The Oregon ADHD-1000: A new longitudinal data resource enriched for clinical cases and multiple levels of analysis.

The fields of developmental psychopathology, developmental neuroscience, and behavioral genetics are increasingly moving toward a data sharing model to improve reproducibility, robustness, and generalizability of findings. This approach is particularly critical for understanding attention-deficit/hyperactivity disorder (ADHD), which has unique public health importance given its early onset, high prevalence, individual variability, and causal association with co-occurring and later developing problems. A further priority concerns multi-disciplinary/multi-method datasets that can span different units of analysis. Here, we describe a public dataset using a case-control design for ADHD that includes: multi-method, multi-measure, multi-informant, multi-trait data, and multi-clinician evaluation and phenotyping. It spans > 12 years of annual follow-up with a lag longitudinal design allowing age-based analyses spanning age 7-19 + years with a full age range from 7 to 21. Measures span genetic and epigenetic (DNA methylation) array data; EEG, functional and structural MRI neuroimaging; and psychophysiological, psychosocial, clinical and functional outcomes data. The resource also benefits from an autism spectrum disorder add-on cohort and a cross sectional case-control ADHD cohort from a different geographical region for replication and generalizability. Datasets allowing for integration from genes to nervous system to behavior represent the "next generation" of researchable cohorts for ADHD and developmental psychopathology.

Benchmarking Adenoma Detection Rates for Colonoscopy: Results From a US-Based Registry.

INTRODUCTION: Adenoma detection rate (ADR) is highly variable across practices, and national or population-based estimates are not available. Our aim was to study the ADR, variability of rates over time, and factors associated with detection rates of ADR in a national sample of patients undergoing colonoscopy. METHODS: We used colonoscopies submitted to the GI Quality Improvement Consortium, Ltd. registry from 2014 to 2018 on adults aged 50-89 years. We used hierarchical logistic models to study factors associated with ADR. RESULTS: A total of 2,646,833 colonoscopies were performed by 1,169 endoscopists during the study period. The average ADR for screening colonoscopies per endoscopist was 36.80% (SD 10.21), 44.08 (SD 10.98) in men and 31.20 (SD 9.65) in women. Adjusted to the US population, the ADR was 39.08%. There was a significant increase in ADR from screening colonoscopies over the study period from 33.93% in 2014 to 38.12% in 2018. DISCUSSION: The average ADR from a large national US sample standardized to the US population is 39.05% and has increased over time.

Representation by Gender of Recognition Award Recipients from Gastroenterology and Hepatology Professional Societies.

Background: Recognition awards from professional medical societies play an important role in physicians' career advancement. Our aim was to evaluate the gender representation of award recipients from gastroenterology and hepatology societies. Methods: We analyzed the lists of award recipients from the American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy and determined the gender of these award recipients. The primary outcome was the overall representation of women physician award recipients as compared with the representation of women in the specialty. Results: Between 1941 and 2019, there were 921 awards, of which 77 (8.4%) were given to women and 844 (91.6%) to men. There was a significant increase in the proportion of women recipients over time, from 0% in 1970-1984 to 22.0% in 2015-2019 (p for trend <0.0001). Compared with the concurrent representation of women in the specialty, women physician recipients were underrepresented from 1970 to 1981 and 1984 to 2015, equitably represented from 1981 to 1984, and overrepresented from 2015 to 2019. Of the total number of awards in each category, women received 13.8% of teaching/mentorship awards and 3.8% of the highest achievement awards (p = 0.002). The proportion of women recipients varied among the societies, from 6.8% to 14.5%. Conclusions: The representation of women physician recipients of gastroenterology and hepatology society recognition awards has generally been low until most recently, when it has surpassed the proportion of women in the specialty. Because award recognition is important to career development, professional societies should have transparent processes that aim to identify and reduce various forms of bias, including gender-related bias, in all phases of award recognition.

Variation Over Time and Factors Associated With Detection Rates of Sessile Serrated Lesion Across the United States: Results Form a National Sample Using the GIQuIC Registry.

INTRODUCTION: Sessile serrated lesions (SSLs) are important precursor lesions for the CpG island-methylated pathway to colorectal cancer. The reported detection rates of SSL are highly variable, and national or population-based estimates are not available. Patient-, provider-, and procedure-level factors associated with the detection rates of SSL have not been well described. The aim of our study was to study the detection rates of SSL, variability of rates over time, and factors associated with detection rates of SSL in a national sample of patients undergoing colonoscopy using the GIQuIC registry. METHODS: We used colonoscopies submitted to the GIQuIC registry from 2014 to 2017 on adults, aged 18-89 years. Only the first colonoscopy record per patient was included. Indications for colonoscopy were categorized as screening, diagnostic, and surveillance. We used the hierarchical logistic models to study the factors associated with the detection rates of SSL. The Cochrane-Armitage test was used to study the significance of trend over time. RESULTS: There were a total of 5,173,211 colonoscopies performed by 3,934 endoscopists during the study period. Among the 2,101,082 screening colonoscopies over the study period in adults older than or equal to 50 years that were complete to the cecum, the average detection rate per endoscopist for SSL was 6.43% (SD 5.18) and 6.25% standardized for the 2010 US population. There was a significant increase in the detection rates of SSLs from screening colonoscopies over the study period from 4.99% in 2014 to 7.09% in 2017 (P trend <0.001). Clinically significant factors associated with higher detection rates of SSL were longer withdrawal times (>11 minutes vs ≤6 minutes) (odds ratio [OR] 9.61; 9.03-10.24), adequate preparation (OR 1.25; 1.22-1.28), female sex (OR 1.17; 1.16-1.18), and use of a specialized gastrointestinal pathology group (OR 1.12; 95% confidence interval 1.04, 1.19). DISCUSSION: Population-based estimates of the detection rates of SSL are 6% and have increased over time.

Repetitive and Self-injurious Behaviors in Children with Cornelia de Lange Syndrome.

Cornelia de Lange syndrome (CdLS) is associated with repetitive and self-injurious behaviors (RBs, SIB). Evaluating children with CdLS, this study: (1) characterizes the spectrum of RBs; (2) characterizes the impact and severity of RBs including SIB; (3) describes how age and adaptive functioning relate to RBs including SIB. Fifty children (5-17 years) with CdLS were assessed with Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD; Aberrant Behavior Checklist (ABC); Vineland Adaptive Behaviors Scales (VABS). All children had ≥ 1 type of RB; 44% had some form of SIB. 64% spent > 1 h/day displaying RBs. Lower VABS adaptive functioning was associated with higher stereotypy and SIB scores (ABC). In children with CdLS, RBs including SIB are common, impactful, and associated with lower adaptive functioning.

Correction to: Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD).

This erratum reports an error in Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011). Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD).

Increase in female faculty in American Society for Gastrointestinal Endoscopy-sponsored programming over time.

BACKGROUND AND AIMS: Female representation in medicine is increasing across all levels of medical training, yet women hold fewer senior leadership positions than men. National recognition, including participation as faculty in society-sponsored programs, is one component of academic advancement. The aim of this study was to characterize female representation among faculty in courses sponsored by the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: We performed a retrospective review of demographic data, including faculty gender and role, year, and program type, from the ASGE database of its sponsored programs between 2009 and 2014. Female faculty rates were compared with the rate of female membership in the ASGE and by faculty role and course type over time. RESULTS: Between 2009 and 2014 there were a total of 2020 ASGE course faculty positions of which women comprised 19%. There was a significant increase in the proportion of women that served as course faculty over time (P < .0005). Female faculty participation exceeded the ASGE female domestic membership rate in all years. Women were more likely to serve as course directors than lecturers (25% vs 18%, P = .004) and to participate in smaller courses (P = .0003). CONCLUSIONS: We found an increase in female participation in ASGE programming over time, suggesting that specialty societies are making efforts to improve female representation at the national level. Future work should evaluate whether or not these opportunities translate into leadership roles for women within their own institutions or lead to promotions for women over time.

View from the Top: Perspectives on Women in Gastroenterology from Society Leaders.

Women are making great strides at all levels of medicine, including gastroenterology. The proportion of women members in gastroenterology societies has increased nearly 2-fold and the percent of women trainees is 36%. Although there continue to be challenges for women in academic and community practice, the American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and other gastroenterology societies have dedicated substantial resources to foster careers of women in gastroenterology and develop women as leaders in our societies. This article outlines ongoing challenges for women in gastroenterology and some key initiatives addressing barriers to success.

Gender Differences in Publication Productivity, Academic Rank, and Career Duration Among U.S. Academic Gastroenterology Faculty.

PURPOSE: Female representation in academic medicine is increasing without proportional increases in female representation at senior ranks. The purpose of this study is to describe the gender representation in academic gastroenterology (GI) and compare publication productivity, academic rank, and career duration between male and female gastroenterologists. METHOD: In 2014, the authors collected data including number of publications, career duration, h-index, and m-index for faculty members at 114 U.S. academic GI programs. RESULTS: Of 2,440 academic faculty, 1,859 (76%) were men and 581 (24%) were women. Half (50%) of men held senior faculty position compared with 29% of women (P < .001). Compared with female faculty, male faculty had significantly (P < .001) longer careers (20 vs. 11 years), more publications (median 24 [0-949] vs. 9 [0-438]), and higher h-indices (8 vs. 4). Higher h-index correlated with higher academic rank (P < .001). The authors detected no difference in the h-index between men and women at the same rank for professor, associate professor, and instructor, nor any difference in the m-index between men and women (0.5 vs. 0.46, respectively, P = .214). CONCLUSIONS: A gender gap exists in the number and proportion of women in academic GI; however, after correcting for career duration, productivity measures that consider quantity and impact are similar for male and female faculty. Women holding senior faculty positions are equally productive as their male counterparts. Early and continued career mentorship will likely lead to continued increases in the rise of women in academic rank.

Impact of gender on requests for ASGE leadership assignments.

BACKGROUND AND AIMS: Committee membership in gastroenterology national societies is considered prestigious, opening the door for leadership roles and professional advancement. Some have hypothesized that women ask for leadership opportunities less frequently than men. Our aim was to examine the gender representation of requests for placement on an American Society for Gastrointestinal Endoscopy (ASGE) committee. METHODS: We analyzed deidentified records of all requests for assignment to ASGE committees from 2011 to 2014, including applicant's gender, prior service to ASGE, year of application, and whether the applicant was appointed. The primary outcome was the proportion of requests from women compared with the overall ASGE female membership. RESULTS: There were 513 requests for ASGE committee appointments; 101 (20%) were from women, exceeding the active ASGE female membership (15%; P = .004). Overall, the total number of committee requests increased over time from 89 to 195 (P = .08); the proportion of requests from women remained stable at 16% to 21% (P = .51). Compared with men, women were significantly less likely to have had previous ASGE service (28% vs 42%; P = .01) and more likely to have a statement of endorsement from a mentor (33% vs 24%; P = .06). The rate of appointment to a committee was 47% (95% confidence interval [CI], 41-52) overall, 42% (95% CI, 37-48) for male applicants, and 65% (95% CI, 54-76) for female applicants. Female gender (odds ratio [OR] 2.6; 1.5-4.5), endorsement from a mentor (OR 3.4; 2.1-5.6), and prior ASGE service (OR 2.3; 1.5-3.5) predicted committee appointment. CONCLUSIONS: For ASGE committee appointments, it appears that women who make requests are successful in receiving these appointments. Future work should evaluate requests and appointments by gender among other gastroenterology societies and explore whether service translates into leadership opportunities for women.

Autism traits in children and adolescents with Cornelia de Lange syndrome.

Cornelia de Lange syndrome (CdLS) is a cohesinopathy causing delayed growth and limb deficits. Individuals with CdLS have mild to profound intellectual disability and autistic features. This study characterizes the behavioral phenotype of children with CdLS, focusing on autistic features, maladaptive behaviors, and impact of age. Children with CdLS (5-18 years) were administered normed instruments to characterize autism features (Childhood Autism Rating Scale, CARS), maladaptive behaviors (Aberrant Behavior Checklist), and adaptive skills (Vineland Adaptive Behaviors Scales). CdLS features and severity were rated with Diagnostic Criteria for CdLS. Forty-one children with CdLS (23 females, 18 males) were classified as having "no autism" (n = 7; 17.1%), "mild autism" (n = 17; 41.4%), and "severe autism" (n = 17; 41.4%), using CARS scores. Characteristic items were abnormal emotional response, stereotypies, odd object use, rigidity, lack of verbal communication, and low intellectual functioning. Verbal communication deficits and repetitive behaviors were higher compared to sensory, social cognition, and behavior abnormalities (P ≤ 0.0001). Maladaptive behaviors associated with autism traits were stereotypies (P = 0.003), hyperactivity (P = 0.01), and lethargy (P = 0.03). Activities of daily living were significantly affected; socialization adaptive skills were a relative strength. However, with advancing age, both socialization (P < 0.0001) and communication (P = 0.001) domains declined significantly. CdLS is characterized by autistic features, notably excessive repetitive behaviors and expressive language deficits. While other adaptive skills are impacted, socialization adaptive skills are less affected. Advancing age can worsen communication and socialization deficits relative to neurotypical peers.

Effect of endoscopic stenting of malignant bile duct obstruction on quality of life.

BACKGROUND AND GOALS: Endoscopic stent insertion is considered the method of choice for palliation of malignant bile duct obstruction (MBDO). However, it can cause complications and requires periodic stent exchanges. Although endoscopic stenting is clearly indicated for relief of cholangitis or refractory pruritus, its role in patients with jaundice alone is less clear. Endoscopic stenting for this relative indication might be justified, if there is a significant improvement in quality of life (QOL) of such patients. The aim of our study was to determine whether endoscopic stenting for MBDO results in improved QOL. PATIENTS AND METHODS: Patients undergoing endoscopic retrograde cholangiopancreatography for MBDO and participating in a randomized trial comparing patency duration of 10 and 11.5-Fr biliary plastic stents, completed the Functional Assessment of Cancer Therapy-General questionnaire at baseline, at 1 month after stent insertion, and at 180 days after stent insertion. RESULTS: A total of 164 patients answered the QOL questionnaire at baseline, 95 patients answered the questionnaire at 30 days, and 54 patients answered the questionnaire at 180 days after stent insertion. Endoscopic biliary stenting resulted in a statistically significant improvement in overall score of QOL, and different aspects of QOL such as physical, emotional, and functional well-being. There was a statistically significant improvement in most of the symptoms specific for MBDO at 30 and 180 days after stenting. CONCLUSIONS: Endoscopic stenting significantly improves QOL in patients with MBDO, and, therefore, is an appropriate part of palliative treatment in this patient population.

Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD).

Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few studies have examined the physiological mechanisms related to emotion regulation in children with this disorder. This study examined parasympathetic and sympathetic nervous system reactivity via measures of respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) in children with ADHD (n=32) and typically developing controls (n=34), using a novel emotion task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. Both groups showed strong task-response effects in RSA. However, typically developing children showed systematic variation in parasympathetic activity (RSA) depending on both emotion valence (more activation for negative emotion, reduced activation for positive emotion) and task demand (more activation for suppression than induction). In contrast, children with ADHD displayed a stable pattern of elevated parasympathetic activity (RSA) across all task conditions compared to baseline. No group differences in sympathetic activity (PEP) were observed. It is concluded ADHD in childhood is associated with abnormal parasympathetic mechanisms involved in emotion regulation.

Altered white matter microstructure in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: Identification of biomarkers is a priority for attention-deficit/hyperactivity disorder (ADHD). Studies have documented macrostructural brain alterations in ADHD, but few have examined white matter microstructure, particularly in preadolescent children. Given dramatic white matter maturation across childhood, microstructural differences seen in adolescents and adults with ADHD may reflect compensatory restructuring, rather than early neurophenotypic markers of the disorder. METHOD: Using tract-based spatial statistics, mean fractional anisotropy (FA) maps were created using diffusion tensor imaging. FA, mean diffusivity (MD), and associated axial and radial diffusivities were compared between 16 children with ADHD and 20 healthy children (age 7-9 years). RESULTS: Youth with ADHD showed decreased FA in frontoparietal, frontolimbic, cerebellar, corona radiata, and temporo-occipital white matter compared with controls. In addition, ADHD was associated with lower MD in the posterior limb of the internal capsule and frontoparietal white matter and greater MD in frontolimbic white matter. Lower axial diffusion and/or higher radial diffusion were differentially observed for youth with ADHD in earlier versus later maturing areas of group FA/MD difference. CONCLUSIONS: This study suggests that, even prior to adolescence, ADHD represents a disorder of altered structural connectivity of the brain, characterized by distributed atypical white matter microstructure. In addition, later maturing frontolimbic pathways were abnormal in children with ADHD, likely due to delayed or decreased myelination, a finding not previously demonstrated in the adolescent or adult stages of the disorder. These results suggest that disruptions in white matter microstructure may play a key role in the early pathophysiology of ADHD.

Delay discounting of reward in ADHD: application in young children.

BACKGROUND: A key underlying process that may contribute to attention-deficit/hyperactivity disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value of immediate over delayed rewards. This study examines whether children with ADHD discount the value of delayed rewards to a greater degree than typically developing children using a delay discounting task. METHODS: Children aged 7-9 years diagnosed with ADHD and controls completed a task in which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days) versus various amounts available immediately. RESULTS: ADHD participants discounted more steeply than controls. However, this effect did not survive covarying of IQ. CONCLUSIONS: ADHD is associated with a steeper delay gradient when contemplating hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and IQ with reward evaluation in ADHD requires further exploration.

Atypical default network connectivity in youth with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a major public health concern. It has been suggested that the brain's default network may provide a crucial avenue for understanding the neurobiology of attention deficit/hyperactivity disorder. Evaluations of the default network have increased over recent years with the applied technique of resting-state functional connectivity magnetic resonance imaging (rs-fcMRI). These investigations have established that spontaneous activity in this network is highly correlated at rest in young adult populations. This coherence seems to be reduced in adults with ADHD. This is an intriguing finding, as coherence in spontaneous activity within the default network strengthens with age. Thus, the pathophysiology of ADHD might include delayed or disrupted maturation of the default network. If so, it is important to determine whether an altered developmental picture can be detected using rs-fcMRI in children with ADHD. METHODS: This study used the typical developmental context provided previously by Fair et al. (2008) to examine coherence of brain activity within the default network using rs-fcMRI in children with (n = 23) and without attention deficit/hyperactivity disorder (n = 23). RESULTS: We found that functional connections previously shown as developmentally dynamic in the default network were atypical in children with attention deficit/hyperactivity disorder-consistent with perturbation or failure of the maturational processes. CONCLUSIONS: These findings are consistent with the hypothesis that atypical consolidation of this network over development plays a role in attention deficit/hyperactivity disorder.