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Exposure to socioeconomic disadvantages (SED) can have negative impacts on mental health, yet SED are a multifaceted construct and the precise processes by which SED confer deleterious effects are less clear. Using a large and diverse sample of preadolescents (ages 9–10 years at baseline, n = 4038, 49% female) from the Adolescent Brain Cognitive Development Study, we examined associations among SED at both household (i.e., income–needs and material hardship) and neighborhood (i.e., area deprivation and neighborhood unsafety) levels, frontoamygdala resting-state functional connectivity, and internalizing symptoms at baseline and 1-year follow-up. SED were positively associated with internalizing symptoms at baseline and indirectly predicted symptoms 1 year later through elevated symptoms at baseline. At the household level, youth in households characterized by higher disadvantage (i.e., lower income-to-needs ratio) exhibited more strongly negative frontoamygdala coupling, particularly between the bilateral amygdala and medial OFC (mOFC) regions within the frontoparietal network. Although more strongly positive amygdala–mOFC coupling was associated with higher levels of internalizing symptoms at baseline and 1-year follow-up, it did not mediate the association between income-to-needs ratio and internalizing symptoms. However, at the neighborhood level, amygdala–mOFC functional coupling moderated the effect of neighborhood deprivation on internalizing symptoms. Specifically, higher neighborhood deprivation was associated with higher internalizing symptoms for youth with more strongly positive connectivity, but not for youth with more strongly negative connectivity, suggesting a potential buffering effect. Findings highlight the importance of capturing multilevel socioecological contexts in which youth develop to identify youth who are most likely to benefit from early interventions.

The Adolescent Brain Cognitive Development (ABCD) Study® is a 10-year longitudinal study of children recruited at ages 9 and 10. A battery of neuroimaging tasks are administered biennially to track neurodevelopment and identify individual differences in brain function. This study reports activation patterns from functional MRI (fMRI) tasks completed at baseline, which were designed to measure cognitive impulse control with a stop signal task (SST; N = 5,547), reward anticipation and receipt with a monetary incentive delay (MID) task (N = 6,657) and working memory and emotion reactivity with an emotional N-back (EN-back) task (N = 6,009). Further, we report the spatial reproducibility of activation patterns by assessing between-group vertex/voxelwise correlations of blood oxygen level-dependent (BOLD) activation. Analyses reveal robust brain activations that are consistent with the published literature, vary across fMRI tasks/contrasts and slightly correlate with individual behavioral performance on the tasks. These results establish the preadolescent brain function baseline, guide interpretation of cross-sectional analyses and will enable the investigation of longitudinal changes during adolescent development. This paper reports activation patterns for fMRI tasks assessing response inhibition, working memory and reward processing obtained at baseline in the longitudinal ABCD Study, providing a reference for research into adolescent brain development.

Are intelligence and creativity distinct abilities, or do they rely on the same cognitive and neural systems? We sought to quantify the extent to which intelligence and creative cognition overlap in brain and behavior by combining machine learning of fMRI data and latent variable modeling of cognitive ability data in a sample of young adults (N = 186) who completed a battery of intelligence and creative thinking tasks. The study had 3 analytic goals: (a) to assess contributions of specific facets of intelligence (e.g., fluid and crystallized intelligence) and general intelligence to creative ability (i.e., divergent thinking originality), (b) to model whole-brain functional connectivity networks that predict intelligence facets and creative ability, and (c) to quantify the degree to which these predictive networks overlap in the brain. Using structural equation modeling, we found moderate to large correlations between intelligence facets and creative ability, as well as a large correlation between general intelligence and creative ability (r = .63). Using connectome-based predictive modeling, we found that functional brain networks that predict intelligence facets overlap to varying degrees with a network that predicts creative ability, particularly within the prefrontal cortex of the executive control network. Notably, a network that predicted general intelligence shared 46% of its functional connections with a network that predicted creative ability-including connections linking executive control and salience/ventral attention networks-suggesting that intelligence and creative thinking rely on similar neural and cognitive systems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

To provide a portrait of gender affirmation surgery (GAS) insurance coverage across the United States, with attention to procedures of the head and neck.Systematic review.Policy review of US medical insurance companies.State policies on transgender care for Medicaid insurance providers were collected for all 50 states. Each state's policy on GAS and facial gender affirmation surgery (FGAS) was examined. The largest medical insurance companies in the United States were identified using the National Association of Insurance Commissioners Market Share report. Policies of the top 49 primary commercial medical insurance companies were examined.Medicaid policy reviews found that 18 states offer some level of gender-affirming coverage for their patients, but only 3 include FGAS (17%). Thirteen states prohibit Medicaid coverage of all transgender surgery, and 19 states have no published gender-affirming medical care coverage policy. Ninety-two percent of commercial medical insurance providers had a published policy on GAS coverage. Genital reconstruction was described as a medically necessary aspect of transgender care in 100% of the commercial policies reviewed. Ninety-three percent discussed coverage of FGAS, but 51% considered these procedures cosmetic. Thyroid chondroplasty (20%) was the most commonly covered FGAS procedure. Mandibular and frontal bone contouring, rhinoplasty, blepharoplasty, and facial rhytidectomy were each covered by 13% of the medical policies reviewed.While certain surgical aspects of gender-affirming medical care are nearly ubiquitously covered by commercial insurance providers, FGAS is considered cosmetic by most Medicaid and commercial insurance providers, potentially limiting patient access.Level V.

Dermal filler injections are common cosmetic procedures and are growing in popularity. While frequently performed, dermal filler injections carry a risk of adverse events including vascular compromise and foreign body granulomas. Here, we discuss an unusual case of a patient with a history of dermal filler injections presenting with a parotid mass and an eyebrow mass requiring surgical resection. This case demonstrates the risk of delayed granuloma formation many years after dermal filler injection and highlights the importance of awareness and management of these potential long-term complications.

Although the feeling of stress is ubiquitous, the neural mechanisms underlying this affective experience remain unclear. Here, we investigate functional hippocampal connectivity throughout the brain during an acute stressor and use machine learning to demonstrate that these networks can specifically predict the subjective feeling of stress. During a stressor, hippocampal connectivity with a network including the hypothalamus (known to regulate physiological stress) predicts feeling more stressed, whereas connectivity with regions such as dorsolateral prefrontal cortex (associated with emotion regulation) predicts less stress. These networks do not predict a subjective state unrelated to stress, and a nonhippocampal network does not predict subjective stress. Hippocampal networks are consistent, specific to the construct of subjective stress, and broadly informative across measures of subjective stress. This approach provides opportunities for relating hypothesis-driven functional connectivity networks to clinically meaningful subjective states. Together, these results identify hippocampal networks that modulate the feeling of stress., Although the feeling of being stressed is ubiquitous and clinically significant, the underlying neural mechanisms are unclear. Using a novel predictive modeling approach, the authors show that functional hippocampal networks specifically and consistently predict the feeling of stress.

OBJECTIVES We sought to investigate the prognostic value of serum lactate on survival in patients postcardiac arrest. BACKGROUND Patients who experience cardiac arrest, in- or out-of-hospital, may have a poor outcome. Initial electrocardiograms may suggest ischemia as an underlying cause and urgent referral for catheterization occurs. It remains unclear which of these patients may suffer a poor outcome. METHODS We retrospectively reviewed all patients at our institution taken for urgent catheterization after cardiac arrest between January 2014 and September 2018. Three hundred and eighty four patients were referred urgently to the cath lab during this period, 50 with prior arrest. RESULTS Sixty six percent underwent coronary intervention. The mean age of the entire cohort was 57 years. Thirty four percent were female, 40% had a history of coronary artery disease, and 94% were intubated at the time of cardiac catheterization. Overall survival to discharge was 40%. Survival in patients who underwent coronary intervention compared with those who did not was similar (45.5 vs. 29.4%, p = .27). Mean lactate level in survivors versus nonsurvivors was 4.7 ± 3.8 and 9.8 ± 4.7 mmol/L, respectively (p

The aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic.Screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods.In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers.COVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.

As we comprehend narratives, our attentional engagement fluctuates over time. Despite theoretical conceptions of narrative engagement as emotion-laden attention, little empirical work has characterized the cognitive and neural processes that comprise subjective engagement in naturalistic contexts or its consequences for memory. Here, we relate fluctuations in narrative engagement to patterns of brain coactivation, and test whether neural signatures of engagement predict later recall. In behavioral studies, participants continuously rated how engaged they were as they watched a television episode or listened to a story. Self-reported engagement was synchronized across individuals and driven by the emotional content of the narratives. During fMRI, we observed highly synchronized activity in the default mode network when people were, on average, more engaged in the same narratives. Models based on time-varying whole-brain functional connectivity predicted evolving states of engagement across participants and even across different datasets. The same functional connections also predicted post-scan event recall, suggesting that engagement during encoding impacts subsequent memory. Finally, group-average engagement was related to fluctuations of an independent functional connectivity index of sustained attention. Together, our findings characterize the neural signatures of engagement dynamics and elucidate relationships between narrative engagement, sustained attention, and event memory.

Postoperative ileus after colorectal surgery is a frequent problem that significantly prolongs hospital stay and increases perioperative costs.The aim was to evaluate the effect of standardized coffee intake on postoperative bowel movement after elective laparoscopic colorectal resection.This is a prospective randomized controlled trial that was conducted between September 2014 and December 2016.This study was performed in a public cantonal hospital in Switzerland with accreditation for colon and rectum cancer surgery.Patients who underwent elective colorectal surgery were included.Patients were randomly assigned either to the intervention group receiving coffee or the control group receiving tea. A total of 150 mL of the respective beverage was drunk 3 times per day every postoperative day until discharge.The primary end point was time to first bowel movement. Secondary end points included the use of laxative, insertion of a nasogastric tube, length of hospital stay, and postoperative complications.A total of 115 patients were randomly assigned: 56 were allocated to the coffee group and 59 to the tea group. After coffee intake, the first bowel movement occurred after a median of 65.2 hours versus 74.1 hours in the control group (intention-to-treat analysis; p = 0.008). The HR for earlier first bowel movement after coffee intake was 1.67 (p = 0.009). In the per-protocol analysis, hospital stay was shorter in the coffee group (6 d in the coffee group vs 7 d in the tea group; p = 0.043).The rate of protocol violation, mostly coffee consumption in the tea arm, was relatively high, even if patients were clearly instructed not to consume coffee if they were in the tea arm.Coffee intake after elective laparoscopic colorectal resection leads to faster recovery of bowel function. Therefore, coffee intake represents a simple and effective strategy to prevent postoperative ileus. See Video Abstract at http://links.lww.com/DCR/A955.clinicaltrials.gov identifier: NCT02469441.

BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is a common postoperative cardiovascular complication and is associated with short and long-term mortality. The objective of the study was to describe the contemporary management of patients with and without MINS after total joint and spine orthopedic surgery at a large tertiary care hospital. METHODS: Adults admitted for total joint and major spine surgery from January 2013 through December 2015 with ≥1 cardiac troponin (cTn) measurement during their hospitalization were identified. MINS was defined by a peak cTn above the 99(th) percentile of the upper reference limit. Demographics, medical comorbidities, and admission and discharge medications were reviewed for all patients. RESULTS: A total of 2,561 patients underwent 2,798 orthopedic surgeries, and 236 cases of MINS were identified. Patients with MINS were older (71.9 ± 10.9 vs. 67.0 ± 10.0, p

OBJECTIVE. The purpose of this study was to determine whether a single, uniform normalized iodine threshold reduces variability and enables reliable differentiation between vascular and nonvascular renal lesions independent of the dual-energy CT (DECT) platform used. MATERIALS AND METHODS. In this retrospective, HIPAA-compliant, institutional review board-approved study, 247 patients (156 men, 91 women; mean age ± SD, 67 ± 12 years old) with 263 renal lesions (193 nonvascular, 70 vascular) underwent unenhanced single- energy and contrast-enhanced DECT scans. One hundred and six nonvascular and 38 vascular lesions were scanned on two dual-source DECT (dsDECT) scanners, and 87 nonvascular and 32 vascular lesions were scanned on two rapid-kilovoltage-switching single-source DECT (rsDECT) scanners. Optimal absolute and normalized (to aorta) lesion iodine thresholds were determined for each platform type and for the entire cohort combined. RESULTS. Mean optimal absolute discriminant thresholds were 1.3 mg I/mL (95% CI, 1.2-1.9 mg I/mL), 1.6 mg I/mL (95% CI, 0.9-1.5 mg I/mL), and 1.5 mg I/mL (95% CI, 1.4- 1.7 mg I/mL) for dsDECT, rsDECT, and combined cohorts, respectively. Optimal normalized discriminant thresholds were 0.3 mg I/mL (95% CI, 0.2-0.4 mg I/mL) for both the dsDECT and rsDECT cohorts, and 0.3 mg I/mL (0.3-0.4 mg I/mL) for the combined cohort. The AUC, sensitivity, and specificity for the combined optimal normalized discriminant threshold of 0.3 mg I/mL was 0.96 (95% CI, 0.92-1.00), 0.93 (0.84-0.97), and 0.95 (0.91-0.98), respectively. Normalization resulted in decreased variability and better lesion separation (effect size, 1.77 vs 1.69, p < 0.0001). CONCLUSION. The optimal absolute discriminant threshold for evaluating renal lesions varies depending on the type of DECT platform, though this difference is not statistically significant. Variation can be reduced with a better separation of vascular and nonvascular lesions by normalizing iodine quantification to the aorta.

The endocannabinoid system is an important regulator of emotional responses such as fear, and a number of studies have implicated endocannabinoid signaling in anxiety. The fatty acid amide hydrolase (FAAH) C385A polymorphism, which is associated with enhanced endocannabinoid signaling in the brain, has been identified across species as a potential protective factor from anxiety. In particular, adults with the variant FAAH 385A allele have greater fronto-amygdala connectivity and lower anxiety symptoms. Whether broader network-level differences in connectivity exist, and when during development this neural phenotype emerges, remains unknown and represents an important next step in understanding how the FAAH C385A polymorphism impacts neurodevelopment and risk for anxiety disorders. Here, we leveraged data from 3,109 participants in the nationwide Adolescent Brain Cognitive Development Study℠ (10.04 ± 0.62 years old; 44.23% female, 55.77% male) and a cross-validated, data-driven approach to examine associations between genetic variation and large-scale resting-state brain networks. Our findings revealed a distributed brain network, comprising functional connections that were both significantly greater (95% CI for p values = [

A large literature exists on positive sequelae of breastfeeding, relying heavily on maternal self-reported infant feeding behaviors. Many such studies use PRAMS data, though estimates of reliability for the breastfeeding duration question on PRAMS have not been published.We used data from Oregon PRAMS (respondents are a median 3.5 months postpartum) and PRAMS-2 (median 25 months) to assess test-retest reliability of maternal self-reported breastfeeding duration, among women who had weaned prior to completing the PRAMS survey.The sample-wide kappa for the paired, self-reported breastfeeding duration was 0.014, and the intraclass correlation coefficient was 0.17, both of which indicate poor agreement. More than 80% of women reported a longer duration on PRAMS-2; the median (interquartile range) difference was +1.0 (0.31 - 2.1) months.Recent literature on this topic from high-income countries falls into two categories: entirely retrospective versus "prospective" reliability assessments. Entirely retrospective assessments (both inquiries occur well after weaning) universally report exceedingly high reliability, whereas "prospective" assessments (women report infant feeding behavior during infancy, immediately after weaning, and some years later are asked to replicate their original answer) universally report poorer reliability. Interestingly, all "prospective" reliability studies, including ours, found that women over-report past breastfeeding durations by about 1 month upon the second inquiry. Researchers need not refrain from using maternal self-reported breastfeeding durations, because participants are largely still ranked correctly, relative to each other. However, such research efforts must avoid attempting to determine any optimal threshold duration.

Summary Human brains share a broadly similar functional organization with consequential individual variation. This duality in brain function has primarily been observed when using techniques that consider the spatial organization of the brain, such as MRI. Here, we ask whether these common and unique signals of cognition are also present in temporally sensitive but spatially insensitive neural signals. To address this question, we compiled electroencephalogram (EEG) data from individuals of both sexes while they performed multiple working memory tasks at two different data-collection sites (n = 171 and 165). Results revealed that trial-averaged EEG activity exhibited inter-electrode correlations that were stable within individuals and unique across individuals. Furthermore, models based on these inter-electrode correlations generalized across datasets to predict participants’ working memory capacity and general fluid intelligence. Thus, inter-electrode correlation patterns measured with EEG provide a signature of working memory and fluid intelligence in humans and a new framework for characterizing individual differences in cognitive abilities.

Cognitive states, such as rest and task engagement, share an 'intrinsic' functional network organization that is subject to minimal variation over time and yields stable signatures within an individual. Importantly, there are also transient state-specific functional connectivity (FC) patterns that vary across neural states. Here, we examine functional brain organization differences that underlie distinct states in a cross-sectional developmental sample. We compare FC fMRI data acquired during naturalistic viewing (i.e., movie-watching) and resting-state paradigms in a large cohort of 157 children and young adults aged 6-20. Naturalistic paradigms are commonly implemented in pediatric research because they maintain the child's attention and contribute to reduced head motion. It remains unknown, however, to what extent the brain-wide functional network organization is comparable during movie-watching and rest across development. Here, we identify a widespread FC pattern that predicts whether individuals are watching a movie or resting. Specifically, we develop a model for prediction of multilevel neural effects (termed PrimeNet), which can with high reliability distinguish between movie-watching and rest irrespective of age and that generalizes across movies. In turn, we characterize FC patterns in the most predictive functional networks for movie-watching versus rest and show that these patterns can indeed vary as a function of development. Collectively, these effects highlight a 'core' FC pattern that is robustly associated with naturalistic viewing, which also exhibits change across age. These results, focused here on naturalistic viewing, provide a roadmap for quantifying state-specific functional neural organization across development, which may reveal key variation in neurodevelopmental trajectories associated with behavioral phenotypes.

The prevalence of risky behavior such as substance use increases during adolescence; however, the neurobiological precursors to adolescent substance use remain unclear. Predictive modeling may complement previous work observing associations with known risk factors or substance use outcomes by developing generalizable models that predict early susceptibility. The aims of the current study were to identify and characterize behavioral and brain models of vulnerability to future substance use. Principal components analysis (PCA) of behavioral risk factors were used together with connectome-based predictive modeling (CPM) during rest and task-based functional imaging to generate predictive models in a large cohort of nine- and ten-year-olds enrolled in the Adolescent BrainCognitive Development (ABCD) study (NDA release 2.0.1). Dimensionality reduction (n = 9,437) of behavioral measures associated with substance use identified two latent dimensions that explained the largest amount of variance: risk-seeking (PC1; e.g., curiosity to try substances) and familial factors (PC2; e.g., family history of substance use disorder). Using cross-validated regularized regression in a subset of data (Year 1 Fast Track data; n1,500), functional connectivity during rest and task conditions (resting-state; monetary incentive delay task; stop signal task; emotional n-back task) significantly predicted individual differences in risk-seeking (PC1) in held-out participants (partial correlations between predicted and observed scores controlling for motion and number of frames [r

Objective Low birthweight is one of the main causes of poor health outcomes among newborns, with Black women having a disproportionately high prevalence. A digital intervention targeted Black women in Orange County, Florida with information on positive pregnancy-related knowledge and attitudes related to low birthweight. This paper reports on campaign methods for the first 2.5 years of implementation. Methods Campaign content was tailored toward Black women, around a reproductive empowerment lens. Content focused on emphasizing healthy pregnancy-related behaviors and creating positive representations of Black women throughout the various stages of pregnancy through both static images and a web series. Digital metrics gauged campaign engagement. Three cross-sectional online surveys conducted in the intervention county examined Black women’s pregnancy-related knowledge, attitudes, and behaviors. Results After two years of campaign implementation, social media accounts showed 1784 followers. While Facebook showed more average monthly impressions, Instagram showed more average monthly engagements. Survey results showed some increases in knowledge about prenatal care, weight gain, exercise, and the health impacts of low birthweight. Conclusions for Practice This study highlights the potential for a culturally-appropriate digital intervention to promote positive pregnancy outcomes among at-risk women. Digital interventions offer a potential way to achieve positive pregnancy-related behavior changes on a larger scale. This may be particularly important given that the COVID-19 pandemic may be changing the ways that pregnant women access information. Studies should examine the impact and feasibility of using culturally-appropriate digital interventions that directly address Black women and their specific experiences during pregnancy.

Affective disorders such as major depression are common but serious illnesses characterized by altered processing of emotional information. Although the frequency and severity of depressive symptoms increase dramatically over the course of childhood and adolescence, much of our understanding of their neurobiological bases comes from work characterizing adults’ responses to static emotional information. As a consequence, relationships between depressive brain phenotypes and naturalistic emotional processing, as well as the manner in which these associations emerge over the lifespan, remain poorly understood. Here, we apply static and dynamic inter-subject correlation analyses to examine how brain function is associated with clinical and non-clinical depressive symptom severity in 112 children and adolescents (7-21 years old) who viewed an emotionally evocative clip from the film Despicable Me during functional MRI. Our results reveal that adolescents with greater depressive symptom severity exhibit atypical fMRI responses during movie viewing, and that this effect is stronger during less emotional moments of the movie. Furthermore, adolescents with more similar item-level depressive symptom profiles showed more similar brain responses during movie viewing. In contrast, children’s depressive symptom severity and profiles were unrelated to their brain response typicality or similarity. Together, these results indicate a developmental change in the relationships between brain function and depressive symptoms from childhood through adolescence. Our findings suggest that depressive symptoms may shape how the brain responds to complex emotional information in a dynamic manner sensitive to both developmental stage and affective context.

Psychopathology can be viewed as a hierarchy of correlated dimensions. Many studies have supported this conceptualization, but they have used alternative statistical models with differing interpretations. In bifactor models, every symptom loads on both the general factor and one specific factor (e.g., internalizing), which partitions the total explained variance in each symptom between these orthogonal factors. In second-order models, symptoms load on one of several correlated lower-order factors. These lower-order factors load on a second-order general factor, which is defined by the variance shared by the lower-order factors. Thus, the factors in second-order models are not orthogonal. Choosing between these valid statistical models depends on the hypothesis being tested. Because bifactor models define orthogonal phenotypes with distinct sources of variance, they are optimal for studies of shared and unique associations of the dimensions of psychopathology with external variables putatively relevant to etiology and mechanisms. Concerns have been raised, however, about the reliability of the orthogonal specific factors in bifactor models. We evaluated this concern using parent symptom ratings of 9-10 year olds in the ABCD Study. Psychometric indices indicated that all factors in both bifactor and second-order models exhibited at least adequate construct reliability and estimated replicability. The factors defined in bifactor and second-order models were highly to moderately correlated across models, but have different interpretations. All factors in both models demonstrated significant associations with external criterion variables of theoretical and clinical importance, but the interpretation of such associations in second-order models was ambiguous due to shared variance among factors.General Scientific SummarySome investigators have proposed that viewing the correlated symptoms of psychopathology as a hierarchy in which all symptoms are related to both a general (p) factor of psychopathology and a more specific factor will make it easier to distinguish potential risk factors and mechanisms that are nonspecifically related to all forms of psychopathology versus those that are associated with specific dimensions of psychopathology. Parent ratings of child psychopathology items from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using two alternative statistical models of the proposed hierarchy. All factors of psychopathology defined in both bifactor and second-order models demonstrated adequate psychometric properties and criterion validity, but associations of psychopathology factors with external variables were more easily interpreted in bifactor than in second-order models.

Inhibitory interneurons orchestrate information flow across the cortex and are implicated in psychiatric illness. Although interneuron classes have unique functional properties and spatial distributions, the influence of interneuron subtypes on brain function, cortical specialization, and illness risk remains elusive. Here, we demonstrate stereotyped negative correlation of somatostatin and parvalbumin transcripts within human and non-human primates. Cortical distributions of somatostatin and parvalbumin cell gene markers are strongly coupled to regional differences in functional MRI variability. In the general population (n = 9,713), parvalbumin-linked genes account for an enriched proportion of heritable variance in in-vivo functional MRI signal amplitude. Single-marker and polygenic cell deconvolution establish that this relationship is spatially dependent, following the topography of parvalbumin expression in post-mortem brain tissue. Finally, schizophrenia genetic risk is enriched among interneuron-linked genes and predicts cortical signal amplitude in parvalbumin-biased regions. These data indicate that the molecular-genetic basis of brain function is shaped by interneuron-related transcripts and may capture individual differences in schizophrenia risk., Interneuron subtypes have distinct properties and spatial distributions. Here, the authors show that the molecular-genetic basis of cortical resting-state brain function is shaped by distributions of interneuron-related transcripts and may capture individual differences in schizophrenia risk.

Background The literature supports the use of short-interval follow-up as an alternative to biopsy for lesions assessed as probably benign, Breast Imaging Reporting and Data System (BI-RADS) category 3, with an expected malignancy rate of less than 2%. Purpose To assess outcomes from 6-, 12-, and 24-month follow-up of probably benign findings first identified at recall from screening mammography in the National Mammography Database (NMD). Materials and Methods This retrospective study included women recalled from screening mammography with BI-RADS category 3 assessment at additional evaluation from January 2009 through March 2018 from 471 NMD facilities. Only the first BI-RADS category 3 occurrence for women aged 25 years or older with no personal history of breast cancer was analyzed, with biopsy or 2-year imaging follow-up. Cancer yield and positive predictive value of biopsies performed (PPV3) were determined at each follow-up. Results Among 45 202 women (median age, 55 years; range, 25-90 years) with a BI-RADS category 3 lesion, 1574 (3.5%) underwent biopsy at the time of lesion detection, yielding 72 cancers (cancer yield, 4.6%; 72 of 1574 women). For the remaining 43 628 women who accepted surveillance, 922 were seen within 90 days (with 78 lesions biopsied and 12 [15%] classified as malignant). The women still in surveillance (31 465 of 43 381 women [72.5%]) underwent follow-up mammography at 6 months. Of 3001 (9.5%) lesions biopsied, 456 (15.2%) were malignant (cancer yield, 1.5%; 456 of 31 465 women; 95% confidence interval [CI]: 1.3%, 1.6%). Among 18 748 of 25 997 women (72.1%) in surveillance who underwent follow-up at 12 months, 1219 (6.5%) underwent biopsy with 230 (18.9%) malignant lesions found (cancer yield, 1.2%; 230 of 18 748 women; 95% CI: 1.1%, 1.4%). Through 2-year follow-up, the biopsy rate was 11.2% (4894 of 43 628 women) with a cancer yield of 1.86% (810 malignancies found among 43 628 women; 95% CI: 1.73%, 1.98%) and a PPV3 of 16.6% (810 malignancies found among 4894 women). Conclusion In the National Mammography Database, Breast Imaging Reporting and Data System (BI-RADS) category 3 use is appropriate, with 1.86% cumulative cancer yield through 2-year follow-up. Of 810 malignancies, 468 (57.8%) were diagnosed at or before 6 months, validating necessity of short-interval follow-up of mammographic BI-RADS category 3 findings. © RSNA, 2020

Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback is a non-invasive, non-pharmacological therapeutic tool that may be useful for training behavior and alleviating clinical symptoms. Although previous work has used rt-fMRI to target brain activity in or functional connectivity between a small number of brain regions, there is growing evidence that symptoms and behavior emerge from interactions between a number of distinct brain areas. Here, we propose a new method for rt-fMRI, connectome-based neurofeedback, in which intermittent feedback is based on the strength of complex functional networks spanning hundreds of regions and thousands of functional connections. We first demonstrate the technical feasibility of calculating whole-brain functional connectivity in real-time and provide resources for implementing connectome-based neurofeedback. We next show that this approach can be used to provide accurate feedback about the strength of a previously defined connectome-based model of sustained attention, the saCPM, during task performance. Although, in our initial pilot sample, neurofeedback based on saCPM strength did not improve performance on out-of-scanner attention tasks, future work characterizing effects of network target, training duration, and amount of feedback on the efficacy of rt-fMRI can inform experimental or clinical trial designs.

PURPOSE To evaluate long-term visual and astigmatic outcomes of sequential corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK). SETTING Single-practice outpatient setting. DESIGN Retrospective case review. METHODS This is a single-surgeon retrospective case review of eyes with keratoconus undergoing sequential CXL and then topography-guided PRK. Change in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), topographic, refractive, and keratometric astigmatism was analyzed using power vector analyses at baseline, 6 months, and 12 months after topography-guided PRK. Changes in higher-order aberrations (HOAs), posterior astigmatism, spherical equivalent (SE), and central corneal thickness (CCT) were also analyzed. Correlations between age, time between CXL and PRK, sex, manifest SE, CCT, maximum and average keratometric values, and HOAs were evaluated for significance. RESULTS Of the 62 eyes studied, regardless of refractive treatment, topography-guided PRK following CXL in patients with keratoconus improved CDVA (mean 20/30; 2-line improvement) and UDVA (mean 20/50; 4-line improvement). Over 12 months, visual acuity continued to improve across all eyes treated (P < .001). Overall, there were significant improvements in corneal astigmatism, maximum keratometry, mean keratometry, SE, posterior astigmatism, and total HOAs. No significant correlations were found between age, sex, time elapsed between CXL and PRK, and age at the time of either procedure on final visual acuity. CONCLUSIONS Results of this study reinforced previous findings that topography-guided PRK in previously cross-linked keratoconus eyes proves to be an efficacious and safe method for improving visual acuity and reducing irregular corneal astigmatism, with continued improvement.

Attention is a critical cognitive function, allowing humans to select, enhance, and sustain focus on information of behavioral relevance. Attention contains dissociable neural and psychological components. Nevertheless, some brain networks support multiple attentional functions. Connectome-based Predictive Models (CPM), which associate individual differences in task performance with functional connectivity patterns, provide a compelling example. A sustained attention network model (saCPM) successfully predicted performance for selective attention, inhibitory control, and reading recall tasks. Here we constructed a visual attentional blink (VAB) model (vabCPM), comparing its performance predictions and network edges associated with successful and unsuccessful behavior to the saCPM’s. In the VAB, attention devoted to a target often causes a subsequent item to be missed. Although frequently attributed to attentional limitations, VAB deficits may attenuate when participants are distracted or deploy attention diffusely. Participants (n=73; 24 males) underwent fMRI while performing the VAB task and while resting. Outside the scanner, they completed other cognitive tasks over several days. A vabCPM constructed from these data successfully predicted VAB performance. Strikingly, the network edges that predicted better VAB performance (positive edges) predicted worse selective and sustained attention performance, and vice versa. Predictions from the saCPM mirrored these results, with the network’s negative edges predicting better VAB performance. Furthermore, the vabCPM’s positive edges significantly overlapped with the saCPM’s negative edges, and vice versa. We conclude that these partially overlapping networks each have general attentional functions. They may indicate an individual’s propensity to diffusely deploy attention, predicting better performance for some tasks and worse for others.Significance statementA longstanding question in psychology and neuroscience is whether we have general capacities or domain-specific ones. For such general capacities, what is the common function? Here we addressed these questions using the attentional blink (AB) task and neuroimaging. Individuals searched for two items in a stream of distracting items; the second item was often missed when it closely followed the first. How often the second item was missed varied across individuals, which was reflected in attention networks. Curiously, the networks’ pattern of function that was good for the AB was bad for other tasks, and vice versa. We propose that these networks may represent not a general attentional ability, but rather the tendency to attend in a less focused manner.

The ability to sustain attention differs across people and changes within a single person over time. Although recent work has demonstrated that patterns of functional brain connectivity predict individual differences in sustained attention, whether these same patterns capture fluctuations in attention within individuals remains unclear. Here, across five independent studies, we demonstrate that the sustained attention connectome-based predictive model (CPM), a validated model of sustained attention function, generalizes to predict attentional state from data collected across minutes, days, weeks, and months. Furthermore, the sustained attention CPM is sensitive to within-subject state changes induced by propofol as well as sevoflurane, such that individuals show functional connectivity signatures of stronger attentional states when awake than when under deep sedation and light anesthesia. Together, these results demonstrate that fluctuations in attentional state reflect variability in the same functional connectivity patterns that predict individual differences in sustained attention.

Background Many CpGs become hyper or hypo-methylated with age. Multiple methods have been developed by Horvath et al. to estimate DNA methylation (DNAm) age including Pan-tissue, Skin & Blood, PhenoAge, and GrimAge. Pan-tissue and Skin & Blood try to estimate chronological age in the normal population whereas PhenoAge and GrimAge use surrogate markers associated with mortality to estimate biological age and its departure from chronological age. Here, we applied Horvath’s four methods to calculate and compare DNAm age in 499 subjects with type 1 diabetes (T1D) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study using DNAm data measured by Illumina EPIC array in the whole blood. Association of the four DNAm ages with development of diabetic complications including cardiovascular diseases (CVD), nephropathy, retinopathy, and neuropathy, and their risk factors were investigated. Results Pan-tissue and GrimAge were higher whereas Skin & Blood and PhenoAge were lower than chronological age (p < 0.0001). DNAm age was not associated with the risk of CVD or retinopathy over 18–20 years after DNAm measurement. However, higher PhenoAge (β = 0.023, p = 0.007) and GrimAge (β = 0.029, p = 0.002) were associated with higher albumin excretion rate (AER), an indicator of diabetic renal disease, measured over time. GrimAge was also associated with development of both diabetic peripheral neuropathy (OR = 1.07, p = 9.24E−3) and cardiovascular autonomic neuropathy (OR = 1.06, p = 0.011). Both HbA1c (β = 0.38, p = 0.026) and T1D duration (β = 0.01, p = 0.043) were associated with higher PhenoAge. Employment (β = − 1.99, p = 0.045) and leisure time (β = − 0.81, p = 0.022) physical activity were associated with lower Pan-tissue and Skin & Blood, respectively. BMI (β = 0.09, p = 0.048) and current smoking (β = 7.13, p = 9.03E−50) were positively associated with Skin & Blood and GrimAge, respectively. Blood pressure, lipid levels, pulse rate, and alcohol consumption were not associated with DNAm age regardless of the method used. Conclusions Various methods of measuring DNAm age are sub-optimal in detecting people at higher risk of developing diabetic complications although some work better than the others.

To evaluate terpinen-4-ol lid scrubs (Cliradex) with Microblepharoexfoliation (MBE) (BlephEx) in the treatment of Demodex blepharitis.An Institutional Review Board (IRB) approved the randomized prospective double-masked trial of 50 patients with Demodex positive blepharitis. All subjects were given an in-office MBE treatment and randomized to masked lid scrubs (terpinen-4-ol or sham) twice daily for 1 month. All subjects then returned for an additional MBE treatment and received open-label terpinen-4-ol scrubs twice daily for 1 month.Demodex levels, Ocular Surface Disease Index, tear osmolarity, MMP-9, Schirmer 1 and grading of the lid margin appearance, meibomian gland dropout, and meibomian gland secretions.Forty-six subjects (23 per group) were included for the analysis; 4 lost to follow up. Total Demodex folliculorum levels in the Cliradex group improved: 4.7 to 3.6 (first month interval P = 0.266) to 2.6 (second month interval P = 0.279), overall P0.05 over 2 months. Total levels in the sham group improved: 5.1 to 3.0 (first month interval P0.05) to 2.5 (second month interval P = 0.496), overall P0.05 over 2 months. No clear statistically meaningful improvements in other dry eye and blepharitis data metrics were observed.In-office MBE treatments combined with either Cliradex terpinen-4-ol medicated lid scrubs or sham scrubs showed a statistically significant reduction in D. folliculorum infestation levels; however, conclusions on clinical significance could not be made. In-office MBE with terpinen-4-ol lid scrubs showed no significant improvement over sham scrubs.

Social determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.

OBJECTIVE. The objective of this study is to determine whether single-phase contrast-enhanced dual-energy CT (DECT) material attenuation analysis improves the characterization of small (< 2.0 cm) incidental indeterminate hypoattenuating hepatic lesions, compared with conventional single-energy CT evaluation. MATERIALS AND METHODS. This retrospective study involved 55 patients (24 men and 31 women; mean [± SD] age, 63.9 ± 15.3 years) with 77 incidental hypoattenuating hepatic lesions (59 benign and 18 malignant lesions) measuring 0.5–2.0 cm who underwent single-phase contrast-enhanced DECT of the abdomen for pain. For each lesion, attenuation measurements were obtained using blended 120-kVp–equivalent images and contrast map images. DECT material attenuation images were used for iodine quantification. Optimal lesion attenuation and iodine concentration threshold values that best distinguished benign lesions from malignant lesions were generated using smooth bootstrapping. The diagnostic accuracy of the optimized thresholds was compared using the Wilcox rank sum test. RESULTS. The optimal mean (± standard error) attenuation threshold values that best differentiated benign and malignant lesions were 50.2 ± 5.2 HU and 11.5 ± 2.0 HU when blended 120-kVp and contrast map images, respectively, were used. The iodine concentration (expressed as milligrams of iodine per milliliter) differed significantly (p < 0.0001) between benign lesions (0.6 ± 0.4 mg I/mL) and malignant lesions (1.7 ± 0.4 mg I/mL). The optimal iodine concentration that best distinguished between benign and malignant lesions was 1.2 ± 0.1 mg I/mL. The sensitivity, specificity, and AUC value were highest for iodine concentration (0.94, 0.93, and 0.97, respectively), compared with blended images (0.89, 0.70, and 0.81, respectively) and contrast map images (0.94, 0.64, 0.77, respectively). CONCLUSION. Iodine quantification performed using single-phase contrast-enhanced DECT material attenuation images improves the characterization of small (< 2 cm) incidental indeterminate hypoattenuating hepatic lesions, compared with conventional attenuation measurements.

Purpose To evaluate a sequential treatment algorithm for visual and keratometric improvement in keratoconus patients after corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK). Setting Ophthalmic Consultants of Long Island, Garden City, New York, USA. Design Retrospective case series. Methods This study reviewed patients with keratoconus who had CXL followed by custom topography-guided PRK between April 2016 and December 2016. The following data were collected at baseline, the time of CXL, and 3 months and 6 months after PRK: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, keratometric astigmatism, spherical equivalent, maximum and mean keratometry readings, and corneal thickness at the cone apex. Demographic data, age at time of CXL and PRK, and time elapsed between CXL and PRK were analyzed for significance and a correlation with visual and astigmatic outcomes. Results The study comprised 56 patients (62 eyes), 34 who had both topographic and refractive treatment and 28 patients who had treatment of topographic irregularities only. The mean age was 38.08 years ± 13.07 (SD) at CXL and 40.33 ± 13.44 years at topography-guided PRK. Six months after PRK, there was a significant improvement in UDVA and CDVA in the refractive group (20/60 and 20/30, respectively) versus the nonrefractive group (20/100 and 20/40, respectively). Ninety-three percent of eyes that had refractive treatment had 20/40 or better CDVA. There were no significant adverse events in any case. Conclusions The data support the use of refractive treatment in addition to topographic treatment for visual improvement in patients with keratoconus having CXL and PRK.

To compare the wound integrity of femtosecond laser-assisted 110-degree reverse side-cut clear corneal incisions (CCIs) with femtosecond laser-assisted 70-degree forward side-cut and manual CCIs in patients having cataract surgery.Island Eye Surgicenter, Carle Place, New York, USA.Prospective case series.Patients having cataract surgery were randomized into 3 treatment groups as follows: Group A had 110-degree femtosecond reverse side-cut CCIs, Group B had 70-degree femtosecond forward side-cut CCIs, Group C had manual CCIs. At the conclusion of surgery, the integrity of the CCI was measured by raising intraocular pressure (IOP) until the CCI began to leak. Postoperatively, the CCIs were assessed for wound leakage at 1 day, 2 weeks, and 1 month.The study comprised 45 patients (45 eyes, 15 in each treatment group). The mean IOP at which CCIs leaked (in response to anterior chamber balanced salt solution irrigation) was statistically significantly higher in Group A (28.20 mm Hg ± 11.69 [SD]) than in Group B (15.07 ± 10.64 mm Hg; P = .005) and Group C (9.93 ± 9.90 mm Hg; P .001). At 1 day postoperatively, the Seidel test with pressure showed no leakage in any of the Group A eyes; however, 53% of eyes in Group B and 87% in Group C showed wound leakage.The femtosecond laser-created reverse side-cut CCIs required significantly higher IOP intraoperatively before leaking and resulted in better wound integrity with significantly less wound leakage postoperatively than laser-created forward side-cut or manual CCIs.

Sustaining attention to the task at hand is a crucial part of everyday life, from following a lecture at school to maintaining focus while driving. Lapses in sustained attention are frequent and often problematic, with conditions such as attention deficit hyperactivity disorder affecting millions of people worldwide. Recent work has had some success in finding signatures of sustained attention in whole-brain functional connectivity (FC) measures during basic tasks, but since FC can be dynamic and task-dependent, it remains unclear how fully these signatures would generalize to a more complex and naturalistic scenario. To this end, we used a previously defined whole-brain FC network - a marker of attention that was derived from a sustained attention task - to predict the ability of participants to recall material during a free-viewing reading task. Though the predictive network was trained on a different task and set of participants, the strength of FC in the sustained attention network predicted reading recall significantly better than permutation tests where behavior was scrambled to simulate chance performance. To test the generalization of the method used to derive the sustained attention network, we applied the same method to our reading task data to find a new FC network whose strength specifically predicts reading recall. Even though the sustained attention network provided significant prediction of recall, the reading network was more predictive of recall accuracy. The new reading network's spatial distribution indicates that reading recall is highest when temporal pole regions have higher FC with left occipital regions and lower FC with bilateral supramarginal gyrus. Right cerebellar to right frontal connectivity is also indicative of poor reading recall. We examine these and other differences between the two predictive FC networks, providing new insight into the task-dependent nature of FC-based performance metrics.

People’s ability to think creatively is a primary means of technological and cultural progress, yet the neural architecture of the highly creative brain remains largely undefined. Here, we employed a recently developed method in functional brain imaging analysis—connectome-based predictive modeling—to identify a brain network associated with high-creative ability, using functional magnetic resonance imaging (fMRI) data acquired from 163 participants engaged in a classic divergent thinking task. At the behavioral level, we found a strong correlation between creative thinking ability and self-reported creative behavior and accomplishment in the arts and sciences (r = 0.54). At the neural level, we found a pattern of functional brain connectivity related to high-creative thinking ability consisting of frontal and parietal regions within default, salience, and executive brain systems. In a leave-one-out cross-validation analysis, we show that this neural model can reliably predict the creative quality of ideas generated by novel participants within the sample. Furthermore, in a series of external validation analyses using data from two independent task fMRI samples and a large task-free resting-state fMRI sample, we demonstrate robust prediction of individual creative thinking ability from the same pattern of brain connectivity. The findings thus reveal a whole-brain network associated with high-creative ability comprised of cortical hubs within default, salience, and executive systems—intrinsic functional networks that tend to work in opposition—suggesting that highly creative people are characterized by the ability to simultaneously engage these large-scale brain networks.

Preliminary data suggest that prohormone convertase 1 (PC1/3) protein expression and proopiomelanocortin (POMC) processing are altered in large corticotroph tumors. The aim of this study was to characterize the levels of ACTH precursors and PC1/3 protein in small and large corticotroph tumors of dogs with Cushing's disease. Pituitary tumors of dogs with Cushing's disease were collected postmortem 30 min to 12h after natural death or euthanasia, and classified as small or large. POMC, pro-ACTH, and PC1/3 were detected by Western blotting. Five small and 6 large corticotroph tumors were collected. POMC and pro-ACTH signals were visualized in 5/6 large tumors and in 4/5 small tumors. The strongest signal intensity was observed in 2 large tumors. The PC1/3 signal was weak to undetectable in 6/6 large tumors but strong in 5/5 small tumors. These results suggest differences in PC1/3 protein levels and patterns of POMC processing between large and small corticotroph tumors. If confirmed in larger groups of tumors, further studies will be required to characterize the mechanism involved in these differences.

The personality dimensions of neuroticism and extraversion are strongly associated with emotional experience and affective disorders. Previous studies reported functional magnetic resonance imaging (fMRI) activity correlates of these traits, but no study has used brain-based measures to predict them. Here, using a fully cross-validated approach, we predict novel individuals’ neuroticism and extraversion from functional connectivity (FC) data observed as they simply rested during fMRI scanning. We applied a data-driven technique, connectome-based predictive modeling (CPM), to resting-state FC data and neuroticism and extraversion scores (self-reported NEO Five Factor Inventory) from 114 participants of the Nathan Kline Institute Rockland sample. After dividing the whole brain into 268 nodes using a predefined functional atlas, we defined each individual’s FC matrix as the set of correlations between the activity timecourses of every pair of nodes. CPM identified networks consisting of functional connections correlated with neuroticism and extraversion scores, and used strength in these networks to predict a left-out individual’s scores. CPM predicted neuroticism and extraversion in novel individuals, demonstrating that patterns in resting-state FC reveal trait-level measures of personality. CPM also revealed predictive networks that exhibit some anatomical patterns consistent with past studies and potential new brain areas of interest in personality.

This study examined whether cognitive functioning was related to treatment outcomes in persons with severe mental illness who received a cognitive behavioral therapy (CBT) program for co-occurring posttraumatic stress disorder (PTSD). The study sample was drawn from a larger controlled trial of 108 persons with severe mental illness and PTSD comparing the effects of CBT with treatment as usual on PTSD and related outcomes, with assessments conducted at baseline, post-treatment, and 3- and 6-month follow-ups. Among the 54 persons in CBT, 49 were administered a neuropsychological battery at baseline and 40 were exposed to the CBT program. Statistical analyses of these 40 participants were conducted to evaluate whether cognitive functioning was related to participation in the CBT program, completion of homework assignments, and improvements in PTSD, and other outcomes. Cognitive functioning was not related to participation in CBT or completion of homework. Lower cognitive functioning predicted less learning of information about PTSD at post-treatment and follow-up, but not less clinical benefit from CBT in PTSD diagnosis or symptoms, other symptoms, or health. The results suggest that cognitive impairment does not attenuate response to the CBT for PTSD program in persons with severe mental illness. Clinical Trials.gov Identifier: NCT00053690.

Rationale and Objectives Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. Materials and Methods This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated. Results For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant. Conclusions Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect.

Objectives Radioiodine (131I) dose determination using radiotracer kinetic studies or scoring systems, and fixed relatively high 131I dose (ie, 4 or 5 mCi) administration, are effective and associated with prolonged survival times for hyperthyroid cats. The latter method is less complicated but could expose patients and veterinary personnel to unnecessary levels of radiation. The aim of this study was to retrospectively evaluate the efficacy of a fixed 3.35 mCi 131I dose for the treatment of 96 hyperthyroid cats with no length estimation for any palpated goitre ⩾20 mm, assess outcome and identify factors associated with survival. Methods Serum total thyroxine concentrations at diagnosis and at follow-up times, survival times and cause of death were recorded. Multivariable Cox regression analysis was used to identify factors associated with time to any cause of death from 131I therapy initiation. Results Administration of a median (interquartile range) dose of 3.35 mCi (3.27–3.44 mCi) radioiodine was an effective treatment in 94/96 cats, but two cats remained hyperthyroid. No death related to hyperthyroidism was recorded. Median survival time was 3.0 years; the 1 and 2 year survival rates after 131I therapy were 90% and 78%, respectively. Low body weight (⩽3.1 kg; adjusted hazard ratio [aHR] 5.88; 95% confidence interval [CI] 2.22–16.67; P Conclusions and relevance This study suggests that a fixed 3.35 mCi 131I dose treatment is effective for hyperthyroid cats with goitre(s) with a maximal length estimation

Secondary analyses were performed on data from two randomized controlled trials of a cognitive behavioral therapy (CBT) program for post-traumatic stress disorder (PTSD) in individuals with severe mental illness (SMI) to examine the feasibility, tolerability, and effectiveness for individuals with borderline personality disorder (BPD). In Study 1, 27 participants received CBT or treatment as usual. In Study 2, 55 participants received CBT or a Brief treatment. Feasibility and tolerability of CBT, PTSD symptoms, and other mental health and functional outcomes were examined, with assessments at baseline, post-treatment, and two follow-up time points. CBT was feasible and tolerable in this population. Study 1 participants in CBT improved significantly more in PTSD symptoms, depression, and self-reported physical health. Study 2 participants in both CBT and Brief improved significantly in PTSD symptoms, posttraumatic cognitions, depression, and overall functioning, with those in CBT acquiring significantly more PTSD knowledge, and having marginally significantly greater improvement in PTSD symptoms. CBT for PTSD was feasible and tolerated in individuals with SMI, BPD, and PTSD, and associated with improvements in PTSD symptoms and related outcomes. Prospective research is needed to evaluate CBT in individuals with BPD, including comparing it with staged interventions for this population.

Background: Maternal pregnancy complications, particularly preeclampsia and gestational diabetes mellitus, are described to increase the risk for subsequent coronary artery disease (CAD). In addition, black women are at higher risk for CAD. The objective of this study was to compare the prevalence and extent of CAD as detected by coronary computed tomographic angiography (CCTA) in black women with and without a history of prior pregnancy complications. Methods: We retrospectively evaluated patient characteristics and CCTA findings in groups of black women with a prior history of preterm delivery (n=154), preeclampsia (n=137), or gestational diabetes mellitus (n=148), and a matched control group of black women who gave birth without such complications (n=445). Univariate and multivariate analyses were performed to assess risk factors of CAD. Results: All groups with prior pregnancy complications showed higher rates of any (≥20% luminal narrowing) and obstructive (≥50% luminal narrowing) CAD (preterm delivery: 29.2% and 9.1%; preeclampsia: 29.2% and 7.3%; and gestational diabetes mellitus: 47.3% and 15.5%) compared with control women (23.8% and 5.4%). After accounting for confounding factors at multivariate analysis, gestational diabetes mellitus remained a strong risk factor of any (odds ratio, 3.26; 95% CI, 2.03–5.22; P P Conclusions: Black women with a history of pregnancy complications, particularly gestational diabetes mellitus, have a higher prevalence of CAD on CCTA while only a history of gestational diabetes mellitus was independently associated with any and obstructive CAD on CCTA.

PURPOSE The molecular chaperone heat shock protein 90 (HSP90) plays an important role in several types of tumors also participating in the modulation of the activity of receptor tyrosine kinases activity such as members of the Her family. We evaluated the significance of HSP90 and Her2 expression in colon cancer. METHODS HSP90 and Her2 expression was determined by immunohistochemistry and by fluorescence in situ hybridization (FISH) on 355 primary resected colon carcinomas. Results were correlated with pathologic features (Union for International Cancer Control (UICC) pTNM category, tumor localisation, tumor differentiation), additional molecular genetic characteristics (BRAF, KRAS mutational status, mismatch repair genes (MMR)), and survival. RESULTS HSP90 immunoreactivity was observed in various degrees. Fifty-one cases (14 %) were positive for Her2 (score 2+ and 3+) with 16/43 cases with Her2 2+ staining pattern showing amplification of Her2 determined by FISH. There was a significant correlation between high HSP90 expression and Her2 overexpression (p = 0.011). High HSP90 expression was associated with earlier tumor stages (p = 0.019), absence of lymph node (p = 0.006), and absence of distant metastases (p = 0.001). Patients with high tumoral HSP90 levels had a better survival (p = 0.032), but this was not independent from other prognostic relevant pathologic parameters. Her2 expression was not associated with any of the investigated histopathological, molecular, or clinical parameters. CONCLUSIONS High HSP90 levels are reflecting lower malignant potential in colon cancer. Her2 positivity can be observed in a small number of cases. Targeting HSP90 and/or Her2 may be an alternative therapeutic approach in colon cancer in a subset of patients.

Brain functional connectivity features can predict cognition and behavior at the level of the individual. Most studies measure univariate signals, correlating timecourses from the average of constituent voxels in each node. While straightforward, this approach overlooks the spatial patterns of voxel-wise signals within individual nodes. Given that multivariate spatial activity patterns across voxels can improve fMRI measures of mental representations, here we asked whether using voxel-wise timecourses can better characterize region-by-region interactions relative to univariate approaches. Using two fMRI datasets, the Human Connectome Project sample and a local test-retest sample, we measured multivariate functional connectivity with multivariate distance correlation and univariate connectivity with Pearson's correlation. We compared multivariate and univariate connectivity estimates, demonstrating that relative to univariate estimates, multivariate estimates exhibited higher reliability at both the edge-level and connectome-level, stronger prediction of individual differences, and greater sensitivity to brain states within individuals. Our findings suggest that multivariate estimates reliably provide more powerful information about an individual's functional brain organization and its relation to cognitive skills.

Purpose The National Mammography Database (NMD) contains nearly 20 million examinations from 693 facilities; it is the largest information source for use and effectiveness of breast imaging in the United States. NMD collects demographic, imaging, interpretation, biopsy, and basic pathology results, enabling facility and physician comparison for quality improvement. However, NMD lacks treatment and clinical outcomes data. The network of state cancer registries (CRs) contains detailed pathologic, treatment, and clinical outcomes data. This pilot study assessed electronic linkage of NMD and CR data at a multicenter institution as proof of concept. Materials and Methods We obtained Quality Oversight Committee approval for this retrospective study. Data of patients diagnosed with breast cancer in 2014 and 2015 were retrieved from our NMD-approved radiology information system (RIS) and matched with reportable patients in our CR using social security number (SSN), first name (fname), last name (lname), and date of birth (DOB). Matching was repeated without SSN. Percentage and reasons for mismatch were evaluated. Results The RIS query identified 1,316 patients. CR linkage was 99.2% successful (n = 1,305 of 1,316) using SSN, fname, lname, and DOB. Eleven mismatches included four CR case-finding failures, one NMD fname error, five nonreportable in the CR, and one with correct identifiers in both databases. Without SSN, linkage was 97.3% successful (n = 1,281 of 1,316); name errors accounted for 19 and DOB accounted for 5 additional mismatches. Conclusion Using common data elements, linkage between the NMD and state CRs may be feasible and could provide critical outcomes information to advance accurate assessment of breast imaging in the United States.

OBJECTIVE. The purpose of this study was to investigate patient- and procedure-related variables affecting the false-negative rate of ultrasound (US)-guided liver biopsy and to develop a standardized patient-tailored predictive model for the management of negative biopsy results. MATERIALS AND METHODS. We retrospectively included 389 patients (mean age ± SD, 62 ± 12 years old) who had undergone US-guided liver biopsy of 405 liver lesions between January 1, 2013, and June 30, 2015. We collected multiple patient- and procedure-related variables. By comparing pathology reports of biopsy and the reference standard (further histology or imaging follow-up), we were able to categorize the biopsy results as true-positive, true-negative, and false-negative. Diagnostic accuracy and diagnostic yield were measured. Univariate and multivariate analyses were performed to identify variables predicting false-negative results. A standardized patient-tailored predictive model of false-negative results based on a decision tree was fitted. RESULTS. Diagnostic accuracy and diagnostic yield were 93.8% (380/405) and 89.4% (362/405), respectively. The false-negative rate was 6.5% (25/387). Predictive variables of false-negative results at univariate analysis included body mass index, lesion size, sample acquisition techniques, and immediate specimen adequacy. The only independent predictors at multivariate analysis were patient age and Charlson comorbidity index. By combining lesion size and location with patient age and history of malignancy, we developed a decision tree model that predicts false-negative results with high confidence (up to 100%). CONCLUSION. False-negative results are not negligible at US-guided liver biopsy. The combination of selected lesion- and patient-specific variables may help predict when aggressive management is warranted in patients with likely false-negative results.

Importance Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings. Objectives To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. Design, setting, and participants This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. Main outcomes and measures Percentage of children with IFs in each category and prevalence of specific IFs. Results A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2 = 0.260; 95% CI, 0.135-0.387). Conclusions and relevance Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.

Recent work has demonstrated that human whole-brain functional connectivity patterns measured with fMRI contain information about cognitive abilities, including sustained attention. To derive behavioral predictions from connectivity patterns, our group developed a connectome-based predictive modeling (CPM) approach (Finn et al., 2015; Rosenberg et al., 2016). Previously using CPM, we defined a high-attention network, comprising connections positively correlated with performance on a sustained attention task, and a low-attention network, comprising connections negatively correlated with performance. Validating the networks as generalizable biomarkers of attention, models based on network strength at rest predicted attention-deficit/hyperactivity disorder (ADHD) symptoms in an independent group of individuals (Rosenberg et al., 2016). To investigate whether these networks play a causal role in attention, here we examined their strength in healthy adults given methylphenidate (Ritalin), a common ADHD treatment, compared with unmedicated controls. As predicted, individuals given methylphenidate showed patterns of connectivity associated with better sustained attention: higher high-attention and lower low-attention network strength than controls. There was significant overlap between the high-attention network and a network with greater strength in the methylphenidate group, and between the low-attention network and a network with greater strength in the control group. Network strength also predicted behavior on a stop-signal task, such that participants with higher go response rates showed higher high-attention and lower low-attention network strength. These results suggest that methylphenidate acts by modulating functional brain networks related to sustained attention, and that changing whole-brain connectivity patterns may help improve attention.SIGNIFICANCE STATEMENTRecent work identified a promising neuromarker of sustained attention based on whole-brain functional connectivity networks. To investigate the causal role of these networks in attention, we examined their response to a dose of methylphenidate, a common and effective treatment for attention-deficit/hyperactivity disorder, in healthy adults. As predicted, individuals on methylphenidate showed connectivity signatures of better sustained attention: higher high-attention and lower low-attention network strength than controls. These results suggest that methylphenidate acts by modulating strength in functional brain networks related to attention, and that changing whole-brain connectivity patterns may improve attention.

Objective: To evaluate quantitative markers derived from coronary CT angiography (coronary CTA) performed prior to percutaneous coronary intervention (PCI) with stent placement for predicting in-stent restenosis (ISR) as defined by quantitative coronary angiography (QCA).Materials and methods: We retrospectively analyzed the data of 74 patients (60 +/- 12 years, 72% male) who had undergone dual-source coronary CTA within 3 months prior to a PCI procedure that included stent placement. Quantitative markers of the target vessel were derived from coronary CTA: Total plaque volume (TPV), calcified and non-calcified plaque volumes (CPV and NCPV), plaque burden (PB in %), remodeling index (RI), and lesion length (LL). Marker performance for predicting ISR, as defined by QCA at follow-up, was assessed.Results: Twenty-one of 74 stented lesions showed ISR on follow-up (mean 616 +/- 447 days). When comparing stent length and LL in patients with ISR, a trend towards less complete stent coverage of the target lesion was observed in cases with ISR (17/21 vs. 4/53 cases, p = 0.07). In multivariate analysis (corrected for dyslipidemia), the following markers showed predictive value for ISR (odds ratio [OR]): NCPV (OR 1.08, p = 0.045), LL (OR 138, p = 0.0024), and RI (OR 1.13, p = 0.0019). Sensitivity and specificity for ISR were: NCPV 65% and 80%, LL 74% and 74%, and RI 71% and 78%. At receiver-operating characteristics analysis, NCPV (0.72, p = 0.001), LL (0.77, p Conclusion: Coronary CTA-derived NCPV, LL, and RI portend predictive value for ISR with incremental predictive value when combining these parameters. (C) 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Adjudicated youth in residential treatment facilities (RTFs) have high rates of trauma exposure and post-traumatic stress disorder (PTSD). This study evaluated strategies for implementing trauma-focused cognitive behavioral therapy (TF-CBT) in RTF. Therapists ( N = 129) treating adjudicated youth were randomized by RTF program ( N = 18) to receive one of the two TF-CBT implementation strategies: (1) web-based TF-CBT training + consultation (W) or (2) W + 2 day live TF-CBT workshop + twice monthly phone consultation (W + L). Youth trauma screening and PTSD symptoms were assessed via online dashboard data entry using the University of California at Los Angeles PTSD Reaction Index. Youth depressive symptoms were assessed with the Mood and Feelings Questionnaire–Short Version. Outcomes were therapist screening; TF-CBT engagement, completion, and fidelity; and youth improvement in PTSD and depressive symptoms. The W + L condition resulted in significantly more therapists conducting trauma screening ( p = .0005), completing treatment ( p = .03), and completing TF-CBT with fidelity ( p = .001) than the W condition. Therapist licensure significantly impacted several outcomes. Adjudicated RTF youth receiving TF-CBT across conditions experienced statistically and clinically significant improvement in PTSD ( p = .001) and depressive ( p = .018) symptoms. W + L is generally superior to W for implementing TF-CBT in RTF. TF-CBT is effective for improving trauma-related symptoms in adjudicated RTF youth. Implementation barriers are discussed.

According to the scientific literature, childrens' cognitive development is not complete until adolescence. Therefore, the problems inherent in children serving as witnesses are crucial. In preschool-aged children, false memories may be identified because of misinformation and insight bias. Additionally, they are susceptible of suggestions. The aim of this study was to verify the levels of suggestibility in children between three and 5 years of age. Ninety-two children were examined (44 male, 48 female; M = 4.5 years, SD = 9.62). We used the correlation coefficient (Pearson's r) and the averages variance by SPSS statistical program. The results concluded that: younger children are almost always more susceptible to suggestibility. The dimension of immediate recall was negatively correlates with that of total suggestibility (r = -0.357 p < 0.001). Social compliance and source monitoring errors contribute to patterns of suggestibility, because older children shift their answers more often (r = 0.394 p < 0.001). Younger children change their answers more times (r = -0.395 p < 0.001).