Brain response to emotional faces in anxiety and depression: neural predictors of cognitive behavioral therapy outcome and predictor-based subgroups following therapy.

BACKGROUND: Neuroimaging studies have shown variance in brain response to emotional faces predicts cognitive behavioral therapy (CBT) outcome. An important next step is to determine if individual differences in neural predictors of CBT response represent distinct patient groups. METHODS: In total, 90 patients with internalizing disorders completed a face-matching task during functional magnetic resonance imaging before and after 12 weeks of CBT and 45 healthy controls completed the task before and after 12 weeks. Patients exhibiting a pre-to-post CBT >50% reduction in symptom severity on two measures were considered treatment responders. Regions of interest (ROIs) for angry, fearful, and happy faces were submitted to receiver operating characteristic (ROC) curve analysis. Significant ROIs were then submitted to decision tree analysis to classify responder/non-responder subgroups. Psychophysiological interactions (PPI) were used to explore functional connectivity in the region(s) that delineated subgroups. RESULTS: A total of 51 patients were treatment responders and ROC curve results were significant for all face types though specific regions varied. Decision tree results revealed superior occipital response to angry faces identified patient subgroups such that the subgroup with 'high' occipital activity had more responders than the 'low' occipital subgroup. Following CBT, the high, relative to low, occipital subgroup was less symptomatic. Controls exhibited stable superior occipital activation over time. Whole-brain PPI showed reduced baseline superior occipital-postcentral gyrus functional connectivity in responders compared to non-responders. CONCLUSIONS: Preliminary findings indicate patients characterized by relatively more pre-treatment superior occipital gyrus engagement to angry faces and reduced superior occipital-postcentral gyrus connectivity, relative to non-responders, may represent a phenotype likely to benefit from CBT.

Health economic evaluations of interventions for supporting adult carers in the UK: a systematic review from the NICE Guideline.

BACKGROUND: Policy making increasingly needs cost-effectiveness evidence to inform resource allocation. The objective of this review is to identify and to investigate evidence evaluating the cost-effectiveness of interventions aimed to support adult carers, drawing on the National Institute for Health and Care guideline on Supporting Adult Carers. METHODS: The protocol of the review was aimed to identify the economic studies published from 2003 onwards on all types of interventions for supporting adult carers. The applicability to the review and methodological quality of included economic evaluations were assessed using pre-established checklists specified in the National Institute for Health and Care (NICE) manual for developing guidelines. RESULTS: Our search yielded 10 economic evaluations. The main types of strategies evaluated were psychological and emotional support, training, and education support interventions. We found that the interventions more likely to be cost-effective were usually tailored to the specific carers' circumstances and delivered face-to-face and were multi-component in nature, including elements of psycho-education, training, psychological and practical support. The narrative synthesis of results indicated a wide variation in cost-effectiveness findings and methodological quality. CONCLUSIONS: This article indicates that systematic reviews of economic evaluations can be considered as an appropriate means to support decision makers in allocating health and social care resources. Given the high economic and social impact of unpaid caring, and based on the research gaps identified, we recommend that future economics research should be targeted on interventions for identifying carers; and programs for providing carers with support and advice to help them to enter, remain in or return to paid work.

The cost-effectiveness of antenatal and postnatal education and support interventions for women aimed at promoting breastfeeding in the UK.

BACKGROUND: Breastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. Breastfeeding rates in the UK are low for various reasons including cultural barriers, inadequate support to initiate and sustain breastfeeding, lack of information, or choice not to breastfeed. Education and support interventions have been developed aiming at promoting breastfeeding rates. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK. METHODS: A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion. RESULTS: The incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16-26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40-£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35-40%. CONCLUSIONS: Available breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.

Evidence linking rapid Arctic warming to mid-latitude weather patterns.

The effects of rapid Arctic warming and ice loss on weather patterns in the Northern Hemisphere is a topic of active research, lively scientific debate and high societal impact. The emergence of Arctic amplification--the enhanced sensitivity of high-latitude temperature to global warming--in only the last 10-20 years presents a challenge to identifying statistically robust atmospheric responses using observations. Several recent studies have proposed and demonstrated new mechanisms by which the changing Arctic may be affecting weather patterns in mid-latitudes, and these linkages differ fundamentally from tropics/jet-stream interactions through the transfer of wave energy. In this study, new metrics and evidence are presented that suggest disproportionate Arctic warming-and resulting weakening of the poleward temperature gradient-is causing the Northern Hemisphere circulation to assume a more meridional character (i.e. wavier), although not uniformly in space or by season, and that highly amplified jet-stream patterns are occurring more frequently. Further analysis based on self-organizing maps supports this finding. These changes in circulation are expected to lead to persistent weather patterns that are known to cause extreme weather events. As emissions of greenhouse gases continue unabated, therefore, the continued amplification of Arctic warming should favour an increased occurrence of extreme events caused by prolonged weather conditions.

2023 White Paper on Recent Issues in Bioanalysis: Deuterated Drugs; LNP; Tumor/FFPE Biopsy; Targeted Proteomics; Small Molecule Covalent Inhibitors; Chiral Bioanalysis; Remote Regulatory Assessments; Sample Reconciliation/Chain of Custody (PART 1A - Recommendations on Mass Spectrometry, Chromatography, Sample Preparation Latest Developments, Challenges, and Solutions and BMV/Regulated Bioanalysis PART 1B - Regulatory Agencies' Inputs on Regulated Bioanalysis/BMV, Biomarkers/IVD/CDx/BAV, Immunogenicity, Gene & Cell Therapy and Vaccine).

The 17th Workshop on Recent Issues in Bioanalysis (17th WRIB) took place in Orlando, FL, USA on June 19-23, 2023. Over 1000 professionals representing pharma/biotech companies, CROs, and multiple regulatory agencies convened to actively discuss the most current topics of interest in bioanalysis. The 17th WRIB included 3 Main Workshops and 7 Specialized Workshops that together spanned 1 week to allow an exhaustive and thorough coverage of all major issues in bioanalysis of biomarkers, immunogenicity, gene therapy, cell therapy and vaccines.Moreover, in-depth workshops on "EU IVDR 2017/746 Implementation and impact for the Global Biomarker Community: How to Comply with this NEW Regulation" and on "US FDA/OSIS Remote Regulatory Assessments (RRAs)" were the special features of the 17th edition.As in previous years, WRIB continued to gather a wide diversity of international, industry opinion leaders and regulatory authority experts working on both small and large molecules as well as gene, cell therapies and vaccines to facilitate sharing and discussions focused on improving quality, increasing regulatory compliance, and achieving scientific excellence on bioanalytical issues.This 2023 White Paper encompasses recommendations emerging from the extensive discussions held during the workshop and is aimed to provide the bioanalytical community with key information and practical solutions on topics and issues addressed, in an effort to enable advances in scientific excellence, improved quality and better regulatory compliance. Due to its length, the 2023 edition of this comprehensive White Paper has been divided into three parts for editorial reasons.This publication covers the recommendations on Mass Spectrometry Assays, Regulated Bioanalysis/BMV (Part 1A) and Regulatory Inputs (Part 1B). Part 2 (Biomarkers, IVD/CDx, LBA and Cell-Based Assays) and Part 3 (Gene Therapy, Cell therapy, Vaccines and Biotherapeutics Immunogenicity) are published in volume 16 of Bioanalysis, issues 7 and 8 (2024), respectively.

Fluctuating Atlantic inflows modulate Arctic atlantification.

Enhanced warm, salty subarctic inflows drive high-latitude atlantification, which weakens oceanic stratification, amplifies heat fluxes, and reduces sea ice. In this work, we show that the atmospheric Arctic Dipole (AD) associated with anticyclonic winds over North America and cyclonic winds over Eurasia modulates inflows from the North Atlantic across the Nordic Seas. The alternating AD phases create a "switchgear mechanism." From 2007 to 2021, this switchgear mechanism weakened northward inflows and enhanced sea-ice export across Fram Strait and increased inflows throughout the Barents Sea. By favoring stronger Arctic Ocean circulation, transferring freshwater into the Amerasian Basin, boosting stratification, and lowering oceanic heat fluxes there after 2007, AD+ contributed to slowing sea-ice loss. A transition to an AD- phase may accelerate the Arctic sea-ice decline, which would further change the Arctic climate system.

The role of cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) in patients with high-grade appendiceal carcinoma and extensive peritoneal carcinomatosis.

BACKGROUND: Patients with peritoneal mucinous carcinomatosis (PMCA) of appendiceal origin and extensive disease are commonly advised against CRS/HIPEC. We hypothesize that CRS/HIPEC is a beneficial treatment for this group. METHODS: Retrospective analysis of 134 patients with appendiceal cancer treated with CRS/HIPEC was performed from a prospective database. Extent of disease, measured by peritoneal cancer index (PCI), was related to completeness of cytoreduction (CC), lymph node (LN) status, and prior surgery score (PSS). Overall survival (OS) was estimated by Kaplan-Meier curves. Test differences were calculated using log-rank test. RESULTS: A total of 77 patients (57%) had PMCA. Mean follow-up was 22 months with a median of 18 months. OS was 88%, 56%, and 40% for 1, 3, and 5 years, respectively. 68% had PCI ≥ 20. LN metastasis was found in 44% of patients in PCI ≥ 20 and PCI < 20 groups. 73% and 60% of patients had PSS of 2 or 3 in PCI ≥ 20 and PCI < 20 groups, respectively (P = .196). Complete cytoreduction was achieved in 65% of PCI ≥ 20 group and 96% of PCI < 20 group (P = .004). With complete cytoreduction, the 5-year OS was 45% in PCI ≥ 20 group and 66% in PCI < 20 group (P = .139). 18 of 19 patients with incomplete cytoreduction had PCI ≥ 20, with 3- and 5-year OS of 27% and 0%. Hazard ratios (by Cox regression) were 2.8 (95% confidence interval [95% CI] 0.8-10.2) and 3.6 (95% CI 1.5-8.8) for PCI < 20 and complete cytoreduction, respectively. CONCLUSIONS: Meaningful long-term survival could be achieved in patients with PMCA even with extensive peritoneal disease. PCI ≥ 20 should not be used as an exclusion criterion when selecting these patients for CRS/HIPEC, and every effort should be made to achieve complete cytoreduction.

Prognostic significance of lymph node metastases in patients with high-grade appendiceal cancer.

BACKGROUND: In treating high-grade appendiceal cancer, appropriate patient selection for cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) is essential. The effect of lymph node (LN) status on survival is not clear. We hypothesize that LN metastases negatively affect long-term survival. METHODS: Retrospective analysis of peritoneal mucinous carcinomatosis (PMCA) patients from a prospective database was conducted. Using Kaplan-Meier survival curves and Cox proportional hazards ratio analysis, the effect of LN status, completeness of cytoreduction (CC), and peritoneal cancer index (PCI) was studied. RESULTS: Of 134 patients with appendiceal cancer who underwent CRS/HIPEC, 77 (57%) had PMCA. Mean follow-up was 22 (range, 3-90) months. Overall survival (OS) was 88, 56, and 40% for 1, 3, and 5-year, respectively. Thirty-four patients (44%) had LN metastases, 23 of whom (68%) had CC, whereas in LN negative patients 35 of 43 (81%) had CC (p = 0.191). PCI ≥ 20 was seen in 23 of 34 patients (68%) with LN metastases and 29 of 43 (67%) without metastases (p = 0.191). Five-year OS for patients with LN metastases was 11% compared with 76% for LN negative (p < 0.001). Among patients with complete cytoreduction, 5-year OS for LN positive vs. negative was 21 and 73%, respectively (p = 0.002). On multivariate regression analysis of LN status, CC score and PCI, the following hazard ratios were obtained: 3.4 (95% confidence interval (CI), 1.3-9.0), 2.6 (95% CI, 1.03-6.7), and 2.8 (95% CI, 0.8-10.4), respectively. CONCLUSIONS: Patient selection for CRS/HIPEC should take into consideration LN status, but it should not be a contraindication if preoperative evaluation revealed a high likelihood of complete cytoreduction.

The impact of stressful life events on relapse of generalized anxiety disorder.

BACKGROUND: Stressful life events (SLEs) are associated with the onset of psychiatric disorders but little is known about the effects of SLEs on individuals already diagnosed with an anxiety disorder, particularly generalized anxiety disorder (GAD) in which worry about life events is a defining characteristic. This study examined the impact of SLEs on relapse in adults already diagnosed with GAD. METHODS: Data are obtained from the Harvard/Brown Anxiety Research Project (HARP), a naturalistic longitudinal study of adults with a current or past history of anxiety disorders. One hundred and twelve adults recovered from an episode of GAD and 27 subsequently relapsed during the study. Eight categories of SLEs were assessed via interview and were examined as predictors of GAD relapse. RESULTS: An increased total number of SLEs was associated with a higher cumulative probability of relapse into episode of GAD and there was a nonsignificant statistical trend indicating specific categories of SLEs including health, death, and family/friends/household were related to an increased probability of relapse into episodes of GAD. CONCLUSIONS: SLEs impact the course of GAD and certain types of stressors may be more relevant to symptomatology than others. The change and uncertainty associated with SLEs may exacerbate existing worry tendencies even among those who have recovered from GAD.

The role of depression in short-term mood and fatigue responses to acute exercise.

BACKGROUND: Depression is associated with reduced physical activity levels, but little is known about the mechanisms accounting for the sedentary lifestyle among depressed individuals. Acute exercise is associated with positive mood in healthy individuals but may evoke negative mood in depressed individuals, which would further reduce the initiation and maintenance of regular exercise. PURPOSE: The present study examined the effects of acute exercise on depressed mood and fatigue in individuals with depression and nondepressed participants. METHOD: Participants with diagnosed Major (n = 12) or Minor Depressive Disorder (n = 2; n = 14, mean age of 41.7 +/- 9.6 years, 50% women) and control participants (n = 16, mean age of 38.1 +/- 6.1 years, 50% women), engaged in treadmill exercise. Mood and fatigue were measured before and after the acute bout of exercise. RESULTS: Immediately following exercise, depressed individuals displayed improvements in depressed mood (Delta from baseline: p = 0.02), but subsequently exhibited increased depressed mood (Delta from baseline: p = 0.05) and fatigue (Delta from baseline: p = 0.005) at 30 min post-exercise. These delayed increases in depressed mood (p = 0.05) and fatigue (p = 0.007) were higher in depressed participants compared to controls. CONCLUSION: These findings indicate that depressed individuals have increased negative mood 30 min post-exercise which may partially explain reduced initiation and adherence to exercise programs in depression.

Increased persistence of large-scale circulation regimes over Asia in the era of amplified Arctic warming, past and future.

Extreme weather events in Asia have been occurring with increasing frequency as the globe warms in response to rising concentrations of greenhouse gases. Many of these events arise from weather regimes that persist over a region for days or even weeks, resulting in disruptive heatwaves, droughts, flooding, snowfalls, and cold spells. We investigate changes in the persistence of large-scale weather systems through a pattern-recognition approach based on daily 500 hPa geopotential height anomalies over the Asian continent. By tracking consecutive days that the atmosphere resides in a particular pattern, we identify long-duration events (LDEs), defined as lasting longer than three days, and measure their frequency of occurrence over time in each pattern. We find that regimes featuring positive height anomalies in high latitudes are occurring more often as the Arctic warms faster than mid-latitudes, both in the recent past and in model projections for the twenty-first century assuming unabated greenhouse gas emissions. The increased dominance of these patterns corresponds to a higher likelihood of LDEs, suggesting that persistent weather conditions will occur more frequently. By mapping observed temperature and precipitation extremes onto each atmospheric regime, we gain insight into the types of disruptive weather events that will become more prevalent as particular patterns become more common.

Graph theoretical measures of the uncinate fasciculus subnetwork as predictors and correlates of treatment response in a transdiagnostic psychiatric cohort.

The internalizing psychopathologies (IP) are a highly prevalent group of disorders for which little data exists to guide treatment selection. We examine whether graph theoretical metrics from white matter connectomes may serve as biomarkers of disease and predictors of treatment response. We focus on the uncinate fasciculus subnetwork, which has been previously implicated in these disorders. We compared baseline graph measures from a transdiagnostic IP cohort with controls. Patients were randomized to either SSRI or cognitive behavioral therapy and we determined if graph theory metrics change following treatment, and whether these changes correlated with treatment response. Lastly, we investigated whether baseline metrics correlated with treatment response. Several baseline nodal graph metrics differed at baseline. Of note, right amygdala betweenness centrality was increased in patients relative to controls. In addition, white matter integrity of the uncinate fasciculus was decreased at baseline in patients versus controls. The SSRI and CBT cohorts had increased left frontal superior orbital betweenness centrality and left frontal medial orbital clustering coefficient, respectively, suggesting the presence of treatment specific neural correlates of treatment response. This study provides insight on shared white matter network features of IPs and elucidates potential biomarkers of treatment response that may be modality-specific.

Effects of the tropospheric large-scale circulation on European winter temperatures during the period of amplified Arctic warming.

We investigate factors influencing European winter (DJFM) air temperatures for the period 1979-2015 with the focus on changes during the recent period of rapid Arctic warming (1998-2015). We employ meteorological reanalyses analysed with a combination of correlation analysis, two pattern clustering techniques, and back-trajectory airmass identification. In all five selected European regions, severe cold winter events lasting at least 4 days are significantly correlated with warm Arctic episodes. Relationships during opposite conditions of warm Europe/cold Arctic are also significant. Correlations have become consistently stronger since 1998. Large-scale pattern analysis reveals that cold spells are associated with the negative phase of the North Atlantic Oscillation (NAO-) and the positive phase of the Scandinavian (SCA+) pattern, which in turn are correlated with the divergence of dry-static energy transport. Warm European extremes are associated with opposite phases of these patterns and the convergence of latent heat transport. Airmass trajectory analysis is consistent with these findings, as airmasses associated with extreme cold events typically originate over continents, while warm events tend to occur with prevailing maritime airmasses. Despite Arctic-wide warming, significant cooling has occurred in northeastern Europe owing to a decrease in adiabatic subsidence heating in airmasses arriving from the southeast, along with increased occurrence of circulation patterns favouring low temperature advection. These dynamic effects dominated over the increased mean temperature of most circulation patterns. Lagged correlation analysis reveals that SCA- and NAO+ are typically preceded by cold Arctic anomalies during the previous 2-3 months, which may aid seasonal forecasting.

Association between symptoms of depression and anxiety with heart rate variability in patients with implantable cardioverter defibrillators.

OBJECTIVE: This study investigated whether depression and anxiety symptoms are associated with measures of autonomic nervous system dysfunction in patients with implantable cardioverter defibrillators who are at high risk of cardiac rhythm disturbances. Depression and anxiety are associated with autonomic nervous system dysfunction, which may promote the risk of malignant cardiac arrhythmias. METHODS: Patients with an implantable cardioverter defibrillator (ICD) underwent ambulatory electrocardiographic (ECG) monitoring (n = 44, mean age = 62.1 +/- 9.3 years). Depression was assessed using the Beck Depression Inventory and anxiety was evaluated using the Taylor Manifest Anxiety Scale. Heart rate variability was assessed using time (RMSSD, pNN50, and SDNN) and frequency domain measures derived from 24-hour R-R intervals. Multivariate models were adjusted for age, sex, hypertension, diabetes, and smoking status. RESULTS: Defibrillator patients with elevated depression symptoms (n = 12) had significantly lower RMSSD (15.25 +/- 1.66 ms versus 24.97 +/- 2.44 ms, p = .002) and pNN50 (1.83 +/- 0.77 versus 5.61 +/- 1.04, p = .006) than defibrillator patients with low depression symptoms (n = 32). These associations remained significant after multivariate adjustment for covariates. ICD patients with high anxiety levels (n = 10) displayed lower RMSSD (p = .013), which became marginally significant when adjusting for covariates (p = .069). CONCLUSIONS: Depression and anxiety in defibrillator patients are associated with autonomic nervous system dysfunction indices of reduced parasympathetic control. Autonomic nervous system dysfunction may partially explain the association between depression and anxiety with life-threatening cardiac outcomes in vulnerable patients.

Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.

OBJECTIVE: To study the independent and interactive effects of depression and anxiety symptoms as predictors of cardiovascular disease (CVD) events in a sample of women with suspected myocardial ischemia. Symptoms of depression and anxiety overlap strongly and are independent predictors of CVD events. Although these symptoms commonly co-occur in medical patients, little is known about combined effects of depression and anxiety on CVD risk. METHOD: A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects. RESULTS: Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3-3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70-1.4; p = .95). CONCLUSION: Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.

Summers with low Arctic sea ice linked to persistence of spring atmospheric circulation patterns.

The declining trend of Arctic September sea ice constitutes a significant change in the Arctic climate system. Large year-to-year variations are superimposed on this sea-ice trend, with the largest variability observed in the eastern Arctic Ocean. Knowledge of the processes important for this variability may lead to an improved understanding of seasonal and long-term changes. Previous studies suggest that transport of heat and moisture into the Arctic during spring enhances downward surface longwave radiation, thereby controlling the annual melt onset, setting the stage for the September ice minimum. In agreement with these studies, we find that years with a low September sea-ice concentration (SIC) are characterized by more persistent periods in spring with enhanced energy flux to the surface in forms of net longwave radiation plus turbulent fluxes, compared to years with a high SIC. Two main atmospheric circulation patterns related to these episodes are identified: one resembles the so-called Arctic dipole anomaly that promotes transport of heat and moisture from the North Pacific, whereas the other is characterized by negative geopotential height anomalies over the Arctic, favoring cyclonic flow from Siberia and the Kara Sea into the eastern Arctic Ocean. However, differences between years with low and high September SIC appear not to be due to different spring circulation patterns; instead it is the persistence and intensity of processes associated with these patterns that distinguish the two groups of anomalous years: Years with low September SIC feature episodes that are consistently stronger and more persistent than years with high SIC.

Emotion-based brain mechanisms and predictors for SSRI and CBT treatment of anxiety and depression: a randomized trial.

Mechanisms and predictors for the successful treatment of anxiety and depression have been elusive, limiting the effectiveness of existing treatments and curtailing the development of new interventions. In this study, we evaluated the utility of three widely used neural probes of emotion (experience, regulation, and perception) in their ability to predict symptom improvement and correlate with symptom change following two first-line treatments-selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Fifty-five treatment-seeking adults with anxiety and/or depression were randomized to 12 weeks of SSRI or CBT treatment (ClinicalTrials.gov identifier: NCT01903447). Functional magnetic resonance imaging (fMRI) was used to examine frontolimbic brain function during emotion experience, regulation, and perception, as probed by the Emotion Regulation Task (ERT; emotion experience and regulation) and emotional face assessment task (EFAT; emotion perception). Brain function was then related to anxiety and depression symptom change. Results showed that both SSRI and CBT treatments similarly attenuated insula and amygdala activity during emotion perception, and greater treatment-related decrease in insula and amygdala activity was correlated with greater reduction in anxiety symptoms. Both treatments also reduced amygdala activity during emotion experience but brain change did not correlate with symptom change. Lastly, greater pre-treatment insula and amygdala activity during emotion perception predicted greater anxiety and depression symptom improvement. Thus, limbic activity during emotion perception is reduced by both SSRI and CBT treatments, and predicts anxiety and depression symptom improvement. Critically, neural reactivity during emotion perception may be a non-treatment-specific mechanism for symptom improvement.

Social networks and incident stroke among women with suspected myocardial ischemia.

OBJECTIVE: To describe the prospective relationship between social networks and nonfatal stroke events in a sample of women with suspected myocardial ischemia. Social networks are an independent predictor of all-cause and cardiovascular mortality, but their relationship with stroke events in at-risk populations is largely unknown. METHOD: A total of 629 women (mean age = 59.6 +/- 11.6 years) were evaluated at baseline for cardiovascular disease risk factors as part of a protocol including coronary angiography; the subjects were followed over a median 5.9 years to track the incidence of cardiovascular events including stroke. Participants also completed the Social Network Index (SNI), measuring the presence/absence of 12 types of common social relationships. RESULTS: Stroke events occurred among 5.1% of the sample over follow-up. More isolated women were older and less educated, with higher rates of smoking and hypertension, and increased use of cardiovascular medications. Women with smaller social networks were also more likely to show elevations (scores of > or =10) on the Beck Depression Inventory (54% versus 41%, respectively; p = .003). Relative to women with higher SNI scores, Cox regression results indicated that more isolated women experienced strokes at greater than twice the rate of those with more social relationships after adjusting for covariates (hazard ratio = 2.7; 95% Confidence Interval = 1.1-6.7). CONCLUSIONS: Smaller social networks are a robust predictor of stroke in at-risk women, and the magnitude of the association rivals that of conventional risk factors.

Warm Arctic episodes linked with increased frequency of extreme winter weather in the United States.

Recent boreal winters have exhibited a large-scale seesaw temperature pattern characterized by an unusually warm Arctic and cold continents. Whether there is any physical link between Arctic variability and Northern Hemisphere (NH) extreme weather is an active area of research. Using a recently developed index of severe winter weather, we show that the occurrence of severe winter weather in the United States is significantly related to anomalies in pan-Arctic geopotential heights and temperatures. As the Arctic transitions from a relatively cold state to a warmer one, the frequency of severe winter weather in mid-latitudes increases through the transition. However, this relationship is strongest in the eastern US and mixed to even opposite along the western US. We also show that during mid-winter to late-winter of recent decades, when the Arctic warming trend is greatest and extends into the upper troposphere and lower stratosphere, severe winter weather-including both cold spells and heavy snows-became more frequent in the eastern United States.