Online Core Curriculum and Mastery (OCCAM): A Behavioral Neurology & Neuropsychiatry (BNNP) Curricular Needs Assessment.

Behavioral neurology & neuropsychiatry (BNNP) fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS). Programs cover the UCNS-recommended topics differently. A curriculum accessible to all fellowships would standardize education and identify gaps in topics that are less well covered across programs. The purpose of the present needs assessment was to inform the development of the Online Core Curriculum and Mastery: BNNP (OCCAM-BNNP), a website for all UCNS-accredited BNNP programs. Program directors and fellows were surveyed to learn how well topics are covered and identify educational gaps, or specific topics on the UCNS website that are less well represented among programs. Thirty-seven fellowship program directors listed on the UCNS website were invited to take the survey and forward it to both current fellows (graduating in 2021) and recent graduates (graduated from 2015 to 2020). There were 29 responses from 37 programs. Of the 34 topics that respondents rated on a 1-5 Likert scale (from "not covered" to "completely covered"), 15 of 34 (44%) were identified as having >40% of responses as mostly "not covered," "incompletely covered," or "partially covered." Ninety-seven percent of respondents affirmed that it would be useful to have a free web-based resource for BNNP education. Slightly under one-half of all BNNP topics were not well covered. A survey was undertaken to identify and fill the educational gaps indicated by fellowship directors and fellows, and the OCCAM-BNNP website was developed as a repository for relevant content, providing a resource that many BNNP clinicians would find useful.

Where Two or Three Are Gathered.

Remembering Christ's words of His presence when two or three are gathered, a physician and a patient's wife join in prayer, knowing that Christ shares our wounds as much as He heals them.

A case report of acquired synesthesia and heightened creativity in a musician after traumatic brain injury.

INTRODUCTION: We report on a musician who acquired synesthesia, enhanced sensory experience, and improved creativity following traumatic brain injury (TBI). BACKGROUND: Creativity and synesthesia can be acquired from an injury, though both simultaneously has not been frequently documented. NARRATIVE: This case report details heightened creativity and developing synesthesia in a 66-year-old right-handed man following TBI. He developed a "compulsion" to write music. Synesthesia included "seeing" the notation and being able to name chord structures of music he heard, both of which were novel experiences. The Synesthesia Battery revealed a vision-sound synesthesia with higher than average level of Vividness of Visual Imagery (VVIQ-2), and "Absolute Pitch/Perfect Pitch." PATIENT EXPERIENCE: The patient experienced an approximate four-month history of these changes, including musical compositions, developing perfect pitch, and enhanced sensory experience of typical phenomena. DISCUSSION: Both creativity and synesthesia depend on novel connections in the brain, and both have been reported following insults to the brain, including in degenerative conditions. However, the development of both simultaneously is not frequently reported. Evidence for the etiology of one prompting the other has not been described. Brain injury may result in increased creativity and synesthesia. Our fields would benefit from increased awareness of this possible relationship.

Scattered Seed and the Harvest: The Best Things That I've Grown I Never Planted.

A physician struggling to grow in her career finds an apt analogy in being a fledgling gardener and learns to trust that God's hand has been planting the seeds all along.

Hamstrung in Prayer.

A neurologist reflects upon the function of the hamstring, including kneeling, and being hamstrung, both physically and spiritually.

This Is My Body: A Reflection on Medical and Spiritual Distancing During the COVID19 Pandemic.

As sentient beings and as patients, clinicians, and Catholics, we long for touch and union. With COVID19, the distancing inherent during the pandemic manifests itself in medical and spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist. Summary: As sentient beings and as patients, clinicians, and Catholics, we long for touch and union. With COVID19, the distancing inherent during the pandemic manifests itself in medical and spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist. COVID19 distancing manifests in medical & spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist.

Mask and Ye Shall Receive.

A physician engages in a social media debate regarding mask-wearing during the COVID-19 pandemic and searches for truth and virtue, primarily charity. While wearing masks is commonplace and vital during the COVID-19 pandemic to those working in healthcare, the lay perspective on wearing masks is more varied and can be skewed by politicization, pseudoscience, and misinterpretation. The practicing Catholic physician serves as an important witness to the truth of science and Christ as the Way, the Truth, and the Life. The question of mask-wearing is transformed from merely being a scientific question to more of a moral and theological question.

When the Pager and/or Jesus Calls.

A physician reflects on the significance of responding to the pager, particularly during one Sunday Mass when she was summoned for assistance. How do we answer when we are called?

Cerebrospinal fluid biomarkers of neurodegeneration, synaptic dysfunction, and axonal injury relate to atrophy in structural brain regions specific to Alzheimer's disease.

INTRODUCTION: Patterns of atrophy can distinguish normal cognition from Alzheimer's disease (AD), but neuropathological drivers of this pattern are unknown. This study examined associations between cerebrospinal fluid biomarkers of AD pathology, synaptic dysfunction, and neuroaxonal injury with two AD imaging signatures. METHODS: Signatures were calculated using published guidelines. Linear regressions related each biomarker to both signatures, adjusting for demographic factors. Bootstrapped analyses tested if associations were stronger with one signature versus the other. RESULTS: Increased phosphorylated tau (p-tau), total tau, and neurofilament light (P-values <.045) related to smaller signatures (indicating greater atrophy). Diagnosis and sex modified associations between p-tau and neurogranin (P-values<.05) and signatures, such that associations were stronger among participants with mild cognitive impairment and female participants. The strength of associations did not differ between signatures. DISCUSSION: Increased evidence of neurodegeneration, axonopathy, and tau phosphorylation relate to greater AD-related atrophy. Tau phosphorylation and synaptic dysfunction may be more prominent in AD-affected regions in females.

Which Cheek did the Resurrected Jesus Turn?

Secular portraits are likely to show more of the left than right side of the face (hemiface). Prior research has shown that emotions are more strongly expressed by the left hemiface. In addition, the valence theory of emotion proposes that the right hemisphere is dominant for mediating negative emotions, and the left hemisphere for positive emotions. Since religious art depicting a scene such as the Resurrection of Jesus is more likely to be associated with positive emotions, we postulated that there would be a significant smaller percentage number of artistic works of the Resurrection that reveal the left side of the face of Jesus than in those art works portraying the Crucifixion. Thus, we analyzed artistic portrayals of the Resurrection of Jesus and compared them to the artistic scenes of the Crucifixion. This analysis revealed that the left side of the face of Jesus is less commonly depicted in portraits of the Resurrection than the Crucifixion. In addition, both the right hemiface, and forward-facing faces were also more commonly portrayed in painting of the Resurrection than the Crucifixion. Whereas this right-left hemiface, Resurrection-Crucifixion dichotomy may be related to right-left hemispheric difference in the mediation of emotional valence other factors such as agency, action-intention, and biblical text may have influenced these differences.

Creativity and neurological disease.

Although humans have long valued creativity, the generation of such innovation is still incompletely understood. Looking at the healthy brain, researchers have localized certain parts for a basic understanding of these mechanisms. By researching the brain affected by neurological disease, scientists have observed unique manifestations of creativity, such as in frontotemporal lobar degeneration, Alzheimer's disease, Parkinson's disease and parkinsonian spectrum disorders, and stroke, which help clarify these creative underpinnings. Incorporating both healthy and disease models of cerebral functioning, neurological and neuroscientific research from recent years has built on established theories and expanded current knowledge.

Agency and the Annunciation.

Prior research has revealed that when healthy participants, who are not artists, are asked to draw a person who is performing an action, they are more likely to position the agent on the left and the person or object receiving this action, the patient, on the right. Thus, the goal of this study was to learn whether in works of art, such as those portraying the Annunciation of the angel Gabriel to the Blessed Virgin Mary, artists would be more likely to place the angel, who is the agent, on the left of Mary, who is the patient. We found that in our sample of 604 paintings of the Annunciation by different artists that the agent Gabriel is significantly more frequently portrayed to left of Mary. Whereas this result supports the left-agent, right-patient hypothesis, the reason for this spatial bias is not entirely known, but may be related to several factors such as the learned left to right direction of reading/writing in European languages, left-versus right-sided emotional facial expressive asymmetries, a left-sided spatial attentional bias and a spatial motor-action preference of upper extremity for making abductive (left to right) movements when using the right upper extremity. Additionally, biblical explanations and theological principles may have influenced the organization of this scene.

Localizing My Paralyzed Grandmother.

A neurologist puzzles over the etiology of her physician grandmother's paralysis in an attempt to localize her lesion and discovers what matters most about her grandmother's history and illness.

Holistic care in healthy aging: Caring for the wholly and holy human.

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.

Veni, Vidi, Scribivi: I Came, I Saw, I Wrote

Narrative medicine talks at the American Academy of Neurology Annual Meeting have included writing prompts to inspire and promote wellness among attendees. The 6-word writing exercise at the 2023 Annual Meeting prompted pithy and powerful stories, which we share in this article.

Randomized Controlled Comparative Effectiveness Trial of Risk Model-Guided Clinical Decision Support for Suicide Screening.

Suicide prevention requires risk identification, appropriate intervention, and follow-up. Traditional risk identification relies on patient self-reporting, support network reporting, or face-to-face screening with validated instruments or history and physical exam. In the last decade, statistical risk models have been studied and more recently deployed to augment clinical judgment. Models have generally been found to be low precision or problematic at scale due to low incidence. Few have been tested in clinical practice, and none have been tested in clinical trials to our knowledge. Methods: We report the results of a pragmatic randomized controlled trial (RCT) in three outpatient adult Neurology clinic settings. This two-arm trial compared the effectiveness of Interruptive and Non-Interruptive Clinical Decision Support (CDS) to prompt further screening of suicidal ideation for those predicted to be high risk using a real-time, validated statistical risk model of suicide attempt risk, with the decision to screen as the primary end point. Secondary outcomes included rates of suicidal ideation and attempts in both arms. Manual chart review of every trial encounter was used to determine if suicide risk assessment was subsequently documented. Results: From August 16, 2022, through February 16, 2023, our study randomized 596 patient encounters across 561 patients for providers to receive either Interruptive or Non-Interruptive CDS in a 1:1 ratio. Adjusting for provider cluster effects, Interruptive CDS led to significantly higher numbers of decisions to screen (42%=121/289 encounters) compared to Non-Interruptive CDS (4%=12/307) (odds ratio=17.7, p-value <0.001). Secondarily, no documented episodes of suicidal ideation or attempts occurred in either arm. While the proportion of documented assessments among those noting the decision to screen was higher for providers in the Non-Interruptive arm (92%=11/12) than in the Interruptive arm (52%=63/121), the interruptive CDS was associated with more frequent documentation of suicide risk assessment (63/289 encounters compared to 11/307, p-value<0.001). Conclusions: In this pragmatic RCT of real-time predictive CDS to guide suicide risk assessment, Interruptive CDS led to higher numbers of decisions to screen and documented suicide risk assessments. Well-powered large-scale trials randomizing this type of CDS compared to standard of care are indicated to measure effectiveness in reducing suicidal self-harm. ClinicalTrials.gov Identifier: NCT05312437.