Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

OBJECTIVES: Digital breast tomosynthesis (DBT) can improve diagnostic accuracy compared to 2D mammography, but DBT reporting is time-consuming and potentially more fatiguing. Changes in diagnostic accuracy and subjective and objective fatigue were evaluated over a DBT reporting session, and the impact of taking a reporting break was assessed. MATERIALS AND METHODS: Forty-five National Health Service (NHS) mammography readers from 6 hospitals read a cancer-enriched set of 40 DBT cases whilst eye tracked in this prospective cohort study, from December 2020 to April 2022. Eye-blink metrics were assessed as objective fatigue measures. Twenty-one readers had a reporting break, 24 did not. Subjective fatigue questionnaires were completed before and after the session. Diagnostic accuracy and subjective and objective fatigue measures were compared between the cohorts using parametric and non-parametric significance testing. RESULTS: Readers had on average 10 years post-training breast screening experience and took just under 2 h (105.8 min) to report all cases. Readers without a break reported greater levels of subjective fatigue (44% vs. 33%, p = 0.04), which related to greater objective fatigue: an increased average blink duration (296 ms vs. 286 ms, p < 0.001) and a reduced eye-opening velocity (76 mm/s vs. 82 mm/s, p < 0.001). Objective fatigue increased as the trial progressed for the no break cohort only (ps < 0.001). No difference was identified in diagnostic accuracy between the groups (accuracy: 87% vs. 87%, p = 0.92). CONCLUSIONS: Implementing a break during a 2-h DBT reporting session resulted in lower levels of subjective and objective fatigue. Breaks did not impact diagnostic accuracy, which may be related to the extensive experience of the readers. CLINICAL RELEVANCE STATEMENT: DBT is being incorporated into many mammography screening programmes. Recognising that reporting breaks are required when reading large volumes of DBT studies ensures this can be factored in when setting up reading sessions. TRIAL REGISTRATION: Clinical trials registration number: NCT03733106 KEY POINTS: • Use of digital breast tomosynthesis (DBT) in breast screening programmes can cause significant reader fatigue. • The effectiveness of incorporating reading breaks into DBT reporting sessions, to reduce mammography reader fatigue, was investigated using eye tracking. • Integrating breaks into DBT reporting sessions reduced reader fatigue; however, diagnostic accuracy was unaffected.

Social Representations and Symbolic Coping: A Cross-Cultural Discourse Analysis of the COVID-19 Pandemic in Newspapers.

This study used a framework grounded in social representations theory to investigate cross-cultural variation and consistency in the discursive construction of the COVID-19 pandemic by the mass media, in the week following WHO's declaration of a global pandemic in March 2020. News reports from media outlets in the United Kingdom and China were sourced, with articles from the most popular media sources selected for analysis. Four discourses were identified to be the most prominent representations present throughout these accounts: war; other illnesses; a general emergency; an unknown situation. The findings demonstrated consistency with past research, highlighting how the sociogenesis of social representations in the case of the COVID-19 pandemic followed a similar pattern to other novel infectious disease outbreaks. Consistency between UK and Chinese media accounts was identifiable throughout the construction of these discourses; however, variation was detectable regarding use of culturally relevant anchors for existing illness representations, along with Chinese media accounts constructing images of a comparatively optimistic local situation, whilst depicting the rest of the world as in the midst of a global emergency. Future research has the potential to build on these findings by going beyond media representations to explore actual lay population beliefs, attitudes, and opinions, considering how they compare to the representations portrayed in mass-mediated news reports.

MSG07: An International Cohort Study Comparing Epidemiology and Outcomes of Patients With Cryptococcus neoformans or Cryptococcus gattii Infections.

BACKGROUND: Cryptococcosis due to Cryptococcus neoformans and Cryptococcus gattii varies with geographic region, populations affected, disease manifestations, and severity of infection, which impact treatment. METHODS: We developed a retrospective cohort of patients diagnosed with culture-proven cryptococcosis during 1995-2013 from 5 centers in North America and Australia. We compared underlying diseases, clinical manifestations, treatment, and outcomes in patients with C. gattii or C. neoformans infection. RESULTS: A total of 709 patients (452 C. neoformans; 257 C. gattii) were identified. Mean age was 50.2 years; 61.4% were male; and 52.3% were white. Time to diagnosis was prolonged in C. gattii patients compared with C. neoformans (mean, 52.2 vs 36.0 days; P < .003), and there was a higher proportion of C. gattii patients without underlying disease (40.5% vs 10.2%; P < .0001). Overall, 59% had central nervous system (CNS) infection, with lung (42.5%) and blood (24.5%) being common sites. Pulmonary infection was more common in patients with C. gattii than in those with C. neoformans (60.7% vs 32.1%; P < .0001). CNS or blood infections were more common in C. neoformans-infected patients (P ≤ .0001 for both). Treatment of CNS disease with induction therapy of amphotericin B and flucytosine occurred in 76.4% of patients. Crude 12-month mortality was higher in patients with C. neoformans (28.4% vs 20.2%; odds ratio, 1.56 [95% confidence interval, 1.08-2.26]). CONCLUSIONS: This study emphasizes differences in species-specific epidemiology and outcomes of patients with cryptococcosis, including underlying diseases, site of infection, and mortality. Species identification in patients with cryptococcosis is necessary to discern epidemiologic patterns, guide treatment regimens, and predict clinical progression and outcomes.

Expert opinions on the regulation of plant genome editing.

Global food security is largely affected by factors such as environmental (e.g. drought, flooding), social (e.g. gender inequality), socio-economic (e.g. overpopulation, poverty) and health (e.g. diseases). In response, extensive public and private investment in agricultural research has focused on increasing yields of staple food crops and developing new traits for crop improvement. New breeding techniques pioneered by genome editing have gained substantial traction within the last decade, revolutionizing the plant breeding field. Both industry and academia have been investing and working to optimize the potentials of gene editing and to bring derived crops to market. The spectrum of cutting-edge genome editing tools along with their technical differences has led to a growing international regulatory, ethical and societal divide. This article is a summary of a multi-year survey project exploring how experts view the risks of new breeding techniques, including genome editing and their related regulatory requirements. Surveyed experts opine that emerging biotechnologies offer great promise to address social and climate challenges, yet they admit that the market growth of genome-edited crops will be limited by an ambiguous regulatory environment shaped by societal uncertainty.

Data challenges for future plant gene editing: expert opinion.

Agricultural data in its multiple forms are ubiquitous. With progress in crop and input monitoring systems and price reductions over the past decade, data are now being captured at an unprecedented rate. Once compiled, organized and analyzed, these data are capable of providing valuable insights into much of the agri-food supply chain. While much of the focus is on precision farming, agricultural data applications coupled with gene editing tools hold the potential to enhance crop performance and global food security. Yet, digitization of agriculture is a double-edged sword as it comes with inherent security and privacy quandaries. Infrastructure, policies, and practices to better harness the value of data are still lacking. This article reports expert opinions about the potential challenges regarding the use of data relevant to the development and approval of new crop traits as well as mechanisms employed to manage and protect data. While data could be of great value, issues of intellectual property and accessibility surround many of its forms. The key finding of this research is that surveyed experts optimistically report that by 2030, the synergy of computing power and genome editing could have profound effects on the global agri-food system, but that the European Union may not participate fully in this transformation.

Friendships in Pediatric Brain Tumor Survivors and Non-Central Nervous System Tumor Survivors.

OBJECTIVE: Brain tumors during childhood may disrupt the development and maintenance of friendships due to the impact of disease- and treatment-related factors on functioning. The goal of this study was to determine if children treated for either a brain tumor or a non-central nervous system (CNS) solid tumor could name a friend and to evaluate the social information processes associated with the ability to name a friend. METHOD: Youth (ages 7-14) treated for either a brain tumor (n = 47; mean age = 10.51 years) or a non-CNS solid tumor (n = 34; mean age = 11.29) completed an assessment within 6 months of the conclusion of treatment that included asking participants to name a friend and completing measures of social information processing (SIP). Rates of self-reported friendship were compared between groups and correlates of being able to name a friend were evaluated. RESULTS: Youth treated for a brain tumor (61.7%) were significantly less likely to name a friend compared with youth treated for a non-CNS solid tumor (85.3%). Diagnosis type (brain vs. non-CNS), relapse status, attribution style, and facial affect recognition were significant predictors of being able to name a friend or not in a logistic regression model. CONCLUSIONS: Youth treated for a brain tumor and those who experienced a disease relapse are at risk for impairments in friendships; difficulties with SIP may increase this risk. Targeted screening and intervention efforts for children diagnosed with brain tumors and those who have relapsed could address difficulties with peers.

Benefits of genome-edited crops: expert opinion.

Innovation in agriculture is pervasive. However, in spite of the success stories of twentieth century plant breeding, the twenty-first century has ushered in a set of challenges that solutions from the past century are unlikely to address. However, sustained research and the amalgamation of a number of disciplines has resulted in new breeding techniques (NBTs), such as genome editing, which offer the promise of new opportunities to resolve some of the issues. Here we present the results of an expert survey on the added potential benefits of genome-edited crops compared to those developed through genetic modification (GM) and conventional breeding. Overall, survey results reveal a consensus among experts on the enhanced agronomic performance and product quality of genome-edited crops over alternatives. The majority of experts indicated that the regulations for health and safety, followed by export markets, consumers, and the media play a major role in determining where and how NBTs, including genome editing, will be developed and used in agriculture. Further research is needed to gauge expert opinion after the Court of Justice of the European Union ruling establishing that site-specific mutagenic breeding technologies are to be regulated in the same fashion as GM crops, regardless of whether foreign DNA is present in the final variety.

Tumor bed proton irradiation in young children with localized medulloblastoma.

BACKGROUND: Radiotherapy is often deferred in very young children with medulloblastoma, in favor of more intense chemotherapy and stem cell rescue; however, posterior fossa radiation has been shown to improve overall survival (OS) and event-free survival compared with adjuvant chemotherapy alone. This study was performed to assess the OS, recurrence-free survival (RFS), patterns of failure, and clinical toxicity for children aged five and under who received focal proton radiation to the tumor bed alone. PROCEDURE: From 2010 to 2017, 14 patients with newly diagnosed medulloblastoma at one institution received tumor bed irradiation following surgery and chemotherapy. The median age of the patients was 40 months (range, 10.9-62.9 months). RESULTS: With a median follow-up of 54 months, four patients relapsed: three within the central nervous system (CNS) outside of the posterior fossa, and one within the tumor bed after subtotal resection. All relapses occurred within 28 months after the completion of radiation therapy. Five-year OS and RFS for this cohort of patients were 84% (95% CI, 48%-96%) and 70% (95% CI, 38%-88%), respectively. One patient experienced significant tumor regrowth soon after completion of radiation, autopsy showed viable tumor and necrosis near and within the brainstem, with relation to radiation unknown; however, no other acute clinical toxicities greater than grade 2 were observed in this group of patients. In the nine patients with available performance status follow-up, no significant changes in Lansky performance status were observed. CONCLUSIONS: Five-year OS and RFS following tumor bed irradiation in young children with medulloblastoma appear to be improved compared with other studies that forego the use of radiation therapy in this patient population. This approach should be further investigated in young children with medulloblastoma.

A prospective study of family predictors of health-related quality of life in pediatric brain tumor survivors.

BACKGROUND: The objective of this study was to examine prospectively the associations between family functioning at the end of tumor-directed treatment and the health-related quality of life (HRQL) of pediatric brain tumor survivors (PBTSs) approximately 9 months later. PROCEDURE: Thirty-five PBTS (age 6-16 years) and their mothers completed measures of family functioning and survivor HRQL within 5 months of completing tumor-directed therapy (baseline) and again approximately 9 months later (follow-up). RESULTS: Survivor-rated general family functioning at baseline significantly predicted mother proxy- and self-reported survivor HRQL at follow-up when controlling for survivor HRQL at baseline and relevant demographic and treatment-related variables. CONCLUSIONS: Family functioning is a key factor contributing to survivor HRQL and should be screened throughout the course of tumor-directed treatment. Psychosocial interventions directed toward improving general family functioning may improve survivor well-being following the completion of treatment.

Trends in discharges from the HIV/AIDS ward at a tertiary Canadian Hospital from 2005 to 2014.

Advances in HIV therapies have transformed HIV infection into a manageable chronic disease. Accordingly, hospital admission trends among people living with HIV may have evolved over time. This study describes discharge diagnoses from the dedicated HIV/AIDS ward at St. Paul's Hospital in Vancouver, Canada. A retrospective database review of admissions to the HIV/AIDS ward between 1 July 2005 and 30 June 2014 was conducted. Primary discharge diagnoses were manually categorized by condition and reviewed by two physicians. Data were analysed in 12-month intervals. Trends were fitted using generalized estimating equations. A total of 1595 individuals with 3919 admissions were included. The median age was 46 years, 77.1% identified as male, 63.6% had a history of injection drug use (IDU) and 61.8% had a history of hepatitis C virus exposure. The most common reasons for admission included non-opportunistic respiratory tract infections (18.2%), cellulitis (7.3%), gastroenteritis (6.0%), endocarditis/bacteremia (4.9%) and bone/joint infections (3.5%). The proportion of admissions attributable to opportunistic infections declined from 16.2% in 2005 to 5.5% in 2014. Over this period, the proportion of individuals on antiretroviral therapy and with virologic suppression increased (odds ratio 1.19 [95% confidence interval 1.16, 1.23] and 1.22 [95% confidence interval 1.17, 1.26], respectively). These results demonstrate a decline in admissions related to opportunistic infections but increased admissions due to other infections among people living with HIV. Preventive and outpatient care for respiratory infections and complications of IDU may further improve health care outcomes and decrease hospital admissions in this setting.

Regulatory T cell subsets in patients with medulloblastoma at diagnosis and during standard irradiation and chemotherapy (PBTC N-11).

BACKGROUND: We evaluated circulating levels of immunosuppressive regulatory T cells (Tregs) and other lymphocyte subsets in patients with newly diagnosed medulloblastoma (MBL) undergoing surgery compared to a control cohort of patients undergo craniectomy for correction of Chiari malformation (CM) and further determined the impact of standard irradiation and chemotherapy on this cell population. METHODS: Eligibility criteria for this biologic study included age 4-21 years, patients with CM undergoing craniectomy (as non-malignant surgical controls) and receiving dexamethasone for prevention of post-operative nausea, and those with newly diagnosed posterior fossa tumors (PFT) undergoing surgical resection and receiving dexamethasone as an anti-edema measure. Patients with confirmed MBL were also followed for longitudinal blood collection and analysis during radiotherapy and chemotherapy. RESULTS: A total of 54 subjects were enrolled on the study [22-CM, 18-MBL, and 14-PFT]. Absolute number and percentage Tregs (defined as CD4+CD25+FoxP3+CD127low/-) at baseline were decreased in MBL and PFT compared to CM [p = 0.0016 and 0.001, respectively). Patients with MBL and PFT had significantly reduced overall CD4+ T cell count (p = 0.0014 and 0.0054, respectively) compared to those with CM. Radiation and chemotherapy treatment in patients with MBL reduced overall lymphocyte counts; however, within the CD4+ T cell compartment, Tregs increased during treatment but gradually declined post therapy. CONCLUSIONS: Our results demonstrate that patients with MBL and PFT exhibit overall reduced CD4+ T cell counts at diagnosis but not an elevated proportion of Tregs. Standard treatment exacerbates lymphopenia in those with MBL while enriching for immunosuppressive Tregs over time.

Increasing Navigation Speed at Endoluminal CT Colonography Reduces Colonic Visualization and Polyp Identification.

Purpose To investigate the effect of increasing navigation speed on the visual search and decision making during polyp identification for computed tomography (CT) colonography Materials and Methods Institutional review board permission was obtained to use deidentified CT colonography data for this prospective reader study. After obtaining informed consent from the readers, 12 CT colonography fly-through examinations that depicted eight polyps were presented at four different fixed navigation speeds to 23 radiologists. Speeds ranged from 1 cm/sec to 4.5 cm/sec. Gaze position was tracked by using an infrared eye tracker, and readers indicated that they saw a polyp by clicking a mouse. Patterns of searching and decision making by speed were investigated graphically and by multilevel modeling. Results Readers identified polyps correctly in 56 of 77 (72.7%) of viewings at the slowest speed but in only 137 of 225 (60.9%) of viewings at the fastest speed (P = .004). They also identified fewer false-positive features at faster speeds (42 of 115; 36.5%) of videos at slowest speed, 89 of 345 (25.8%) at fastest, P = .02). Gaze location was highly concentrated toward the central quarter of the screen area at faster speeds (mean gaze points at slowest speed vs fastest speed, 86% vs 97%, respectively). Conclusion Faster navigation speed at endoluminal CT colonography led to progressive restriction of visual search patterns. Greater speed also reduced both true-positive and false-positive colorectal polyp identification. © RSNA, 2017 Online supplemental material is available for this article.

Carboplatin Rechallenge After Hypersensitivity Reactions in Pediatric Patients With Low-Grade Glioma.

BACKGROUND: The high prevalence of carboplatin hypersensitivity reactions (HSR) significantly affects the treatment of pediatric patients with low-grade glioma (LGG). Rechallenging patients is an option that must balance the risks of repeat allergic reaction to the benefits of retaining an effective anti-tumor regimen. PROCEDURE: We performed a retrospective review of children with LGG treated with carboplatin and vincristine between October 2000 and April 2013, who had a documented HSR to carboplatin. Patients were re-exposed to carboplatin using either precautionary measures (prolonged infusion time and premedication with H1 antagonists, H2 antagonists, and corticosteroids), a desensitization protocol, or both. RESULTS: We report the results of our institutional experience of carboplatin re-exposure using both premedication with a prolonged infusion time and a desensitization protocol. Overall, 40 of 55 (73%) patients were successfully rechallenged with carboplatin, including 19 of 25 (76%) patients who underwent desensitization. CONCLUSION: Our results demonstrate re-exposure to be a safe alternative to abandoning carboplatin for patients with a hypersensitivity reaction. We propose a clinical algorithm for treatment.

Image Size Influences Visual Search and Perception of Hemorrhages When Reading Cranial CT: An Eye-Tracking Study.

OBJECTIVE: The aim of this study was to explore reader gaze, performance, and preference during interpretation of cranial computed tomography (cCT) in stack mode at two different sizes. BACKGROUND: Digital display of medical images allows for the manipulation of many imaging factors, like image size, by the radiologists, yet it is often not known what display parameters better suit human perception. METHOD: Twenty-one radiologists provided informed consent to be eye tracked while reading 20 cCT cases. Half of these cases were presented at a size of 14 × 14 cm (512 × 512 pixels), half at 28 × 28 cm (1,024 × 1,024 pixels). Visual search, performance, and preference for the two image sizes were assessed. RESULTS: When reading small images, significantly fewer, but longer, fixations were observed, and these fixations covered significantly more slices. Time to first fixation of true positive findings was faster in small images, but dwell time on true findings was longer. Readers made more false positive decisions in small images, but no overall difference in either jackknife alternative free-response receiver operating characteristic or reading time was found. CONCLUSION: Overall performance is not affected by image size. However, small-stack-mode cCT images may better support the use of motion perception and acquiring an overview, whereas large-stack-mode cCT images seem better suited for detailed analyses. APPLICATION: Subjective and eye-tracking data suggest that image size influences how images are searched and that different search strategies might be beneficial under different circumstances.

Longitudinal clinical findings and outcome among patients with Cryptococcus gattii infection in British Columbia.

BACKGROUND: Cryptococcus gattii (Cg) infection emerged in British Columbia in 1999. A longitudinal, clinical description of patients has not been reported. METHODS: Medical records were reviewed for Cg patients identified through surveillance (1999-2007). Risk factors for Cg mortality were explored using multivariate Cox regression; longitudinal patterns in serum cryptococcal antigen (SCrAg) titers and the probability of chest cryptococcomas over time were estimated using cubic B-splines in mixed-effects regression models. RESULTS: Among 152 patients, 111 (73.0%) were culture confirmed. Isolated lung infection was present in 105 (69.1%) patients; 47 (30.9%) had central nervous system infection, with or without lung involvement. Malignancy was the provisional diagnosis in 64 (42.1%) patients. Underlying diseases were present in 91 (59.9%) patients; 23 (15.1%) were immunocompromised, and 23 (15.1%) had asymptomatic disease. There were only 2 (1.8%) culture positive relapses, both within 12 months of follow-up. The estimated median time to resolution of lung cryptococcomas and decline in SCrAg titer to <1:8 was 2.8 and 2.9 years, respectively. Cg-related and all-cause mortality among culture-confirmed cases at 12 months' follow-up was 23.3% and 27.2%, respectively. Cg-related mortality was associated with age >50 years (hazard ratio [HR], 15.6; 95% confidence interval [CI], 1.9-130.5) and immunocompromise (HR, 5.8; CI, 1.5-21.6). All Cg-related mortality occurred among culture-positive cases within 1 year of diagnosis. CONCLUSIONS: Cryptococcomas and serum antigenemia were slow to resolve. However, late onset of failed therapy or relapse was uncommon, suggesting that delayed resolution of these findings does not require prolongation of treatment beyond that recommended by guidelines.

Incomplete coexistence systems and international food trade impacts.

Trade disruptions have been both common and costly for the few GM crops that are produced and marketed. We use a range of adoption studies (compiled by Smyth et al. in Handbook on Agriculture, Biotechnology and Development, Edward Elgar Publishing Ltd, Cheltenham, 2014a), regulatory data and production and trade data to quantify the scale for low level presence incidents. To gain a full perspective on the potential scale of this problem in coming years, we use a combination of recent GM trait commercialization studies and corporate pipeline analysis to identify which traits are planned for which products and the countries in which the technology is likely to be commercialized. Their potential impact will be a result of the intended markets, the regulatory process (especially asynchronous decisions) and the scale and scope of trade in those products. Finally, the article examines the potential for some existing trade and industry institutions to manage the inherent risks of uncertain markets and market impacts.

An economic analysis of private incentives to adopt DNA barcoding technology for fish species authentication in Canada.

The increasing spate of species substitution and mislabelling in fish markets has become a concern to the public and a challenge to both the food industry and regulators. Species substitution and mislabelling within fish supply chains occurs because of price incentives to misrepresent products for economic gain. Emerging authenticity technologies, such as the DNA barcoding technology that has been used to identify plants and animal (particularly fish) species through DNA sequencing, offer a potential technological solution to this information problem. However, the adoption of these authenticity technologies depends also on economic factors. The present study uses economic welfare analysis to examine the effects of species substitution and mislabelling in fish markets, and examines the feasibility of the technology for a typical retail store in Canada. It is assumed that increased accuracy of the technology in detecting fraud and enforcement of legal penalties and other associated costs would be likely to discourage cheating. Empirical results suggest that DNA barcoding technology would be feasible presently for a typical retail store only if authentication is done in a third party laboratory, as it may not be feasible on an individual retail store level once fixed and other associated costs of the technology are considered.

The effect of computer-aided detection markers on visual search and reader performance during concurrent reading of CT colonography.

OBJECTIVE: We aimed to identify the effect of computer-aided detection (CAD) on visual search and performance in CT Colonography (CTC) of inexperienced and experienced readers. METHODS: Fifteen endoluminal CTC examinations were recorded, each with one polyp, and two videos were generated, one with and one without a CAD mark. Forty-two readers (17 experienced, 25 inexperienced) interpreted the videos during infrared visual search recording. CAD markers and polyps were treated as regions of interest in data processing. This multi-reader, multi-case study was analysed using multilevel modelling. RESULTS: CAD drew readers' attention to polyps faster, accelerating identification times: median 'time to first pursuit' was 0.48 s (IQR 0.27 to 0.87 s) with CAD, versus 0.58 s (IQR 0.35 to 1.06 s) without. For inexperienced readers, CAD also held visual attention for longer. All visual search metrics used to assess visual gaze behaviour demonstrated statistically significant differences when "with" and "without" CAD were compared. A significant increase in the number of correct polyp identifications across all readers was seen with CAD (74 % without CAD, 87 % with CAD; p < 0.001). CONCLUSIONS: CAD significantly alters visual search and polyp identification in readers viewing three-dimensional endoluminal CTC. For polyp and CAD marker pursuit times, CAD generally exerted a larger effect on inexperienced readers. KEY POINTS: • Visual gaze is attracted by computer-assisted detection (CAD) marks on polyps • Inexperienced readers' gaze is affected more by CAD than experienced readers. • CAD marks could mean that the unannotated endoluminal surface is relatively neglected. • Correct polyp identification is increased significantly by CAD.

Social competence in pediatric brain tumor survivors: application of a model from social neuroscience and developmental psychology.

Pediatric brain tumor (BT) survivors are at risk for psychosocial late effects across many domains of functioning, including neurocognitive and social. The literature on the social competence of pediatric BT survivors is still developing and future research is needed that integrates developmental and cognitive neuroscience research methodologies to identify predictors of survivor social adjustment and interventions to ameliorate problems. This review discusses the current literature on survivor social functioning through a model of social competence in childhood brain disorder and suggests future directions based on this model. Interventions pursuing change in survivor social adjustment should consider targeting social ecological factors.