Limbic pathway vulnerability associates with neurologic outcome in children after cardiac arrest.

AIM: To analyze whether brain connectivity sequences including diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging (rsfMRI) identify vulnerable brain regions and networks associated with neurologic outcome after pediatric cardiac arrest. METHODS: Children aged 2 d-17 y with cardiac arrest were enrolled in one of 2 parent studies at a single center. Clinically indicated brain MRI with DTI and rsfMRI and performed within 2 weeks after arrest were analyzed. Tract-wise fractional anisotropy (FA) and axial, radial, and mean diffusivity assessed DTI, and functional connectivity strength (FCS) assessed rsfMRI between outcome groups. Unfavorable neurologic outcome was defined as Pediatric Cerebral Performance Category score 4-6 or change > 1 between 6 months after arrest vs baseline. RESULTS: Among children with DTI (n = 28), 57% had unfavorable outcome. Mean, radial, axial diffusivity and FA of varying direction of magnitude in the limbic tracts, including the right cingulum parolfactory, left cingulum parahippocampal, corpus callosum forceps major, and corpus callosum forceps minor tracts, were associated with unfavorable neurologic outcome (p < 0.05). Among children with rsfMRI (n = 12), 67% had unfavorable outcome. Decreased FCS in the ventromedial and dorsolateral prefrontal cortex, insula, precentral gyrus, anterior cingulate, and inferior parietal lobule were correlated regionally with unfavorable neurologic outcome (p < 0.05 Family-Wise Error corrected). CONCLUSION: Decreased multimodal connectivity measures of paralimbic tracts were associated with unfavorable neurologic outcome after pediatric cardiac arrest. Longitudinal analysis correlating brain connectivity sequences with long term neuropsychological outcomes to identify the impact of pediatric cardiac arrest in vulnerable brain networks over time appears warranted.

Engendering healthy masculinities to prevent sexual violence: Rationale for and design of the Manhood 2.0 trial.

Violence against women and girls is an important global health concern. Numerous health organizations highlight engaging men and boys in preventing violence against women as a potentially impactful public health prevention strategy. Adapted from an international setting for use in the US, "Manhood 2.0" is a "gender transformative" program that involves challenging harmful gender and sexuality norms that foster violence against women while promoting bystander intervention (i.e., giving boys skills to interrupt abusive behaviors they witness among peers) to reduce the perpetration of sexual violence (SV) and adolescent relationship abuse (ARA). Manhood 2.0 is being rigorously evaluated in a community-based cluster-randomized trial in 21 lower resource Pittsburgh neighborhoods with 866 adolescent males ages 13-19. The comparison intervention is a job readiness training program which focuses on the skills needed to prepare youth for entering the workforce, including goal setting, accountability, resume building, and interview preparation. This study will provide urgently needed information about the effectiveness of a gender transformative program, which combines healthy sexuality education, gender norms change, and bystander skills to interrupt peers' disrespectful and harmful behaviors to reduce SV/ARA perpetration among adolescent males. In this manuscript, we outline the rationale for and evaluation design of Manhood 2.0. Clinical Trials #: NCT02427061.

The association between social support, intrusive thoughts, avoidance, and adjustment following an experimental cancer treatment.

A social-cognitive processing model was used to examine the association of social support with intrusive thoughts and avoidance in predicting adjustment in 53 patients receiving an experimental vaccine for the treatment of either metastatic melanoma (n=24) or metastatic renal cell cancer (n=29). Social support, intrusive thoughts/avoidance, psychological distress and quality of life were assessed on the day of the first treatment, on the day of the final treatment, and 1 month after the end of treatment during a routine follow-up visit. Social support at the beginning of treatment was negatively associated with psychological distress and positively associated with mental health quality of life (QOL) 1 month after treatment, and these associations were mediated by intrusive thoughts/avoidance at the end of treatment. There was also an interaction between social support and intrusive thoughts/avoidance at the beginning of treatment in predicting both psychological distress and mental health QOL 1 month after treatment. Specifically, for patients with lower levels of support, greater intrusive thoughts/avoidance was associated with greater psychological distress and poorer mental health QOL 1 month after treatment. However, there was no association between intrusive thoughts/avoidance and adjustment in patients with high levels of social support. These results suggest that social support buffers the negative association between intrusive thoughts/avoidance and psychological adjustment. Overall, the results are consistent with a social-cognitive processing model of post-trauma reactions among cancer patients. Our results highlight the need to assess patients' perceived support and to further develop and assess the benefits of interventions to increase patients' supportive networks and to facilitate cognitive processing of the cancer experience.