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“Brain-predicted age” quantifies apparent brain age compared to normative neuroimaging trajectories. Advanced brain-predicted age has been well established in symptomatic Alzheimer disease (AD), but is underexplored in preclinical AD. Prior brain-predicted age studies have typically used structural MRI, but resting-state functional connectivity (FC) remains underexplored. Our model predicted age from FC in 391 cognitively normal, amyloid-negative controls (ages 18–89). We applied the trained model to 145 amyloid-negative, 151 preclinical AD, and 156 symptomatic AD participants to test group differences. The model accurately predicted age in the training set. FC-predicted brain age gaps (FC-BAG) were significantly older in symptomatic AD and significantly younger in preclinical AD compared to controls. There was minimal correspondence between networks predictive of age and AD. Elevated FC-BAG may reflect network disruption during symptomatic AD. Reduced FC-BAG in preclinical AD was opposite to the expected direction, and may reflect a biphasic response to preclinical AD pathology or may be driven by inconsistency between age-related vs. AD-related networks. Overall, FC-predicted brain age may be a sensitive AD biomarker.

Importance: More than 4 million Medicare beneficiaries have enrolled in dual-eligible Special Needs Plans (D-SNPs), and coordination-only D-SNPs are common. Little is known about the impact of coordination-only D-SNPs on Medicaid-covered services and spending, including long-term services and supports, which are financed primarily by Medicaid., Objective: To evaluate changes in Medicaid fee-for-service (FFS) spending before and after new enrollment in coordination-only D-SNPs vs new enrollment in non-D-SNP Medicare Advantage (MA) plans among community-living beneficiaries enrolled in both Medicare and North Carolina Medicaid., Design, Setting, and Participants: This cohort study applied a new user, active comparator design to control for selection into MA and inverse probability of treatment weighting to improve the comparability between groups. The cohort included community-living dual-eligible Medicare and Medicaid beneficiaries in North Carolina with 365 days of Medicare FFS enrollment prior to new enrollment in D-SNP (treatment) or other MA plan (active comparator). Linked 100% Medicare and North Carolina Medicaid claims data (2014-2017) provided payments across both payers prior to MA enrollment; after MA enrollment, payments for Medicaid-funded services and supplemental Medicaid payments for Medicare-funded services were observed. Data were analyzed from August 2023 to November 2024., Exposure: New D-SNP enrollment., Main Outcomes and Measures: Outcomes included annualized 1-year Medicaid FFS spending overall and by claim type, including inpatient, outpatient, carrier, home health, personal care services, and behavioral health services., Results: Among 8869 participants in the D-SNP cohort, 4762 (53.7%) were younger than 65 years, 5833 (65.8%), were female, and 975 (11.0%) resided in rural areas. After inverse probability of treatment weighting, characteristics were similar among the comparison MA cohort of 4389 participants (4706 [53.2%] aged <65 years; 5739 [64.9%] female; 971 [11.0%] rural). There were no significant differences in Medicaid FFS spending per person-year (PPY) at baseline or differential change in the year following new enrollment (mean marginal effect, -$387 [95% CI, -$1274 to $501) between groups. There were significant differences between groups in the change in spending on long-term services and supports, with maintained spending on community-based personal care services following new enrollment in D-SNPs compared with reductions for other MA, resulting in a relative increase of $343 (95% CI, $147 to $539)., Conclusions and Relevance: This cohort study found that coordination-only D-SNPs was associated with maintained North Carolina Medicaid FFS spending levels for long-term services and supports compared with other MA plans, despite limited integration requirements. However, to reduce or delay nursing home transitions, higher levels of integration may be necessary.

Lay Abstract: Black and non-White Latinx children tend to receive autism diagnoses later in life and with a higher degree of impairment than White children. The purpose of this study was to learn what is currently helping as well as preventing Black and non-White Latinx children from getting access to autism evaluation and services. We held virtual interviews with 26 experts who work with autistic children and their families, including clinical providers, researchers, advocates, and policymakers/government representatives. From these interviews, we identified four themes that have an impact on equity in autism services: (1) who makes up the workforce , (2) w orkforce capacity and accessibility , (3) workforce payment structure , and (4) changes due to the COVID-19 pandemic. These findings show the need for improved workforce diversity, autism-specific education, payment structures, and additional support for workforce members to avoid burnout. To make childhood autism services more equitable, diversity in recruitment across training levels, cultural awareness, increased autism education for all pediatric providers, and partnerships with caregivers as experts must be prioritized. These investments in the autism workforce will allow professionals in the field to better meet the needs of children and families from Black and non-White Latinx communities and achieve equity in early childhood autism services., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Missed infant well-child visits (WCV) result in lost opportunities for critical preventive care. Black infants consistently receive less WCV care than other racial groups. We sought to understand barriers and facilitators to timely infant WCV for Black families in the context of COVID-19., Methods: We conducted 21 semi-structured interviews with caregivers of Medicaid-insured Black children aged 15- to 24-months who attended six or fewer of eight recommended well-child visits within the first 15 months of life. Interviews focused on WCV value, barriers, and facilitators. After developing our initial coding structure through rapid qualitative analysis, we inductively derived the final codebook and themes through line-by-line content analysis., Results: Caregivers attended a mean of 3.53 of eight infant visits. Structural (e.g., transportation) and psychological (e.g., maternal depression) barriers delayed Black infant WCV. Families most frequently valued monitoring development and addressing concerns. Caregivers perceived visits as less urgent when infants seemed healthy or more recently avoided visits due to fears around COVID-19. Long waits and feeling rushed/dismissed were linked to WCV delays; positive provider relationships encouraged WCV attendance. Most caregivers reported reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV., Conclusions: Caregivers described several factors that impacted WCV attendance for Black infants. Persistent structural and psychological barriers are compounded by perceptions that caregiver time is not respected and by notable vaccine hesitancy. To address these barriers, well-care can meet Black families in their communities, better address caregiver wellbeing, more efficiently use caregiver and provider time, and cultivate partnerships with Black caregivers., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity., Competing Interests: The authors report no financial relationships with commercial interests.

Background: Cognitive behavioural therapy (CBT) and medication are widely accepted and useful interventions for individuals with depression. However, a gap remains in our current understanding of how CBT directly benefits adolescents with depression., Aims: The purpose of this study was to examine the short- and long-term effectiveness of CBT only, CBT+Medication, or Medication alone in reducing the duration of major depressive episodes, lessening internalizing and externalizing symptoms and improving global functioning., Methods: Data were extracted from 14 unique studies with a total of 35 comparisons. Network meta-analysis was conducted and p -scores, a measure of the extent of certainty that one treatment is better than another, were used to rank treatments., Results: There was no significant difference between any two treatments for depression, nor internalizing or externalizing symptoms. For global functioning, CBT had significantly greater effect at the longest follow-up than CBT+Medication. CBT+Medication had the highest p -score for depression, short- and long-term effects, and internalizing and externalizing symptoms long-term effects. No indication of publication bias was found., Conclusions: Neither modality, CBT nor medication, is superior for treating adolescent depression. However, CBT was superior in improving global functioning, which is essential for meeting developmental goals.

Background: Childhood food insecurity increased considerably during the COVID-19 pandemic and is associated with compromised health. Health care systems are increasingly prioritizing food insecurity interventions to improve health, but it is unclear how health systems collaborate with other sectors that are addressing food insecurity. In this study, we aimed to evaluate existing collaborations and explore opportunities for further cross-sector engagement., Methods: From December 2020 to March 2021, we conducted semi-structured interviews (N = 34) with informants involved in increasing child food access in North Carolina. Our informants represented different sectors, including community (e.g., food pantry), education (e.g., school lunch program), and government (e.g., Supplemental Nutrition Assistance Program). Rapid qualitative analysis was used to interpret the results and identify themes., Results: Informants rarely mentioned the health care sector as a source of referrals or as a collaborator. Barriers limiting access to food insecurity programs were exacerbated by the COVID-19 pandemic, including lack of transportation, stigma deterring use, limited food choice, and burdensome enrollment processes. Stakeholders recommended mitigating barriers through the expansion of food delivery, colocalization of assistance programs in schools and health care settings, increased food choice, and supporting cross-program enrollment mechanisms., Limitations: The majority of the stakeholders represented programs from five counties in central North Carolina, with only a few representing statewide initiatives., Conclusions: The COVID-19 pandemic both highlighted the fragmented system of food insecurity organizations and accelerated development of cross-sector collaborations to reduce access barriers. Health care systems are siloed from school and community efforts but have the opportunity to leverage ongoing innovative policy initiatives to construct novel cross-sector models. Such models can better link food insecurity screening with community-based solutions to address family-level food access barriers., Competing Interests: Disclosure of interests. All authors report no relevant conflicts of interest.

Objective: The authors aimed to examine racial-ethnic differences in filled psychotropic prescriptions among a pediatric Medicaid population., Methods: This retrospective cohort study included patients ages 0-21 with at least one North Carolina Medicaid claim from October 1, 2017, through September 30, 2018 (N=983,886). The primary outcome was a filled psychotropic prescription. Separate multivariable modified Poisson regression models generated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs), adjusted for patient demographic characteristics., Results: Black and Hispanic patients were significantly less likely to receive any filled psychotropic prescription (ARR=0.61, 95% CI=0.60-0.62; ARR=0.29, 95% CI=0.28-0.29, respectively) compared with White and non-Hispanic patients. Furthermore, Black and Hispanic patients were less likely to receive filled prescriptions in the four included drug classes compared with White and non-Hispanic patients., Conclusions: Future studies should focus on understanding the factors contributing to racial and ethnic differences among pediatric patients receiving filled psychotropic prescriptions.

Objective: We examined characteristics associated with receiving the North Carolina Home and Community-Based Services Waiver for intellectual and developmental disabilities (I/DDs) and its association with emergency department (ED) utilization., Method: Through analysis of the North Carolina 2017 to 2018 Medicaid claims and enrollment data, we examined characteristics (age, sex, race and ethnicity, geography, diagnosis (intellectual disability [ID] with or without autism spectrum disorders or autism spectrum disorder without ID) associated with receiving the NC I/DD Waiver and the association of this Wavier with ED utilization. We identified patients with at least 1 International Classification of Diseases-10-CM diagnosis code for an ID or autism spectrum disorder. We excluded patients with missing county information and whose enrollment in the NC I/DD Waiver program began after October 1, 2017., Results: Only 22% of 53,531 individuals with I/DD in North Carolina received the Waiver. Non-Hispanic Blacks and Hispanic individuals were less likely to receive the Waiver than non-Hispanic White individuals. Adults (>21 years old), men, and urban residents were more likely to receive the Waiver. Individuals who received the Waiver were 31% less likely to use the ED., Conclusion: Innovative strategies are needed to provide equitable access to the NC I/DD Waiver and provide services to the 14,000 people with I/DD currently waiting to receive the Waiver. Through the Waiver, those with I/DD can access preventative and therapeutic outpatient services and decrease their need for ED care. These findings highlight the need for policy reform to address inequities in access to the Waiver for individuals with I/DD., Competing Interests: Disclosure: J. Howard discloses personal fees from Roche. The remaining authors declare no conflict of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID); thus, new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge., Objective: Our objective was to describe the development of a new method for identifying individuals with ID within large, population-level studies not targeted on ID., Methods: We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet the criteria of ID. The three criteria of ID (intellectual functioning, adaptive functioning, and disability originating during the developmental period) were derived from the definitions of ID used by the American Psychiatric Association and the American Association on Intellectual and Developmental Disabilities. The ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations included in the Add Health database from Waves I to III., Results: This method identified 441 adolescents who met criteria of ID and had sampling weights. At Wave I, the mean age of this subsample of adolescents with ID was 16.1 years. About half of the adolescents were male and from minority racial groups. Their parents were predominately female, were married, had less than a high school education, and had a median age of 41.62 years. The adolescents' mean maximum abridged Peabody Picture Vocabulary Test standardized score was 69.6, and all demonstrated at least one adaptive functioning limitation., Discussion: This study demonstrates the development of a data-driven method to identify individuals with ID using commonly available data elements in nationally representative population data sets. By utilizing this method, researchers can leverage existing rich data sets holding potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.

Purpose: This study explored the health care transition (HCT) experiences of parents of adolescents and young adults (AYAs) with intellectual disability (ID), 18-33 years of age, including barriers and facilitators to the AYA's transition to adulthood within and between the medical, educational, community, and vocational systems., Design and Methods: A qualitative descriptive design with semi-structured individual interviews with 16 parent participants was used. Purposive sampling of parents was utilized with variation on race/ethnicity and AYA age, stage in transition, and condition. This study was conducted through a major medical center in the southeast United States. Content analysis was utilized., Results: Three overarching themes represented the factors and essence of supporting AYAs with ID transition to adulthood. Inefficient and siloed systems illuminated barriers families are commonly experiencing within and between the medical, educational, community, and vocational systems. 'Left out here floundering' in adulthood, described the continued inadequacy of resources within each of these systems and parent's having to find available resources themselves. Hope despite uncertainty, included the perceived costs and benefits of their AYA's disability and the value of parent peer support in providing key knowledge of resources, strategies, and perspectives., Conclusions: Our findings illuminate the need for improved infrastructure to provide effective HCT and partnerships to help integrate HCT support within other life course systems. Results support the rationale for non-categorical HCT-focused approach., Practice Implications: A parent peer coach-facilitated intervention offers promise for bridging the gap between systems and meeting family needs., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Having valid, reliable, and culturally adapted tools to screen for adolescent depression is a crucial concern for mental health care professionals who promote preventive care. To this aim, this study tested the psychometric properties and factor structure of the Center for Epidemiologic Studies Depression (CES-D) Scale among Arab adolescents. A nationally representative sample of 3,292 Jordanian adolescents aged 13-17 completed the CES-D 20-item scale. A principal axis factoring with a varimax rotation was used to identify the factor structure of the scale on a half of the sample ( n 1  = 1,655), followed by a confirmatory factor analysis to assess the fitness of the factor structure to the other half of the sample ( n 2  = 1,637) on a variety of model-fit indices. Findings did not support the original four-factor structure. The results indicated that two factors provide a reasonably better fit: Factor 1 combined items on depressed affect, somatic complaints and interpersonal problems, and Factor 2 consisted of the remaining four positive affect items. The modified model showed high internal reliability and excellent construct validity. The results revealed that depression construct among Arab adolescents, as measured by the CES-D, differs from that in other ethnic groups. Nurses and other health professionals need to closely examine the different presentation of depressive symptoms across racial and ethnic groups to avoid diagnostic errors, inappropriate management, and poor compliance.

Objective: In adulthood, depressive mood is often comorbid with ADHD, but its role in ADHD-inattentiveness and especially relations with mind wandering remains to be elucidated. This study investigated the effects of laboratory-induced dysphoric mood on task-unrelated mind wandering and its consequences on cognitive task performance in college students with high (n = 46) or low (n = 44) ADHD-Inattention symptomatology and Hyperactivity/Impulsivity symptoms in the normal range., Methods: These non-clinical high/low ADHD-Inattention symptom groups underwent negative or positive mood induction after which mind wandering frequency was measured in a sustained attention (SART), and a reading task. Effects of ruminative response style and working memory capacity on mind wandering frequency were also investigated., Results: Significantly higher frequencies of self -reported mind wandering in daily life, in the SART and reading task were reported in the ADHD-Inattention symptom group, with detrimental effects on text comprehension in the reading task. Induced dysphoric mood did specifically enhance the frequency of mind wandering in the ADHD-Inattention symptom group only during the SART, and was related to their higher self-reported intrusive ruminative response styles. Working memory capacity did not differ between high/low attention groups and did not influence any of the reported effects., Conclusions: These combined results suggest that in a non-clinical sample with high ADHD-inattention symptoms, dysphoric mood and a ruminative response style seem to be more important determinants of dysfunctional mind wandering than a failure in working memory capacity/executive control, and perhaps need other ways of remediation, like cognitive behavioral therapy or mindfulness training.

Objective: To determine whether femoral osteotomies that change frontal plane alignment without affecting torsion influence anteversion and inclination., Methods: Femurs without deformity were scanned to create three-dimensional reconstructions. The femoral head-neck axis was identified by placement of a virtual intramedullary pin. A proximal osteotomy was simulated to create three conditions while keeping torsion constant: Normal, Coxa Valga (neck-shaft angle increased by 12°), and Coxa Vara (neck-shaft angle decreased by 12°). Femoral anteversion was measured from an axial image in all three conditions. Femoral inclination was calculated for all conditions using the neck-shaft and anteversion angles. Changes in anteversion and inclination were calculated and compared using a one-way repeated measures analysis of variance. Distal femoral osteotomies were then simulated with the native femurs, inducing 18° of distal varus with no change to torsion. Changes in anteversion and inclination for the Normal and Distal Varus conditions were calculated and compared by a paired t-test., Results: Version changed by a mean of 13.9° (± 1.5; p <0.0001) from the Coxa Valga to Coxa Vara conditions while inclination changed by a mean of 1.3° (± 0.39; p <0.01). Version changed by a mean of 6.6° (± 0.7; p <0.0001) between the Distal Varus and Normal conditions while inclination changed by a mean of -3.8° (± 0.75; p <0.001)., Clinical Significance: Femoral version changes with changing frontal plane alignment even when torsion is constant. This should be considered when correcting femoral deformities.

Objective: Although earlier work has shown a link between mind-wandering and ADHD symptoms, this relationship has not been further investigated by taking into account recent advances in mind-wandering research., Method: The present study provides a comprehensive assessment of the relationship between mind-wandering and ADHD symptomatology in an adult community sample ( N = 105, 71 females, M age = 23.1) using laboratory measures and experience sampling during daily life., Results: Mind-wandering and detrimental mind-wandering were positively associated with ADHD symptoms. Meta-awareness of mind-wandering mediated the relationship between ADHD symptomatology and detrimental mind-wandering, suggesting that some of the negative consequences can be ameliorated by strategies that facilitate meta-awareness. Interestingly, participants with low ADHD scores showed a positive relationship between detrimental mind-wandering and useful mind-wandering; however, participants with high ADHD scores failed to engage in this type of "strategic" mind-wandering., Conclusion: These results provide new insights into the relationship between ADHD symptomatology and mind-wandering that could have important clinical implications.

Introspection and language are the cognitive prides of humankind, but their interactions in healthy cognition remain unclear. Episodes of mind-wandering, where personal thoughts often go unnoticed for some time before being introspected, offer a unique opportunity to study the role of language in introspection. In this paper, we show that inner speech facilitates awareness of mind-wandering. In two experiments, we either interfered with verbal working memory, via articulatory suppression (Exp. 1), or entrained it, via presentation of verbal material (Exp. 2), and measured the resulting awareness of mind-wandering. Articulatory suppression decreased the likelihood to spontaneously notice mind-wandering, whereas verbal material increased retrospective awareness of mind-wandering. In addition, an ecological study using smartphones confirmed that inner speech vividness positively predicted mind-wandering awareness (Exp. 3). Together, these findings support the view that inner speech facilitates introspection of one's thoughts, and therefore provides empirical evidence for a positive relation between language and consciousness., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the aftermarket efficacy of ocriplasmin for vitreomacular adhesion (VMA) and identify the frequency and duration of structural changes on optical coherence tomography., Methods: The authors conducted a retrospective case series of 36 eyes treated with ocriplasmin for symptomatic VMA at a single center between February 2013 and September 2013. Eyes were evaluated for release of VMA at 1 month postinjection, preinjection adhesion size, postinjection closure of macular hole, presence of subretinal fluid after release of adhesion, size of subretinal fluid, outer retinal structural change, and visual acuity at 1 month, 6 months, and 1 year., Results: Fifteen eyes (42%) had complete release of VMA at 1 month postinjection, and 78% of eyes had closure of the macular hole. Eyes that did not have an epiretinal membrane that had a smaller initial adhesion size and a smaller macular hole size were more likely to have complete release of VMA. Subretinal fluid was present after release in 73.3% of treated eyes, and ellipsoid zone changes were present in 66.7% of treated eyes. At the end of 1 year, complete resolution of subretinal fluid occurred in 87% of treated eyes with only trace subretinal fluid remaining in 2 eyes. Complete resolution of ellipsoid zone changes was found in all eyes. Best-corrected visual acuity improved throughout the first year after treatment., Conclusion: Ocriplasmin is effective in the treatment of patients with symptomatic VMA. Results can be improved with patient selection based on specific criteria. Subretinal fluid and ellipsoid zone changes are common after treatment but mostly resolve over 1 year.

Purpose: Current treatment paradigms for macular edema associated with retinal vein occlusions (RVO) often involve initial treatment with anti-vascular endothelial growth factor (VEGF) agents, then switching to intravitreal dexamethasone implant (IDI; Ozurdex, Allergan, Parsippany, NJ) for poor responders. However, many patients undergo multiple injections prior to being declared a nonresponder. We devised a method for prediction of poor anti-VEGF response after one injection, and show that these patients subsequently respond well to IDI., Methods: This study is a retrospective consecutive interventional case series of patients with RVO receiving anti-VEGF agents that were switched to IDI. Patients were categorized as nonresponders to anti-VEGF agents (edema did not improve) or responders (edema improved, but switched to IDI for longer treatment duration). Receiver operating characteristics (ROC) curve analysis was used to determine cutoffs of reduction in central retinal thickness (CRT) to predict poor response to anti-VEGF treatment., Results: Twenty-three patients met inclusion criteria. There were 14 nonresponders and 9 responders. The ROC curve analysis found that the maximal sensitivity and specificity in correctly identifying responders to anti-VEGF therapy was those with &gt;25% reduction in CRT 1 month after 1 anti-VEGF treatment (sensitivity 0.89, specificity 0.79, area under the curve 0.93). After IDI placement, anti-VEGF nonresponders showed significant improvement in visual acuity (VA) (p = 0.02) and CRT (p = 0.01)., Conclusions: In patients with macular edema secondary to RVOs, a reduction in CRT by ≤25%, 1 month after 1 anti-VEGF injection, is predictive of poor response to anti-VEGF treatment. These patients may benefit from earlier conversion to IDI treatment, which in our study, resulted in improved VA and CRT.

Although implicit learning has been widely studied, controversy remains regarding its reliance on attentional resources. A central issue in this controversy is the question of how best to manipulate attention. The usual approach of comparing implicit learning in a serial reaction time (SRT) task under single- versus dual-task conditions is known to be problematic, because the secondary task may not only divert attention away from the primary task, but also interfere with the implicit-learning process itself. To address this confound, in the present study we used an experience-sampling instead of a dual-task approach. We assessed lapses of attention (mind-wandering) with experience-sampling thought probes during a standard implicit-learning SRT task. The results revealed a significant negative correlation between mind-wandering and implicit learning. Thus, greater task focus was associated with improved implicit sequence learning. This result suggests that, at least in the context of this SRT task, optimal implicit learning relies on attention.

The electroencephalogram (EEG) of mind-wandering (MW) was examined in event-related potentials (ERPs) and pre-stimulus alpha (8-12 Hz), over lateral-posterior sites of left and right brain hemispheres, while individuals read text passages. After controlling for individual differences in general intelligence (g), P1-asymmetry was greater (right-minus- left) and N1 amplitudes were more negative, when individuals were not MW (i.e., they were reading attentively). Approximately 82% of variance in reading comprehension was accounted for by the predictors: g, pre-stimulus alpha, left- and right-hemisphere P1, and left-hemisphere N1 (when individuals were not MW). Together, individual differences in MW-sensitive ERPs uniquely accounted for approximately 38% of the variance in reading comprehension, over and above prediction by g and pre-stimulus alpha. The within-person effect of MW on P1-asymmetry was estimated to account for an additional 4.6% of criterion variance. Implications for EEG/ERP research into attention, language processing, hemispheric asymmetries, and individual differences are discussed., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Although mind-wandering during silent reading is well documented, to date no research has investigated whether similar processes occur during reading aloud. In the present study, participants read a passage either silently or aloud while periodically being probed about mind-wandering. Although their comprehension accuracies were similar for both reading conditions, participants reported more mind-wandering while they were reading aloud. These episodes of mindless reading were associated with nearly normal prosody, but were nevertheless distinguished by subtle fluctuations in volume that were predictive of both overall comprehension accuracy and individual sentence comprehension. Together, these findings reveal that previously hidden within the common activity of reading aloud lies: (1) a demonstration of the remarkable automaticity of speech, (2) a situation that is surprisingly conducive to mind-wandering, (3) subtle vocal signatures of mind-wandering and comprehension accuracy, and (4) the promise of developing useful interventions to improve reading.

Mind-wandering is the focus of extensive investigation, yet until recently there has been no validated scale to directly measure trait levels of task-unrelated thought. Scales commonly used to assess mind-wandering lack face validity, measuring related constructs such as daydreaming or behavioral errors. Here we report four studies validating a Mind-Wandering Questionnaire (MWQ) across college, high school, and middle school samples. The 5-item scale showed high internal consistency, as well as convergent validity with existing measures of mind-wandering and related constructs. Trait levels of mind-wandering, as measured by the MWQ, were correlated with task-unrelated thought measured by thought sampling during a test of reading comprehension. In both middle school and high school samples, mind-wandering during testing was associated with worse reading comprehension. By contrast, elevated trait levels of mind-wandering predicted worse mood, less life-satisfaction, greater stress, and lower self-esteem. By extending the use of thought sampling to measure mind-wandering among adolescents, our findings also validate the use of this methodology with younger populations. Both the MWQ and thought sampling indicate that mind-wandering is a pervasive-and problematic-influence on the performance and well-being of adolescents.

The negative effects of mind-wandering on performance and mood have been widely documented. In a recent well-cited study, Killingsworth and Gilbert (2010) conducted a large experience sampling study revealing that all off-task episodes, regardless of content, have equal to or lower happiness ratings, than on-task episodes. We present data from a similarly implemented experience sampling study with additional mind-wandering content categories. Our results largely conform to those of the Killingsworth and Gilbert (2010) study, with mind-wandering generally being associated with a more negative mood. However, subsequent analyses reveal situations in which a more positive mood is reported after being off-task. Specifically when off-task episodes are rated for interest, the high interest episodes are associated with an increase in positive mood compared to all on-task episodes. These findings both identify a situation in which mind-wandering may have positive effects on mood, and suggest the possible benefits of encouraging individuals to shift their off-task musings to the topics they find most engaging.

Given that the ability to attend to a task without distraction underlies performance in a wide variety of contexts, training one's ability to stay on task should result in a similarly broad enhancement of performance. In a randomized controlled investigation, we examined whether a 2-week mindfulness-training course would decrease mind wandering and improve cognitive performance. Mindfulness training improved both GRE reading-comprehension scores and working memory capacity while simultaneously reducing the occurrence of distracting thoughts during completion of the GRE and the measure of working memory. Improvements in performance following mindfulness training were mediated by reduced mind wandering among participants who were prone to distraction at pretesting. Our results suggest that cultivating mindfulness is an effective and efficient technique for improving cognitive function, with wide-reaching consequences.

Smallwood (2013) made important contributions to the science of mind wandering by distinguishing between 2 aspects of the mind-wandering experience: (a) how the mind wanders, which entails the process of maintaining the continuity of a mind-wandering episode, and (b) why the mind wanders, which refers to those mechanisms that lead to the occurrence of a mind-wandering episode. This new process-occurrence framework offers a way to compare and contrast existing theories of mind wandering and highlights key questions to be addressed in future work; however, we suggest that in characterizing one of the core mechanisms of mind wandering, Smallwood conflated the occurrence of a phenomenon with its explanation. Specifically, the occurrence of perceptual decoupling (i.e., that mind wandering is associated with reduced attention to external stimuli) was conflated with an explanation for its occurrence (i.e., in order to insulate the internal train of thought). Disentangling the theory of perceptual decoupling raises questions regarding both its role in insulating the internal train of thought in mind wandering and its unique theoretical contributions to the how/process of mind wandering., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Mind-wandering is both pervasive and detrimental to task performance. As such, identifying covert physiological measures that are associated with this off-task state could inform theories of mind-wandering and lead to interventions that improve task focus. Although previous work suggests that pupil dilation (PD) may vary between on- and off-task states, no studies have examined whether PD systematically varies within a subject as they report becoming disengaged from a task-a key step in developing useful mind-wandering prediction algorithms. In the present study, PD was measured while participants advanced through a passage one word at a time. Spontaneous mind-wandering was assessed during reading using standard thought probe methodology. Results revealed higher PD prior to off-task than prior to on-task reading. This newly discovered relationship between momentary fluctuations of attention and PD offers promise for future innovations that use these systematic changes in PD to predict and better control mind-wandering.

Tests of working memory capacity (WMC) and fluid intelligence (gF) are thought to capture variability in a crucial cognitive capacity that is broadly predictive of success, yet pinpointing the exact nature of this capacity is an area of ongoing controversy. We propose that mind-wandering is associated with performance on tests of WMC and gF, thereby partially explaining both the reliable correlations between these tests and their broad predictive utility. Existing evidence indicates that both WMC and gF are correlated with performance on tasks of attention, yet more decisive evidence requires an assessment of the role of attention and, in particular, mind-wandering during performance of these tests. Four studies employing complementary methodological designs embedded thought sampling into tests of general aptitude and determined that mind-wandering was consistently associated with worse performance on these measures. Collectively, these studies implicate the capacity to avoid mind-wandering during demanding tasks as a potentially important source of success on measures of general aptitude, while also raising important questions about whether the previously documented relationship between WMC and mind-wandering can be exclusively attributed to executive failures preceding mind-wandering (McVay & Kane, 2010b)., ((PsycINFO Database Record (c) 2012 APA, all rights reserved).)

Although anecdotes that creative thoughts often arise when one is engaged in an unrelated train of thought date back thousands of years, empirical research has not yet investigated this potentially critical source of inspiration. We used an incubation paradigm to assess whether performance on validated creativity problems (the Unusual Uses Task, or UUT) can be facilitated by engaging in either a demanding task or an undemanding task that maximizes mind wandering. Compared with engaging in a demanding task, rest, or no break, engaging in an undemanding task during an incubation period led to substantial improvements in performance on previously encountered problems. Critically, the context that improved performance after the incubation period was associated with higher levels of mind wandering but not with a greater number of explicitly directed thoughts about the UUT. These data suggest that engaging in simple external tasks that allow the mind to wander may facilitate creative problem solving.

Although consciousness can be brought to bear on both perceptual and internally generated information, little is known about how these different cognitive modes are coordinated. Here we show that between-participant variance in thoughts unrelated to the task being performed (known as task unrelated thought, TUT) is associated with longer response times (RT) when target presentation occurs during periods when baseline Pupil Diameter (PD) is increased. As behavioral interference due to high baseline PD can reflect increased tonic activity in the norepinephrine system (NE), these results might implicate high tonic NE activity in the facilitation of TUTs. Based on these findings, it is hypothesised that high tonic mode NE leads to a generalised de-amplification of task relevant information that prioritses internally generated thought and insulates it from the potentially disruptive events taking place in the external environment.

Although mind wandering during reading is extremely common, researchers have only recently begun to study how it relates to reading behavior. In the present study, we used a word-by-word reading paradigm to investigate whether it could be possible to predict in real time whether a participant would report mind wandering when probed. By taking advantage of the finding that reaction times to individual words vary based on reports of mind wandering (with participants being less affected by length, number of syllables, and familiarity, and also showing an overall speed-up, during mindless reading), we were able to develop an algorithm that could successfully predict in real time whether a participant would report being on versus off task. In addition, for participants run without thought probes, there was a significant negative correlation between the number of predicted mind-wandering episodes and reading comprehension. Together, these findings offer a key advance toward the development of pedagogical tools for minimizing the negative impact of mindless reading, and they provide a new covert measure that could be used to study mind wandering without requiring participants to report on their mental states.

Accumulating evidence suggests that the brain can efficiently process both external and internal information. The processing of internal information is a distinct "offline" cognitive mode that requires not only spontaneously generated mental activity; it has also been hypothesized to require a decoupling of attention from perception in order to separate competing streams of internal and external information. This process of decoupling is potentially adaptive because it could prevent unimportant external events from disrupting an internal train of thought. Here, we use measurements of pupil diameter (PD) to provide concrete evidence for the role of decoupling during spontaneous cognitive activity. First, during periods conducive to offline thought but not during periods of task focus, PD exhibited spontaneous activity decoupled from task events. Second, periods requiring external task focus were characterized by large task evoked changes in PD; in contrast, encoding failures were preceded by episodes of high spontaneous baseline PD activity. Finally, high spontaneous PD activity also occurred prior to only the slowest 20% of correct responses, suggesting high baseline PD indexes a distinct mode of cognitive functioning. Together, these data are consistent with the decoupling hypothesis, which suggests that the capacity for spontaneous cognitive activity depends upon minimizing disruptions from the external world.

The N400 is an event-related potential (ERP) component that is elicited by semantically meaningful stimuli; one of its defining characteristics is that it is amplified for sentence completions that are semantically unexpected or incongruous with the preceding context. Some prior reports using visual sentence reading paradigms have suggested that there may also be a Cz-centered P400 (a P400cz) that is also responding to semantic congruity manipulations, distinct from the classic Pz-centered N400 (the N400pz). In the present experiment, sentences were presented visually one word at a time, and half of the sentences ended with a semantically incongruent ending. High-density 129-channel event-related potential data were recorded from 26 participants. A combination of temporo-spatial principal components analysis (PCA) and item averaging was applied to decompose the waveforms. The presence of the P400cz was confirmed. The P400cz was much more sensitive to congruity and somewhat more sensitive to cloze probability than the N400pz. The separation of the N400 semantic effect into these two portions is consistent with both MEG studies and intracranial studies. The data suggest that the N400pz has its major source in the bilateral anterior medial temporal lobe (AMTL) whereas it is suggested that the P400cz has its major source in the medial parietal region. It is further suggested that whereas the N400pz process appears to be semantic in nature, some prior reports suggest that the P400cz reflects a general sequential expectancy system., (Copyright © 2010 Elsevier B.V. All rights reserved.)

The role of the intraparietal sulcus (IPS) in the representation of numerical magnitude is well established. Recently, there has also been speculation that the IPS is involved in the representation of ordinal information as well. These claims, however, overlook the fact that all neuroimaging paradigms in which participants make judgments about either magnitude and/or order result in a behavioral distance effect (i.e., the comparison is easier when the stimuli span a greater distance). This leaves open two possibilities: It may be that activation of the IPS is due to the mechanism that yields distance effects, or it may be that the IPS is involved in the representation of information about both magnitude and order. The current study used fMRI to compare a magnitude task in which participants show distance effects to an order-judgment task that yields reverse-distance effects. The results reveal activation of the IPS for both the magnitude and order tasks that is based on participants' strategies as opposed to the actual distance between the numbers. This leads to the conclusion that the IPS represents a mental number line, and that accessing this line can lead to distance effects when participants compare magnitudes and to reverse-distance effects when participants check for order.

Despite a great deal of research on the processing of numerical magnitude (e.g., the quantity denoted by the number 5), few studies have investigated how this magnitude information relates to the ordinal properties of numbers (e.g., the fact that 5 is the fifth integer). In the present study, we investigated order-related processing of numbers, as well as months of the year, with a novel ordering task to see whether the processing of order information differs from the processing of magnitude information. In Experiments 1 and 2, participants were shown three numbers (Experiment 1) or three months (Experiment 2) and were required to indicate whether the stimuli were in the correct order. In Experiment 3, participants were again shown three numbers; however, now they were instructed to indicate whether the three numbers were ordered in a forward, backward, or mixed direction. Whereas number comparison tasks typically reveal distance effects (comparisons become easier with increased distance between two numbers), these three experiments reveal a different pattern of results. There were reverse distance effects when the stimuli crossed a boundary (i.e., when numbers crossed a decade or months crossed the year boundary) and no effect of distance when the stimuli did not cross a boundary (i.e., when numbers were within a decade and months were within the January-December calendar year). These data suggest that additional mechanisms are involved in the processing of order information: a scanning mechanism and a long-term memory checking mechanism.

A significant body of education literature has begun using multilevel statistical models to examine data that reside at multiple levels of analysis. In order to provide a primer for medical education researchers, the current work gives a brief overview of some issues associated with multilevel statistical modeling. To provide an example of this technique, we then present a multilevel analysis examining the relationship between two individual-level variables and the "cross-level" interaction between this relationship and a school-level variable. In offering this discussion and example of multilevel modeling, we hope to provide medical educators with a basic introduction to multilevel statistics, including the advantages of utilizing these techniques.

Participants read sentences presented one word at a time, half of which ended with a semantically incongruent ending. 1.5T functional magnetic resonance imaging data were collected from 11 participants, showing that the left posterior inferior temporal region, which has previously been termed the Language Formulation Area (LFA), responded to cloze probability. It is suggested, based on anatomical positioning and a literature review, that the responsiveness of the LFA to cloze probabilities may reflect a role in coordinating the lexical and non-lexical reading pathways. Finally, it is noted that previous studies have implicated this region in dyslexia and some speculations are made in this regard.

Objective: To determine whether ERP components can differentiate between the semantic priming mechanisms of automatic spreading activation, expectancy, and semantic matching., Methods: The present study manipulated two factors known to differentiate semantic priming mechanisms: associations between words (forward, backward, and symmetrical) and prime-target stimulus onset asynchrony (SOA). Twenty-six participants were tested in each SOA condition while high-density 128-channel data were collected. Principal components analysis was applied to separate the ERP components., Results: Priming was observed for all conditions. Three semantic components were present: (1) the standard N400 effect for symmetric and forward priming pairs at both short and long SOAs, (2) an N300 for the long SOA symmetric priming pairs, and (3) a right-lateralized posterior N400RP for long SOA backward priming pairs., Conclusions: Results suggest that the N300 reflects expectancy, but only for categorical and/or semantic similarity priming. Results further suggest that the N400RP is a replicable ERP component that responds to semantic matching. There is also some evidence that the N400 indirectly responds to both ASA and expectancy, perhaps as part of a post-lexical updating process and that backward priming at short SOAs is different from that at long SOAs., Significance: Improved understanding of the semantic properties of the N400 and related ERP components may increase their utility for understanding language processes and for diagnostic purposes.

The current study sought to uncover how temporal information is represented in our knowledge about routine events. In Experiment 1 we collected norming data on eight routines taken from Galambos (1983). In Experiment 2 participants were presented with two actions of varying distance from a routine and asked "Are the actions in the correct order?". We found that a number of variables interact with distance, including action position, routine familiarity, and experimental block. These data suggest that sometimes participants are faster when the actions are far apart in the routine, while at other times they are faster when actions are closer together, providing evidence for both distance and reverse-distance effects, respectively. A model is presented to help interpret these data in which temporal information for routine events is both: (1) coarsely coded, and processed by an estimation mechanism; and (2) represented serially, and processed by a scanning mechanism.

While it has been established that the weight of the female rhesus monkey brain is less than that of the male, the sexual dimorphism of specific brain structures has not been well-documented. To further understand potential sex differences, we measured the whole brain volume and the size of the corpus callosum (mid-sagittal) and amygdala (largest coronal section) in MRI images from juvenile to adult male and female rhesus monkeys between 8 months and 7.2 years of age. The mean volume of the male brain was 89.2 +/- 1.9 (S.E.M.) compared to the female brain volume of 70.8 +/- 0.72 cm3. The average area of the corpus callosum increased from 8 months to 4.5 years; 0.56 to 0.93 cm2 in males and 0.45 to 0.66 cm2 in females. However, the average area of splenium is significantly greater in females (0.280 cm2), than males (0.184 cm2). The average area of the amygdala did not change with age; it was 1.07 +/- 0.037 (S.E.M.) in males and 1.08 +/- 0.022 cm2 in females. This data suggests that the whole brain volume and the size of the entire corpus callosum of young adult female rhesus monkeys are approximately 20% smaller than those of young adult males. Interestingly, the area of the splenial portion of the corpus callosum is larger in female monkeys. The size of the amygdala showed no sex difference.