) who were assigned to CBGT, MBSR, or WL in a randomized controlled trial. At pretreatment, posttreatment, and 12-month follow-up, patients with SAD completed measures of social anxiety, emotional clarity, and attention to emotions. Controls completed measures at baseline only. At pretreatment, patients with SAD had lower levels of emotional clarity than controls. Emotional clarity increased significantly among patients receiving CBGT, and changes were maintained at 12-month follow-up. Emotional clarity at posttreatment did not differ between CBGT and MBSR or between MBSR and WL. Changes in emotional clarity predicted changes in social anxiety, but emotional clarity did not moderate treatment outcome. Analyses of attention to emotions were not significant. Implications for the role of emotional clarity in the treatment of SAD are discussed.

People frequently do not regulate their emotions even when doing so would be adaptive. Further, people often use maladaptive emotion regulation strategies, despite knowledge of more adaptive strategies. We propose that such anomalies can be explained at least in part by the orienting attention/action readiness (OAAR) framework according to which people are more likely to implement a particular emotion regulation strategy when (1) they direct a sufficient level orienting attention towards initiating it, and/or (2) they have a sufficient level of action readiness with respect to that strategy because they have recently/frequently implemented it in similar contexts. We provide evidence for the OAAR framework and discuss how it might be leveraged to promote more effective regulation of undesirable emotions.

Background Major depressive disorder (MDD) is characterized by maladaptions in affective brain circuitry and in emotion regulation. It remains unknown whether these maladaptions characterize first-degree relatives of probands who are unaffected yet have a higher risk of developing MDD. Methods Participants were 72 unaffected first-degree relatives of probands with MDD and 66 matched non-relative controls. We investigated brain circuit function and self-reported emotion regulation strategies for reappraisal and suppression. During functional magnetic resonance imaging, we probed circuitry relevant to both negative and positive valence systems using facial expressions signaling potential threat, sadness and happiness, presented under both conscious and subliminal viewing conditions. We compared groups using a statistically controlled region of interest (ROI) approach including the amygdala, insula, anterior cingulate cortex (ACC), ventromedial prefrontal cortex and dorsolateral prefrontal cortex. We also used a data-driven cluster analytic approach for characterizing the relatives by their brain function profiles. Results As a group, relatives were distinguished by hyper-reactivity of the pregenual ACC during subliminal viewing of threat-related expressions but hypo-activation of the amygdala, insula and dorsal ACC during explicit viewing of the same threat-related expressions and sadness. When considered individually, this brain function profile characterized two-thirds of relatives, and these relatives were also less likely to use reappraisal to regulate negative emotion. Limitations The design was cross-sectional and therefore does not provide direct evidence as to the trait- (versus state-) like profile observed in relatives. Conclusions Familial risk for MDD may involve a disruption to the normal recruitment of neural circuits for appraising salient emotions, both implicit and explicit. Interventions targeting reappraisal strategies for regulating negative emotion may serve to buffer this risk.

The prevalence and impact of child maltreatment make the scientific investigation of this phenomenon a matter of vital importance. Prior research has examined associations between problematic patterns of parents' emotion reactivity and regulation and child maltreatment and maltreatment risk. However, the strength and specificity of these relationships is not yet clear. To address this, we conducted a systematic literature search of four databases from inception through February 2021 to identify studies that reported these relationships. Our resulting meta-analysis of maltreatment involved parents of children who are up to 18 years of age (k = 46, encompassing 6669 parents). Our focus was the magnitude of the difference in levels of emotion reactivity and regulation between parents who maltreat or are at risk of maltreating and parents who do not maltreat their children or are not at risk of maltreating their children. As expected, results from meta-analyses using robust variance estimation indicated significantly higher problems with reactivity and regulation in maltreating parents / parents at risk (r = 0.40, k = 140; 95% CI [0.34, 0.45]), indicating that maltreating / at risk parents were more likely to have overall worse measures of reactivity and regulation. In comparison to non-maltreating parents, maltreating / at risk parents experience more negative emotions, display more negative emotion behavior, and are more dysregulated. These effects were fairly stable with little to no remaining heterogeneity. The current review concludes with a theoretical framework outlining the role of emotion reactivity and regulation in multiple risk factors of maltreatment, aiming to guide future study in this area.

Loneliness is a risk factor for mental disorders and is a significant and growing public health issue, but to date, loneliness interventions have had limited success. We propose that an emotion regulation perspective might be useful for understanding loneliness and for suggesting new treatment targets. In this study, our aim was to test the basis for this proposal by examining whether individual differences in emotion regulation strategy use can explain significant variance in loneliness, and to establish what profile of strategy use might characterize loneliness. We administered a comprehensive battery of loneliness and emotion regulation questionnaires to 501 adults. In a regression model, emotion regulation strategy use accounted for over half (52.2%) the variance in loneliness. A latent profile analysis revealed four profiles, with the “high loneliness” profile characterized cognitively by greater use of rumination, catastrophising, blame-attribution, and lesser use of cognitive reappraisal type strategies. Behaviorally, loneliness was characterised by greater use of expressive suppression, and regulating emotions by actively rejecting or withdrawing from others. We conclude that individual differences in emotion regulation may play an important role in explaining loneliness, and could therefore represent a promising treatment target.

Background Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS. Methods The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed. Results Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS. Conclusion In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.