Susceptibility of livestock to SARS-CoV-2 infection.

We report pilot studies to evaluate the susceptibility of common domestic livestock (cattle, sheep, goat, alpaca, rabbit, and horse) to intranasal infection with SARS-CoV-2. None of the infected animals shed infectious virus via nasal, oral, or faecal routes, although viral RNA was detected in several animals. Further, neutralizing antibody titres were low or non-existent one month following infection. These results suggest that domestic livestock are unlikely to contribute to SARS-CoV-2 epidemiology.

Multimodal Investigations of Reward Circuitry and Anhedonia in Adolescent Depression.

Depression is a highly prevalent condition with devastating personal and public health consequences that often first manifests during adolescence. Though extensively studied, the pathogenesis of depression remains poorly understood, and efforts to stratify risks and identify optimal interventions have proceeded slowly. A major impediment has been the reliance on an all-or-nothing categorical diagnostic scheme based solely on whether a patient endorses an arbitrary number of common symptoms for a sufficiently long period. This approach masks the well-documented heterogeneity of depression, a disorder that is highly variable in presentation, severity, and course between individuals and is frequently comorbid with other psychiatric conditions. In this targeted review, we outline the limitations of traditional diagnosis-based research and instead advocate an alternative approach centered around symptoms as unique dimensions of clinical dysfunction that span across disorders and more closely reflect underlying neurobiological abnormalities. In particular, we highlight anhedonia-the reduced ability to anticipate and experience pleasure-as a specific, quantifiable index of reward dysfunction and an ideal candidate for dimensional investigation. Anhedonia is a core symptom of depression but also a salient feature of numerous other conditions, and its severity varies widely within clinical and even healthy populations. Similarly, reward dysfunction is a hallmark of depression but is evident across many psychiatric conditions. Reward function is especially relevant in adolescence, a period characterized by exaggerated reward-seeking behaviors and rapid maturation of neural reward circuitry. We detail extensive work by our research group and others to investigate the neural and systemic factors contributing to reward dysfunction in youth, including our cumulative findings using multiple neuroimaging and immunological measures to study depressed adolescents but also trans-diagnostic cohorts with diverse psychiatric symptoms. We describe convergent evidence that reward dysfunction: (a) predicts worse clinical outcomes, (b) is associated with functional and chemical abnormalities within and beyond the neural reward circuitry, (c) is linked to elevated peripheral levels of inflammatory biomarkers, and (d) manifests early in the course of illness. Emphasis is placed on high-resolution neuroimaging techniques, comprehensive immunological assays, and data-driven analyses to fully capture and characterize the complex, interconnected nature of these systems and their contributions to adolescent reward dysfunction.

Peridomestic Mammal Susceptibility to Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Wild animals have been implicated as the origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but it is largely unknown how the virus affects most wildlife species and if wildlife could ultimately serve as a reservoir for maintaining the virus outside the human population. We show that several common peridomestic species, including deer mice, bushy-tailed woodrats, and striped skunks, are susceptible to infection and can shed the virus in respiratory secretions. In contrast, we demonstrate that cottontail rabbits, fox squirrels, Wyoming ground squirrels, black-tailed prairie dogs, house mice, and racoons are not susceptible to SARS-CoV-2 infection. Our results expand the knowledge base of susceptible species and provide evidence that human-wildlife interactions could result in continued transmission of SARS-CoV-2.

Characteristics of Conversion Disorder in an Urban Academic Children's Medical Center.

Background. Literature on childhood conversion disorder (CD) is sparse and is mostly limited to the outpatient population. Method. Our study retrospectively examines the characteristics of childhood CD in 42 children and adolescents seen by the psychiatric consultation-liaison service in an urban academic medical center with a large minority population. Results. CD accounted for 11% of our consultations. The majority of patients were female adolescents, but in the younger cohort, the male-to-female ratio equalized. Other somatic symptoms and additional psychiatric diagnoses were common, anxiety disorders in particular. Antecedent stressors were identified in 95% of patients, most commonly related to family stressors. Recent or remote history of abuse was rare. Neurological presentations were complex, with almost half of the patients presenting with multiple distinct neurological symptoms. Hyperkinetic symptoms were more common than hypokinetic symptoms, and paroxysmal symptoms were more common than non-paroxysmal. No distress (la belle indifference) was found in only 25% of patients and about half of patients had no socio-academic impairment. High resource utilization was noted based on multiple specialist consultants, diagnostic studies, and length of stay. Conclusion. Much of our data confirms previous findings and contributes to what is becoming a more robust characterization of this population.

Core Competencies for Pediatric Consultation-Liaison Psychiatry in Child and Adolescent Psychiatry Fellowship Training.

BACKGROUND: Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship. OBJECTIVE: The objective of this project was to develop a national consensus on pediatric CLP competencies to help guide training in this specialty. METHODS: An expert working group developed a list of candidate competences based on previously established educational outcomes for CLP (formerly Psychosomatic Medicine), child and adolescent psychiatry, and general psychiatry. A survey was distributed to members of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee to determine child and adolescent psychiatry fellowship educational needs on pediatric CLP services and generate consensus regarding pediatric CLP competencies. RESULTS: Most survey respondents were supportive of the need for a national consensus on core competencies for pediatric CLP. Consensus from a panel of experts in the field of pediatric CLP generated a list of proposed core competencies that track the Accreditation Council for Graduate Medical Education's six core competencies. CONCLUSIONS: Consistent learning outcomes provide the foundation for further development of tools to support training in pediatric CLP. There is a need to develop further tools including outcome assessment instruments and self-directed learning materials that can be used to support lifelong learning.

The Standard for the Exchange of Nonclinical Data (SEND): Challenges and Promises.

The Standard for the Exchange of Nonclinical Data (SEND) is an implementation of the Study Data Tabulation Model for nonclinical studies that enables the U.S. Food and Drug Administration (FDA) to modernize and streamline the review process. As a result, patients may benefit from speedier approval of new drugs. However, SEND implementation and compliance can be challenging and require effective cooperation between pharmaceutical companies and contract research organizations. In order to improve Society of Toxicologic Pathology (STP) members' awareness about SEND, including the steps, obstacles, and mistakes to avoid in its implementation while applying for FDA approval, the Career Development and Outreach Committee of the STP sponsored a career development lunchtime series panel discussion entitled "The Standard for the Exchange of Nonclinical Data (SEND): Challenges and Promise" in conjunction with the STP 37th Annual Symposium. The presentations and discussion at this workshop provided perspectives of experts including pathologists and information technology professionals familiar with the SEND submission process and FDA reviewers. This article is designed to provide brief summaries of their talks as well as the questions asked during this well-received panel discussion.

Migratory, metabolic and functional alterations of fibrocytes in type 2 diabetes.

Fibrocytes are bloodborne mesenchymal progenitor cells that are recruited to injured tissue sites and contribute to the repair process by acquiring a myofibroblast-like phenotype and producing extracellular matrix components and growth factors. Treatment with normal fibrocytes or their exosomes restores the ability of genetically diabetic mice to heal skin wounds, suggesting the existence of dysfunctional alterations in diabetic fibrocytes. This study compared the migratory, metabolic and functional characteristics of fibrocytes from patients with type 2 diabetes (T2DPs) and healthy controls (HCs). It was found that the frequency of these cells was abnormally low in the peripheral blood of T2DPs. Diabetic fibrocytes showed reduced expression of the C-X-C motif and C-C motif chemokine receptors (CXCR)4, (CCR)5, and CCR7, and demonstrated reduced migration in response to their ligands (CXCL)12, (CCL)5, and CCL21. They exhibited increased expression of the receptor for advanced glycation end product, suppression of the alternative AGE receptor 1, increased intracellular concentrations of AGEs, decreased expression of sirtuin-1 and elevated oxidative stress. In short-term cultures, fibrocytes from T2DPs released larger amounts of proinflammatory cytokines than those from HCs. Unlike normal fibrocytes, diabetic fibrocytes did not exhibit increased expression of type I collagen and α-smooth muscle actin on stimulation with transforming growth factor (TGF)-ß1 and this abnormal response was associated with downregulation of TGF-ß1 type II receptor on the cell surface. Study findings uncover multiple migratory and functional alterations of diabetic fibrocytes that may contribute to explain why T2DPs experience impaired wound healing and chronic ulcers. © 2018 IUBMB Life, 70(11):1122-1132, 2018.

Catatonia in the medically ill: Etiology, diagnosis, and treatment. The Academy of Consultation-Liaison Psychiatry Evidence-Based Medicine Subcommittee Monograph.

BACKGROUND: Catatonia in medically ill patients is rare but often unrecognized. This monograph summarizes current knowledge on the diagnosis, epidemiology, etiology, and management of catatonia occurring in the medical setting. METHODS: PubMed searches were used to identify relevant articles from 1962 to present. RESULTS: More than 3,000 articles were obtained and reviewed for relevance, including references of articles identified by the initial search. Several areas were identified as important, including: (1) catatonia and delirium; (2) malignant catatonia; (3) pediatric catatonia; (4) catatonia associated with another medical condition (CAMC); (5) drug exposure and withdrawal syndromes associated with catatonia; and (6) treatment of catatonia in the medical setting. CONCLUSIONS: Catatonia in the medically ill appears to have numerous etiologies, although etiology does not seem to modify the general treatment approach of prompt administration of lorazepam. Delirium and catatonia are commonly comorbid in the medical setting and should not be viewed as mutually exclusive. Electroconvulsive therapy should be offered to patients who do not respond to benzodiazepines or have malignant features. Removing offending agents and treating the underlying medical condition is paramount when treating CAMC. Memantine or amantadine may be helpful adjunctive agents. There is not enough evidence to support the use of antipsychotics or stimulants in treating CAMC.

Human fibrocyte-derived exosomes accelerate wound healing in genetically diabetic mice.

Diabetic ulcers represent a substantial societal and healthcare burden worldwide and scarcely respond to current treatment strategies. This study was addressed to evaluate the therapeutic potential of exosomes secreted by human circulating fibrocytes, a population of mesenchymal progenitors involved in normal wound healing via paracrine signaling. The exosomes released from cells sequentially stimulated with platelet-derived growth factor-BB and transforming growth factor-ß1, in the presence of fibroblast growth factor 2, did not show potential immunogenicity. These exosomes exhibited in-vitro proangiogenic properties, activated diabetic dermal fibroblasts, induced the migration and proliferation of diabetic keratinocytes, and accelerated wound closure in diabetic mice in vivo. Important components of the exosomal cargo were heat shock protein-90α, total and activated signal transducer and activator of transcription 3, proangiogenic (miR-126, miR-130a, miR-132) and anti-inflammatory (miR124a, miR-125b) microRNAs, and a microRNA regulating collagen deposition (miR-21). This proof-of-concept study demonstrates the feasibility of the use of fibrocytes-derived exosomes for the treatment of diabetic ulcers.

Updates in Psychosomatic Medicine: 2014.

BACKGROUND: The amount of literature published annually related to psychosomatic medicine is vast; this poses a challenge for practitioners to keep up-to-date in all but a small area of expertise. OBJECTIVES: To introduce how a group process using volunteer experts can be harnessed to provide clinicians with a manageable selection of important publications in psychosomatic medicine, organized by specialty area, for 2014. METHODS: We used quarterly annotated abstracts selected by experts from the Academy of Psychosomatic Medicine and the European Association of Psychosomatic Medicine in 15 subspecialties to create a list of important articles. RESULTS: In 2014, subspecialty experts selected 88 articles of interest for practitioners of psychosomatic medicine. For this review, 14 articles were chosen. CONCLUSIONS: A group process can be used to whittle down the vast literature in psychosomatic medicine and compile a list of important articles for individual practitioners. Such an approach is consistent with the idea of physicians as lifelong learners and educators.

Individual differences in field independence influence the ability to determine accurate needle angles.

OBJECTIVE: "Field dependence" is used in cognitive psychology to describe an individual's tendency to be visually distracted by the surrounding environment. Notwithstanding the role of field dependence in contexts in which spatial judgment is important, such as piloting an aircraft, to date, studies linking field dependence to surgical skills have been limited. We evaluated whether field dependence correlates with an ability to anticipate appropriate needle angles in a simulated setting. METHODS: Trainees underwent field dependence testing and then participated in a surgical skills exercise. Correlations between field dependence and surgical skill were computed. Specifically, cardiothoracic surgery residents (n=11) took a battery of cognitive examinations to assess general reasoning and visuospatial judgment. Two written tests, the Rod and Frame test and the Judgment of Line Orientation test, measured the degree of field dependence. The subjects then underwent surgical skills testing. Using a standard needle driver, the participants placed curved needles into a cylindrical silicone mitral valve model with 10 premarked needle entry and exit sites. The components assessed included the ability to load a needle on driver at the appropriate angle. RESULTS: The test results showed a parametric distribution, with internal cognitive testing controls demonstrating valid testing techniques and methods. Performance on the cognitive tests measuring spatial judgment and field dependence correlated significantly with skill at determining the appropriate needle angle load in an inverse fashion (Judgment of Line Orientation test, r=0.61, P<.05; Rod and Frame test, r=-0.52, P=.05), suggesting that residents who were not distracted by surrounding objects performed better. Performance on the cognitive examinations did not correlate with resident training level. CONCLUSIONS: Although our study was of a small cohort, the findings suggest that individuals described as field independent (not easily distracted by external visual cues) might possess improved ability to determine appropriate needle angle loads compared with field-dependent individuals. Additional studies examining the role field dependence might play in the acquisition and execution of surgical tasks are warranted.

Pediatric psychosomatic medicine: creating a template for training.

There is a critical public health problem in the United States today, the problem of childhood psychiatric disorders in youngsters with physical illnesses. Currently there is a pressing need for well-trained pediatric psychosomatic medicine practitioners as well as advanced training in the field. Yet, this training does not currently exist. This article will present the innovative Montefiore Medical Center/Albert Einstein College of Medicine (MMC/AECOM) program as a model for a training curriculum, clinical training experience, and clinical research training setting in this important and rapidly expanding area of need in pediatric mental health.

The role of body image in pediatric illness: therapeutic challenges and opportunities.

The body image is the individual's mental representation of his own body, a representation that encompasses both perceptual and ideational components. In this paper I will explore the concept of body image, its development and its relationship to self-image and object relations in children with chronic medical illness. From this discussion and with the help of specific cases of medically ill children I have treated for a variety of psychological symptoms, I will recommend an approach to the assessment and treatment of this challenging group of patients.