The dorsomedial prefrontal cortex prioritizes social learning during rest.

Sociality is a defining feature of the human experience: We rely on others to ensure survival and cooperate in complex social networks to thrive. Are there brain mechanisms that help ensure we quickly learn about our social world to optimally navigate it? We tested whether portions of the brain's default network engage "by default" to quickly prioritize social learning during the memory consolidation process. To test this possibility, participants underwent functional MRI (fMRI) while viewing scenes from the documentary film, Samsara. This film shows footage of real people and places from around the world. We normed the footage to select scenes that differed along the dimension of sociality, while matched on valence, arousal, interestingness, and familiarity. During fMRI, participants watched the "social" and "nonsocial" scenes, completed a rest scan, and a surprise recognition memory test. Participants showed superior social (vs. nonsocial) memory performance, and the social memory advantage was associated with neural pattern reinstatement during rest in the dorsomedial prefrontal cortex (DMPFC), a key node of the default network. Moreover, it was during early rest that DMPFC social pattern reinstatement was greatest and predicted subsequent social memory performance most strongly, consistent with the "prioritization" account. Results simultaneously update 1) theories of memory consolidation, which have not addressed how social information may be prioritized in the learning process, and 2) understanding of default network function, which remains to be fully characterized. More broadly, the results underscore the inherent human drive to understand our vastly social world.

Individuals who see the good in the bad engage distinctive default network coordination during post-encoding rest.

Focusing on the upside of negative events often promotes resilience. Yet, the underlying mechanisms that allow some people to spontaneously see the good in the bad remain unclear. The broaden-and-build theory of positive emotion has long suggested that positive affect, including positivity in the face of negative events, is linked to idiosyncratic thought patterns (i.e., atypical cognitive responses). Yet, evidence in support of this view has been limited, in part, due to difficulty in measuring idiosyncratic cognitive processes as they unfold. To overcome this barrier, we applied Inter-Subject Representational Similarity Analysis to test whether and how idiosyncratic neural responding supports positive reactions to negative experience. We found that idiosyncratic functional connectivity patterns in the brain's default network while resting after a negative experience predicts more positive descriptions of the event. This effect persisted when controlling for connectivity 1) before and during the negative experience, 2) before, during, and after a neutral experience, and 3) between other relevant brain regions (i.e., the limbic system). The relationship between idiosyncratic default network responding and positive affect was largely driven by functional connectivity patterns between the ventromedial prefrontal cortex and the rest of the default network and occurred relatively quickly during rest. We identified post-encoding rest as a key moment and the default network as a key brain system in which idiosyncratic responses correspond with seeing the good in the bad.

Get out of my head: social evaluative brain states carry over into post-feedback rest and influence remembering how others view us.

Learning how others perceive us helps us tune our behavior to form adaptive relationships. But which perceptions stick with us? And when in the learning process are they codified in memory? We leveraged a popular television series-The Office-to answer these questions. Prior to their functional magnetic resonance imaging (fMRI) session, viewers of The Office reported which characters they identified with, as well as which characters they perceived another person (i.e. counterpart) was similar to. During their fMRI scan, participants found out which characters other people thought they and the counterpart were like, and also completed rest scans. Participants remembered more feedback inconsistent with their self-views (vs. views of the counterpart). Although neural activity while encoding self-inconsistent feedback did not meaningfully predict memory, returning to the inconsistent self feedback during subsequent rest did. During rest, participants reinstated neural patterns engaged while receiving self-inconsistent feedback in the dorsomedial prefrontal cortex (DMPFC). DMPFC reinstatement also quadratically predicted self-inconsistent memory, with too few or too many reinstatements compromising memory performance. Processing social feedback during rest may impact how we remember and integrate the feedback, especially when it contradicts our self-views.

Temporal self-compression: Behavioral and neural evidence that past and future selves are compressed as they move away from the present.

A basic principle of perception is that as objects increase in distance from an observer, they also become logarithmically compressed in perception (i.e., not differentiated from one another), making them hard to distinguish. Could this basic principle apply to perhaps our most meaningful mental representation: our own sense of self? Here, we report four studies that suggest selves are increasingly non-discriminable with temporal distance from the present as well. In Studies 1 through 3, participants made trait ratings across various time points in the past and future. We found that participants compressed their past and future selves, relative to their present self. This effect was preferential to the self and could not be explained by the alternative possibility that individuals simply perceive arbitrary self-change with time irrespective of temporal distance. In Study 4, we tested for neural evidence of temporal self-compression by having participants complete trait ratings across time points while undergoing functional MRI. Representational similarity analysis was used to determine whether neural self-representations are compressed with temporal distance as well. We found evidence of temporal self-compression in areas of the default network, including medial prefrontal cortex and posterior cingulate cortex. Specifically, neural pattern similarity between self-representations was logarithmically compressed with temporal distance. Taken together, these findings reveal a "temporal self-compression" effect, with temporal selves becoming increasingly non-discriminable with distance from the present.

Don't You Forget About Me: The Importance of Studying the Brain Basis of Real-world Interpersonal Memory.

Despite the fact that humans are a highly social species, we know relatively little about how people remember the rich interpersonal information filling their social lives. This gap is surprising: One function of memory has been suggested to be relationship maintenance [Neisser, U. Time present and time past. Practical Aspects of Memory: Current Research and Issues, 2, 545-560, 1988]. A major barrier to understanding the brain basis of interpersonal memory is that traditional brain imaging methods are not ideally suited to study memory for the nuanced interpersonal experiences comprising our social lives. Yet, recent and rapidly developing advances in the analysis of brain responses to naturalistic social information can help researchers surpass this methodological barrier. This perspective piece articulates the importance of studying the brain basis of real-world social memories and suggests new directions in interpersonal memory research. This includes investigating the brain mechanisms that represent the content and structure of real-world interpersonal memories as well as how they are altered in mental health conditions associated with social memory biases.

Psychosocial issues and quality of life of parenting partners of young women with breast cancer.

PURPOSE: Data are lacking about the association between quality of life (QOL) and psychosocial issues of partners of young women with breast cancer who co-parent dependent children. METHODS: We conducted a cross-sectional analysis of partners of women with breast cancer diagnosed at age ≤ 40. Among those partners reporting at least one dependent child under 18 years old at the time of diagnosis, we used multiple linear regression to examine associations between partner QOL and sociodemographic and psychosocial factors, and the patient's cancer stage and time since diagnosis. RESULTS: Of the 219 parenting partners, all identified as male with a median age of 44 years; 96% (204/213) reported working full-time at the time of the survey. Fifty-four percent endorsed behaviors indicating maladaptive coping. In adjusted analyses, less than full-time employment (ß = - 8.76; 95% CI = - 17.37, - 0.14), younger age (ß = - 0.35; 95% CI = - 0.069, - 0.02), greater parenting concerns (ß = 0.56; 95% CI = 0.36, 0.75), clinically relevant anxiety symptoms (ß = 13.79; 95% CI = 10.24, 17.35), lower post-traumatic growth score (ß = - 0.33; 95% CI = - 0.51, - 0.16), lower social support (ß = - 0.21; 95% CI = - 0.29, - 0.12), lower sexual satisfaction (ß = - 0.40; 95% CI = - 0.62, - 0.19), and breast cancer stages 3 (ß = 7.61; 95% CI = 0.19, 15.02) and 4 (ß = 12.63; 95% CI = 1.91, 23.34), when compared to stage 0, were associated with lower partner QOL. CONCLUSION: Parenting partners of young women with breast cancer have substantial unmet psychosocial needs. Interventions are needed to enhance QOL and promote adaptive coping for this population.

Self-Other Representation in the Social Brain Reflects Social Connection.

Social connection is critical to well-being, yet how the brain reflects our attachment to other people remains largely unknown. We combined univariate and multivariate brain imaging analyses to assess whether and how the brain organizes representations of others based on how connected they are to our own identity. During an fMRI scan, female and male human participants (N = 43) completed a self- and other-reflection task for 16 targets: the self, five close others, five acquaintances, and five celebrities. In addition, they reported their subjective closeness to each target and their own trait loneliness. We examined neural responses to the self and others in a brain region that has been associated with self-representation (mPFC) and across the whole brain. The structure of self-other representation in the mPFC and across the social brain appeared to cluster targets into three social categories: the self, social network members (including close others and acquaintances), and celebrities. Moreover, both univariate activation in mPFC and multivariate self-other similarity in mPFC and across the social brain increased with subjective self-other closeness ratings. Critically, participants who were less socially connected (i.e., lonelier) showed altered self-other mapping in social brain regions. Most notably, in mPFC, loneliness was associated with reduced representational similarity between the self and others. The social brain apparently maintains information about broad social categories as well as closeness to the self. Moreover, these results point to the possibility that feelings of chronic social disconnection may be mirrored by a "lonelier" neural self-representation.SIGNIFICANCE STATEMENT Social connection is critical to well-being, yet how the brain reflects our attachment to people remains unclear. We found that the social brain stratifies neural representations of people based on our subjective connection to them, separately clustering people who are and are not in our social network. Moreover, the people we feel closest to are represented most closely to ourselves. Finally, lonelier individuals also appeared to have a "lonelier" neural self-representation in the mPFC, as loneliness attenuated the similarity between self and other neural representations in this region. The social brain appears to map our interpersonal ties, and alterations in this map may help explain why lonely individuals endorse statements such as "people are around me but not with me."

Exploring neural mechanisms of the health benefits of gratitude in women: A randomized controlled trial.

BACKGROUND: Gratitude has received growing interest as an emotion that can bring greater happiness and health. However, little is known about the effects of gratitude on objective measures of physical health or the neural mechanisms that underlie these effects. Given strong links between gratitude and giving behavior, and giving and health, it is possible that gratitude may benefit health through the same mechanisms as giving to others. Thus, this study investigated whether gratitude activates a neural 'caregiving system' (e.g., ventral striatum (VS), septal area (SA)), which can downregulate threat responding (e.g., amygdala) and possibly cellular inflammatory responses linked to health. METHODS: A parallel group randomized controlled trial examined the effect of a six-week online gratitude (n = 31) vs. control (n = 30) writing intervention on neural activity and inflammatory outcomes. Pre- and post-intervention, healthy female participants (ages 35-50) reported on support-giving behavior and provided blood samples to assess circulating plasma levels and stimulated monocytic production of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)). Post-intervention, participants completed a gratitude task and a threat reactivity task in an fMRI scanner. RESULTS: There were no significant group differences (gratitude vs. control intervention) in neural responses (VS, SA, or amygdala) to the gratitude or threat tasks. However, across the entire sample, those who showed larger pre- to- post-intervention increases in self-reported support-giving showed larger reductions in amygdala reactivity following the gratitude task (vs. control task). Additionally, those who showed larger reductions in amygdala reactivity following the gratitude task showed larger pre-to-post reductions in the stimulated production of TNF-α and IL-6. Importantly, gratitude-related reductions in amygdala reactivity statistically mediated the relationship between increases in support-giving and decreases in stimulated TNF-α production. CONCLUSION: The observed relationships suggest that gratitude may benefit health (reducing inflammatory responses) through the threat-reducing effects of support-giving.

Neurocognitive mechanisms of poor social connection in posttraumatic stress disorder: Evidence for abnormalities in social working memory.

BACKGROUND: Poor social connection is a central feature of posttraumatic stress disorder (PTSD), but little is known about the neurocognitive processes associated with social difficulties in this population. We examined recruitment of the default network and behavioral responses during social working memory (SWM; i.e., maintaining and manipulating social information on a moment-to-moment basis) in relation to PTSD and social connection. METHODS: Participants with PTSD (n = 31) and a trauma-exposed control group (n = 21) underwent functional magnetic resonance imaging while completing a task in which they reasoned about two or four people's relationships in working memory (social condition) and alphabetized two or four people's names in working memory (nonsocial condition). Participants also completed measures of social connection (e.g., loneliness, social network size). RESULTS: Compared to trauma-exposed controls, individuals with PTSD reported smaller social networks (p = .032) and greater loneliness (p = .038). Individuals with PTSD showed a selective deficit in SWM accuracy (p = .029) and hyperactivation in the default network, particularly in the dorsomedial subsystem, on trials with four relationships to consider. Moreover, default network hyperactivation in the PTSD group (vs. trauma-exposed group) differentially related to social network size and loneliness (p's < .05). Participants with PTSD also showed less resting state functional connectivity within the dorsomedial subsystem than controls (p = .002), suggesting differences in the functional integrity of a subsystem key to SWM. CONCLUSIONS: SWM abnormalities in the default network may be a basic mechanism underlying poorer social connection in PTSD.

Engaging Institutional Stakeholders to Develop and Implement Guidelines for Recruiting Participants in Research Studies Using Social Media: Mixed Methods, Multi-Phase Process.

BACKGROUND: Limited regulatory guidance surrounding the use of social media channels for participant recruitment is an interdisciplinary challenge. Establishing stakeholder-informed procedures is essential for ethical and effective use of social media for participant recruitment. OBJECTIVE: This study aims to provide replicable procedures for developing and implementing guidelines for using social media to recruit participants in research studies. METHODS: Social media use cases at the university were used to identify institutional stakeholders for the initiative. After establishing workflow procedures, a scoping review of web-based materials about recruitment and research on the internet and social media from 19 peer institutions and 2 federal agencies was conducted to inform the structure of the policies and procedures. End users (investigators and study coordinators; N=14) also provided feedback on the policies and procedures and implementation. RESULTS: Representatives (n=7) from 5 institutional offices and 15 subject-matter experts from 5 areas were identified as stakeholders in the development of policies and procedures. Peers with web-based materials (n=16) identified in the scoping review revealed 4 themes that served as a basis for developing our policies and procedures. End user feedback further informed the policies and procedures and implementation. A centrally managed social media account for communicating with participants and hosting advertising campaigns on social media was also established and, when combined with the policies and procedures, resulted in 39 advertising campaigns, and 2846 participants were enrolled in health and clinical research studies. CONCLUSIONS: Our policies and procedures allow research teams to harness the potential of social media to increase study recruitment and participation; the transparent, stakeholder-informed process can be replicated by institutional administrators to establish policies and procedures that meet the interests and needs of their research community.

Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II.

BACKGROUND: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. OBJECTIVE: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. METHODS: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. RESULTS: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. CONCLUSIONS: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic.

Memory of Others' Disclosures Is Consolidated during Rest and Associated with Providing Support: Neural and Linguistic Evidence.

Social scientists have documented the power of being heard: Disclosing emotional experiences to others promotes mental and physical health. Yet, far less is known about how listeners digest the sensitive information people share with them. We combined brain imaging and text analysis methods with a naturalistic emotional disclosure paradigm to assess how listeners form memories of others' disclosures. Neural and linguistic evidence support the hypothesis that listeners consolidate memories for others' disclosures during rest after listening and that their ability to do so facilitates subsequently providing the speakers with support. In Study 1, brain imaging methods showed that functional connectivity between the dorsomedial subsystem of the default network and frontoparietal control network increased during rest after listening to others' disclosures and predicted subsequent memory for their experiences. Moreover, graph analytic methods demonstrated that the left anterior temporal lobe may function as a connector hub between these two networks when consolidating memory for disclosures. In Study 2, linguistic analyses revealed other-focused thought increased during rest after listening to others' disclosures and predicted not only memory for the information disclosed but also whether listeners supported the speakers the next day. Collectively, these findings point to the important role of memory consolidation during rest in helping listeners respond supportively to others' disclosures. In our increasingly busy lives, pausing to briefly rest may not only help us care for ourselves but also help us care for others.

Oral arsenic trioxide ORH-2014 pharmacokinetic and safety profile in patients with advanced hematologic disorders.

Daily intravenous arsenic trioxide administered with all-trans retinoid acid, the standard-of-care for acute promyelocytic leukemia, is costly and challenging to administer. ORH-2014 is a novel, oral arsenic trioxide formulation, consisting of micron-size drug particles with rapid dissolution and high bioavailability. We conducted a multicenter phase 1 dose-escalating study in patients with advanced hematologic malignancies. Twelve patients received ORH-2014 at 5 mg (n=3), 10 mg (n=6), or 15 mg (n=3) orally once a day (fasted state). Objectives were to assess the safety, tolerability and pharmacokinetics of ORH-2014 to support a dose recommendation for future trials. The median age of the patients was 77 years (range: 45-81) and they had received a median of two (range: 1-5) prior therapies. There were no dose limiting toxicities and no drug-related severe adverse events, except one grade III QT prolongation occurring beyond the dose limiting toxicity assessment period and resolving after treatment interruption. ORH-2014 steady-state plasma concentration was reached on day 15. ORH-2014, 15 mg Cmax was comparable to the calculated approved dose of intravenous arsenic trioxide (mean [% coefficient of variation]: 114 [21%] vs 124 [60%] ng/mL) and area under the curve from 0 to 24 hours was 2,140 (36%) versus 1,302 (30%) h*ng/mL. These results indicate that ORH-2014 at 15 mg is safe, bioavailable, and provides the required arsenic exposure compared to intravenous arsenic trioxide at the approved dose (0.15 mg/kg); this ORH-2014 dose is recommended for future trials. (NCT03048344; www.clin-icaltrials.gov).

Evidence That Default Network Connectivity During Rest Consolidates Social Information.

Brain regions engaged during social inference, medial prefrontal cortex (MPFC) and tempoparietal junction (TPJ), are also known to spontaneously engage during rest. While this overlap is well known, the social cognitive function of engaging these regions during rest remains unclear. Building on past research suggesting that new information is committed to memory during rest, we explored whether one function of MPFC and TPJ engagement during rest may be to consolidate new social information. MPFC and TPJ regions significantly increased connectivity during rest after encoding new social information (relative to baseline and post nonsocial encoding rest periods). Moreover, greater connectivity between rTPJ and MPFC, as well as other portions of the default network (vMPFC, anterior temporal lobe, and middle temporal gyrus) during post social encoding rest corresponded with superior social recognition and social associative memory. The tendency to engage MPFC and TPJ during rest may tune people towards social learning.

The utility of magnetic resonance imaging in early-stage breast cancer survivors-An institutional experience and literature review.

The role of breast magnetic resonance imaging (MRI) in the screening of breast cancer survivors with remaining breast tissue is not well studied. We sought to evaluate the outcomes of screening breast MRI in a cohort of breast cancer survivors. A population of patients with history of stage I-IIIa breast cancer and ≥1 MRI a year or later from diagnosis between 2006-2008 were identified using the National Comprehensive Cancer Network data base from two large Boston-area cancer centers. Patient and disease characteristics were obtained from the data base, and medical records were reviewed to identify the index MRI (first eligible), indications, and two-year outcomes. Overall, 647 patients had breast MRI scans during the study period including 342 eligible patients whose index MRIs were done for breast screening purposes. 47/342 (13.7%) were abnormal, and 3.8% (13/342) underwent biopsy, resulting in the detection of 3 cases of locoregional recurrence or new primary breast cancer (0.9%, 95% CI = 0.2%-2.5%). Of 295 patients with a normal index screening MRI, 12 had a breast cancer recurrence diagnosed within 2 years (4.1% 95%CI = 2.1%-7.0%), and 5 of these recurrences were limited to MRI-screened breast tissue. No statistically significant difference in the rate of 2-year locoregional or distant recurrence was observed between patients with an abnormal screening MRI and those with a normal scan. Adjunct single breast MRI surveillance in a general population of breast cancer survivors one year after diagnosis detected few recurrences, and its effect on short-term outcomes was unclear.

Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study.

BACKGROUND: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. OBJECTIVE: By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? METHODS: Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. RESULTS: During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19-related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.03) were significantly associated with COVID-19-related news. CONCLUSIONS: Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods to reduce the impact of future catastrophic events on the mental health of the population.

Partners of young breast cancer survivors: a cross-sectional evaluation of psychosocial concerns, coping, and mental health.

PURPOSE: Evaluation of psychosocial concerns, coping style, and mental health in partners of young (diagnosed at ≤40 years) survivors of early-stage breast cancer (BC). DESIGN: Cross-sectional; partners participated in a one-time survey. SAMPLE: 289 participants; most were male, white, working full-time, college educated, with median age of 43 years, parenting children <18 years old. METHODS: Logistic regression was used to explore associations with anxiety and depression (≥8 on Hospital Anxiety and Depression sub-scales). FINDINGS: Overall, 41% reported symptoms of anxiety, 18% reported symptoms of depression, and 44% identified maladaptive coping. Multivariable regression analyses revealed: lower social support and poorer quality of life significantly associated with depression (p < .05); maladaptive coping, fulltime employment, poorer caregiver QOL, and less education significantly associated with anxiety. CONCLUSIONS: Partners of young BC survivors who use more maladaptive coping strategies, report less social support, work fulltime, and/or who have lower education levels experience negative mental health outcomes. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY: Enhancing constructive coping and ensuring all partners have access to supportive resources may improve partners' emotional adjustment.

Nonadherent behaviors among young women on adjuvant endocrine therapy for breast cancer.

BACKGROUND: Young age is a known factor associated with suboptimal adherence to endocrine therapy (ET) for adjuvant breast cancer (BC) treatment. This study was aimed at assessing nonadherent behaviors and associated factors among young women with early-stage hormone receptor-positive BC. METHODS: As part of a multicenter, prospective cohort of women with a diagnosis of BC at or under the age of 40 years, participants were surveyed 30 months after their diagnosis about adherent behaviors. Among those who reported taking ET, adherence was measured with a 3-item Likert-type scale: Do you ever forget to take your ET? If you feel worse when you take your ET, do you stop taking it? Did you take your ET exactly as directed by your doctor over the last 3 months? Women reporting at least 1 nonadherent behavior were classified as nonadherers. Variables with a P value <.20 were included in a multivariable logistic model. RESULTS: Among 384 women, 194 (51%) were classified as nonadherers. Univariate factors that retained significance in the multivariable model included educational level (odds ratio [OR], 0.50 for high vs low; P = .04), level of social support according to the Medical Outcome Study Social Support Survey (OR, 0.98 per 1 point; P = .01), and confidence with the decision regarding ET measured on a 0 to 10 numerical scale (OR, 0.63 for high vs low; P = .04). CONCLUSIONS: Findings from this study could help to identify young patients at higher risk for nonadherence. Interventions adapted to the level of education and aimed at reinforcing support and patients' confidence in their decision to take ET could improve adherence and associated outcomes in this population.

Contemporary management of breast cancer during pregnancy and subsequent lactation in a multicenter cohort of young women with breast cancer.

The incidence of breast cancer diagnosed during pregnancy is increasing. We sought to characterize patient, treatment, pregnancy and lactation factors among young women with newly diagnosed breast cancer during pregnancy in a prospective cohort study. We identified all women who were pregnant when diagnosed with invasive breast cancer among those enrolled in the Young Women's Breast Cancer Study (NCT01468246), and collected details on pregnancy, birth and lactation from surveys, and treatment information medical record review. Of 1302 enrolled participants, 976 women with invasive breast cancer completed full baseline surveys, among whom 39 (4.0%) patients reported being pregnant at diagnosis. Median age at diagnosis was 34 years (range: 25-40), with stage distribution: I, 28%; II, 44%; III, 23%; and IV, 5%. 74% of patients (29/39) had grade 3 tumors, 59% (23/39) ER-positive, and 31% (12/39) HER2-positive disease. 23 (59%) had surgery during pregnancy, 4 (17%) during the first trimester. Among the women who had surgery during pregnancy, 61% (14/23) underwent lumpectomy, 35% (8/23) unilateral, and 4% (1/23) bilateral mastectomy. All patients who had chemotherapy (51%, 20/39) received it in second and third trimesters, and had ACx4. There were 31 live births, 2 spontaneous, and 5 therapeutic abortions. Among live births, 16 (41%) were before 37 weeks of gestation. Three women reported breastfeeding. Within 6 months after delivery, comprehensive staging in 13 patients showed upstaging in four patients. In a contemporary cohort of young women with breast cancer, pregnancy at diagnosis is relatively uncommon. Treatment during pregnancy can generally be consistent with standard surgical and chemotherapy approaches, with attention to timing of therapies. Longer-term outcomes including effects of some timing issues including delayed use of anti-HER2 therapy on patient outcomes warrant further research.

Why People Are Always Thinking about Themselves: Medial Prefrontal Cortex Activity during Rest Primes Self-referential Processing.

Humans have a tendency to think about themselves. What generates this self-focus? One clue may come from the observation that the same part of the brain that supports self-reflection-the medial pFC (MPFC/Brodmann's area 10 [BA 10])-also spontaneously engages by default whenever the brain is free from external demands to attention. Here, we test the possibility that the default tendency to engage MPFC/BA 10 primes self-referential thinking. Participants underwent fMRI while alternating between brief periods of rest and experimental tasks in which they thought about their own traits, another person's traits, or another location's traits. Greater default engagement in MPFC/BA 10 during momentary breaks preferentially facilitated task performance on subsequent self-reflection trials on a moment-to-moment basis. These results suggest that reflexively engaging MPFC/BA 10 by default may nudge self-referential thinking, perhaps explaining why humans think about themselves so readily.