The 2017 and 2022 ILAE epilepsy classification systems identify needs and opportunities in care: A paediatric hospital-based study.

OBJECTIVES: There is a paucity of studies reporting the epilepsy spectrum using the 2017 and 2022 ILAE classification systems in everyday clinical practice. To identify gaps and opportunities in care we evaluated a hospital-based cohort applying these epilepsy classification systems, including aetiology and co-morbidity, and the utility of molecular genetic diagnosis to identify available precision therapies. METHODS: Cross sectional retrospective study of all children with epilepsy (≤16 years) attending University Hospital Galway (2017-2022). Data collection and analysis of each case was standardised to ensure a systematic approach and application of the recent ILAE categorisation and terminology (2017 and 2022). Ethics approval was obtained. RESULTS: Among 356 children, epilepsy was classified as focal (46.1 %), generalised (38.8 %), combined (6.2 %), and unknown (9 %). Epilepsy syndrome was determined in 145/356 (40.7 %), comprising 24 different syndromes, most commonly SeLECTS (9 %), CAE (7 %), JAE (6.2 %) and IESS (5.9 %). New aetiology-specific syndromes were identified (e.g. CDKL5-DEE). Molecular diagnosis was confirmed in 19.9 % (n = 71) which encompassed monogenic (13.8 %) and chromosomopathy/CNV (6.2 %). There was an additional 35.7 % (n = 127) of patients who had a presumed genetic aetiology of epilepsy. Remaining aetiology included structural (18.8 %, n = 67), infectious (2 %, n = 7), metabolic (1.7 %, n = 6) and unknown (30.3 %, n = 108). Encephalopathy categorisation was determined in 182 patients (DE in 38.8 %; DEE in a further 11.8 %) associated with a range of co-morbidities categorised as global delay (29.2 %, n = 104), severe neurological impairment (16.3 %, n = 58), and ASD (14.6 %, n = 52). Molecular-based "precision therapy" was deemed available in 21/356 (5.9 %) patients, with "molecular precision" approach utilised in 13/356 (3.7 %), and some benefit noted in 6/356 (1.7 %) of overall cohort or 6/71 (8.5 %) of the molecular cohort. CONCLUSION: Applying the latest ILAE epilepsy classification systems allow comparison across settings and identifies a major neuro-developmental co-morbidity rate and a large genetic aetiology. We identified very few meaningful molecular-based disease modifying "precision therapies". There is a monumental gap between aetiological identification, and impact of meaningful therapies, thus the new 2017/2022 classification clearly identifies the major challenges in the provision of routine epilepsy care.

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States.

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

Examination of the role of adrenergic receptor stimulation in the sensitization of neuroinflammatory-based depressive-like behavior in isolated Guinea pig pups.

Early-life attachment disruption appears to sensitize neuroinflammatory signaling to increase later vulnerability for stress-related mental disorders, including depression. How stress initiates this process is unknown, but studies with adult rats and mice suggest sympathetic nervous system activation and/or cortisol elevations during the early stress are key. Guinea pig pups isolated from their mothers exhibit an initial active behavioral phase characterized by anxiety-like vocalizing. This is followed by inflammatory-dependent depressive-like behavior and fever that sensitize on repeated isolation. Using strategies that have been successful in adult studies, we assessed whether sympathetic nervous system activity and cortisol contributed to the sensitization process in guinea pig pups. In Experiment 1, the adrenergic agonist ephedrine (3 or 10 mg/kg), either alone or with cortisol (2.5 mg/kg), did not increase depressive-like behavior or fever during initial isolation the following day as might have been expected to if this stimulation was sufficient to account for the sensitization process. In Experiment 2, both depressive-like behavior and fever sensitized with repeated isolation, but beta-adrenergic receptor blockade with propranolol (10 or 20 mg/kg) did not affect either of these responses or their sensitization. The high dose of propranolol did, however, reduce vocalizing. These results suggest sympathetic nervous system activation is neither necessary nor sufficient to induce the presumptive neuroinflammatory signaling underlying sensitization of depressive-like behavioral or febrile responses in developing guinea pigs. Thus, processes mediating sensitization of neuroinflammatory-based depressive-like behavior following early-life attachment disruption in this model appear to differ from those previously found to underlie neuroinflammatory priming in adults.

Athletes Drink Gatorade: DMA Advertising Expenditures, Ad Recall, and Athletic Identity Influence Energy and Sports Drink Consumption.

Understanding why sports and energy drinks remain increasingly popular among adolescents despite declines in other sugar sweetened beverages is critical. This study points to memory for advertising exposure and adolescent athletic identity as two aspects that together help to explain consumption. An online survey of U.S. adolescents aged 14-18 (n = 503) was combined with Nielsen data for television and social media advertising expenditures by sports and energy drink brands in participants' designated market areas (DMAs). Advertisement recall mediates the relationship between social media DMA expenditures and sports and energy drink consumption. Recall for television advertisements is related to consumption but is unrelated to television DMA expenditures. Athletic identity moderated the relationship between recall and consumption such that consumption increased as both recall and athletic identity increased, suggesting a role for motivated memory and motivated processing of ad messages based on athletic identity consistent with the limited capacity model of motivated media message processing. Based on these results, we conclude that effectiveness of expenditures in influencing behavior is dependent upon both ad recall and ad relevance, and that athletic identity is an important factor in ad effectiveness in the context of sports and energy drinks advertising.

How intention to join an Alzheimer's participant recruitment registry differs by race, ethnicity, sex, and family history: Results from a national survey of US adults.

INTRODUCTION: Alzheimer's-focused participant recruitment registries are tools for accelerating enrollment into studies, however, registry members are primarily White women. METHODS: We conducted a national online survey of 1501 adults ages 50-80, oversampling for Black and Hispanic/Latino respondents, assessing intention to join a generic "brain health" registry and to join a registry that required specific tasks. RESULTS: Intention to join a registry was low (M 3.48, SD 1.77), and lower than intention to join a registry requiring specific tasks. Intention was greatest for registries requiring completing surveys (M 4.70, SD 1.77). Differences in intention were primarily between White women and Black women; differences between other groups were limited to specific tasks required. DISCUSSION: The results indicate uncertainty about what a registry is, its purpose, and/or the concept of "brain health." Using the Reasoned Action Approach (RAA) to develop evidence-based outreach messages describing a registry and required tasks may increase diversity.

Psychosocial Determinants of COVID-19 Vaccination Intention Among White, Black, and Hispanic Adults in the US.

BACKGROUND: COVID-19 vaccine uptake is an urgent public health priority. PURPOSE: To identify psychosocial determinants (attitudes, normative pressure, and perceived behavioral control) of COVID-19 vaccination intentions for U.S. White, Black, and Hispanic adults, and how COVID-19 misperceptions, beliefs about the value of science, and perceived media bias relate to these determinants. METHODS: Longitudinal online survey using two national samples (18-49 years old/50 years and older), each stratified by racial/ethnic group (n = 3,190). Data were collected in October/November 2020 and were weighted by race group to be representative. RESULTS: Path analyses showed that more positive attitudes about getting vaccinated predict intention across age and racial/ethnic groups, but normative pressure is relevant among older adults only. Belief in the value of science was positively associated with most determinants across all groups, however the association of COVID-19 misperceptions and perceived media bias with the determinants varied by age group. CONCLUSIONS: Messages that emphasize attitudes toward vaccination can be targeted to all age and racial/ethnic groups, and positive attitudes are universally related to a belief in the value of science. The varying role of normative pressure poses messages design challenges to increase vaccination acceptance.

A content analysis of sports and energy drink advertising.

This study identifies constructs from key persuasion theories that are present in popular sports and energy drink advertising. A theory-driven content analysis was conducted on 315 popular television and social media sports and energy drink advertisements from top selling brands. The advertisements were analyzed for the presence of persuasive cues as per the Elaboration Likelihood Model (e.g, onscreen consumption, presence of celebrities) as well as Reasoned Action behavioral expectancies and normative beliefs Approach related to consumption. Descriptive statistics were calculated. Differences between sports and energy drinks were assessed and reliability statistics for all codes were calculated. Advertisements relied on peripheral cues like sports and celebrities that were not related to the drinks themselves. Theory-relevant beliefs about improved athletic performance and consumption of the drinks onscreen were common. Sports drinks were more likely to focus on mainstream sports; energy drinks featured extreme sports, and energy drink advertisements promoted the drinks for use beyond sports (e.g., work settings). The cues and beliefs identified in these ads help to clarify the role of advertising in beliefs about sports drinks being healthy and energy drinks being helpful to achieve goals. Future research is needed that links exposure to coded advertisement features to adolescents' beliefs about sports and energy drinks.

Sensitization of depressive-like behavior is attenuated by disruption of prostaglandin synthesis days following brief early attachment-figure isolation.

Childhood psychological trauma appears to sensitize stress-related neuroinflammatory systems to increase later vulnerability for depression and other stress-related mental disorders. Isolation of guinea pig pups from the maternal attachment figure for 3 h in threatening surroundings leads to a sensitization of inflammatory-mediated, depressive-like behavior and fever during later isolations. A previous study found the non-selective COX inhibitor naproxen administered before the initial isolation moderated depressive-like behavior and its sensitization. Here, we examined effects of naproxen given following early isolation. Male and female guinea pig pups surgically implanted with telemetry devices to measure core temperature were isolated for 3 h on 2 consecutive days near weaning (first isolation Day 20-24). Several days later, they began 4 consecutive days of injection with either saline vehicle or 10 or 20 mg/kg naproxen prior to a third isolation in early adolescence, that is, 10 days after their first isolation. Across the first two isolations, depressive-like behavior and fever sensitized. Both doses of naproxen attenuated depressive-like behavior during the third isolation. Fever was unaffected. Results suggest prostaglandin mediation of sensitization of depressive-like behavioral, but not febrile, responses to subsequent isolation. Findings also support further study of anti-inflammatory treatments to mitigate lasting consequences of early-attachment disruption.

Quantification of Ion-Implanted Single-Atom Dopants in Monolayer MoS2 via HAADF STEM Using the TEMUL Toolkit.

In recent years, atomic resolution imaging of two-dimensional (2D) materials using scanning transmission electron microscopy (STEM) has become routine. Individual dopant atoms in 2D materials can be located and identified using their contrast in annular dark-field (ADF) STEM. However, in order to understand the effect of these dopant atoms on the host material, there is now the need to locate and quantify them on a larger scale. In this work, we analyze STEM images of MoS2 monolayers that have been ion-implanted with chromium at ultra-low energies. We use functions from the open-source TEMUL Toolkit to create and refine an atomic model of an experimental image based on the positions and intensities of the atomic columns in the image. We then use the refined model to determine the likely composition of each atomic site. Surface contamination stemming from the sample preparation of 2D materials can prevent accurate quantitative identification of individual atoms. We disregard atomic sites from regions of the image with hydrocarbon surface contamination to demonstrate that images acquired using contaminated samples can give significant atom statistics from their clean regions, and can be used to calculate the retention rate of the implanted ions within the host lattice. We find that some of the implanted chromium ions have been successfully integrated into the MoS2 lattice, with 4.1% of molybdenum atoms in the transition metal sublattice replaced with chromium.

TopoTEM: A Python Package for Quantifying and Visualizing Scanning Transmission Electron Microscopy Data of Polar Topologies.

The exotic internal structure of polar topologies in multiferroic materials offers a rich landscape for materials science research. As the spatial scale of these entities is often subatomic in nature, aberration-corrected transmission electron microscopy (TEM) is the ideal characterization technique. Software to quantify and visualize the slight shifts in atomic placement within unit cells is of paramount importance due to the now routine acquisition of images at such resolution. In the previous ~decade since the commercialization of aberration-corrected TEM, many research groups have written their own code to visualize these polar entities. More recently, open-access Python packages have been developed for the purpose of TEM atomic position quantification. Building on these packages, we introduce the TEMUL Toolkit: a Python package for analysis and visualization of atomic resolution images. Here, we focus specifically on the TopoTEM module of the toolkit where we show an easy to follow, streamlined version of calculating the atomic displacements relative to the surrounding lattice and thus plotting polarization. We hope this toolkit will benefit the rapidly expanding field of topology-based nano-electronic and quantum materials research, and we invite the electron microscopy community to contribute to this open-access project.

The Mediating Role of Family and Cultural Food Beliefs on the Relationship between Family Communication Patterns and Diet and Health Issues across Racial/Ethnic Groups.

Consumption of red meat has been linked to a variety of health issues, yet Americans are resistant to reducing their meat consumption. Family communication environments shape beliefs about food and meat consumption, and therefore are locations for potential interventions to change the way people think about food. Families are embedded in cultures, and both family and cultural norms shape beliefs about what people should eat. This study (N = 773) is interested in understanding how family communication is associated with food beliefs, meat consumption, and health issues across three racial/ethnic groups: Black/African American (n = 256), Hispanic (n = 260), non-Hispanic White (n = 257). Structural equation modeling results showed that conversation orientation was consistently associated with stronger endorsement of family cultural food beliefs across race/ethnicity groups. Family food beliefs were associated with either more health issues or more meat consumption depending on race/ethnicity and mediated the association between conversation orientation and health issues/meat consumption. Conversation orientation moderated the association between conformity orientation and food beliefs for Hispanic and non-Hispanic White participants. Implications for family communication patterns theory and health scholars are discussed along with recommendations for culturally tailored family-focused health interventions.

Presence of mother prompts dissociation of sickness behavior, fever, and hypothalamic gene expression in lipopolysaccharide-injected guinea pig pups.

During infection, sickness behaviors, such as a hunched stance with piloerection, can facilitate host resistance by supporting the generation and maintenance of fever. Fever, in turn, is mediated by hypothalamic neuroimmune signaling. Sickness behaviors, however, can also be influenced by social stimuli. In this study, guinea pig pups were injected with lipopolysaccharide to simulate a bacterial infection and then exposed to a novel, threatening environment while either with their mother or alone. We found that the presence of the mother suppressed sickness behavior, but enhanced fever, and had no measureable effect on gene expression of hypothalamic mediators of fever. This 3-way dissociation induced by the mother's presence is interpreted in terms of the differential adaptive consequences of behavioral and febrile responses for pups in this situation. The results contribute to a growing literature linking immunological and social processes.

#digital hood: Engagement with Risk Content on Social Media among Black and Hispanic Youth.

The digital neighborhood is the amalgamation of the spaces online where youth connect with others. Just as Black and Hispanic youth live in neighborhoods that influence their health, they are also influenced by online digital neighborhoods. Youth are exposed to social media content featuring substance use, sexual risk, and violence, yet little is known about the extent to which youth engage with such content. Using a modified venue sampling strategy, we administered CASI surveys to 145 Black and Hispanic youth aged 13-24 living in low-income urban neighborhoods. Across social media platforms, respondents reported high levels of exposure to sexual, alcohol, drug, and violence-related content (65-84%). Users reported lower levels of engagement with risk-related content (on an engagement continuum), ranging from passive exposure to dissemination. While negative risks may be amplified in the digital neighborhood, youth appear to strategically limit their engagement with that content. However, because risk behavior messaging is common in these digital neighborhoods, these spaces provide opportunities for health promotion interventions.

Anterior Chamber Angle Evaluation Using Gonioscopy: Consistency and Agreement between Optometrists and Ophthalmologists.

SIGNIFICANCE: In our intermediate-tier glaucoma care clinic, we demonstrate fair to moderate agreement in gonioscopy examination between optometrists and ophthalmologists, but excellent agreement when considering open versus closed angles. We highlight the need for increased consistency in the evaluation and recording of angle status using gonioscopy. PURPOSE: The consistency of gonioscopy results obtained by different clinicians is not known but is important in moving toward practice modalities such as telemedicine and collaborative care clinics. The purpose of this study was to evaluate the description and concordance of gonioscopy results among different practitioners. METHODS: The medical records of 101 patients seen within a collaborative care glaucoma clinic who had undergone gonioscopic assessment by two clinicians (one optometrist and either one general ophthalmologist [n = 50] or one glaucoma specialist [n = 51]) were reviewed. The gonioscopy records were evaluated for their descriptions of deepest structure seen, trabecular pigmentation, iris configuration, and other features. These were compared between clinicians (optometrist vs. ophthalmologist) and against the final diagnosis. RESULTS: Overall, 51.9 and 59.8% of angles were graded identically in terms of deepest visible structure when comparing between optometrist versus general ophthalmologist and optometrist versus glaucoma specialist, respectively. The concordance increased when considering ±1 of the grade (67.4 and 78.5%, respectively), and agreement with the final diagnosis was high (>90%). Variations in angle grading other than naming structures were observed (2.0, 30, and 3.9% for optometrist, general ophthalmologist, and glaucoma specialist, respectively). Most of the time, trabecular pigmentation or iris configuration was not described. CONCLUSIONS: Fair to moderate concordance in gonioscopy was achieved between optometrists and ophthalmologists in a collaborative care clinic in which there is consistent feedback and clinical review. To move toward unified medical records and a telemedicine model, improved consistency of record keeping and angle description is required.

Sensation Seeking and Impulsivity Can Increase Exposure to Risky Media and Moderate Its Effects on Adolescent Risk Behaviors.

Media exposure to risky behaviors (e.g., alcohol use, violence) has been associated with adolescent engagement in risk-taking behaviors, but not all adolescents are equally at risk. Here we focus on individual differences in impulsivity and sensation seeking and assess their effects on the relation between media risk exposure and adolescent risk behavior. Survey data from 1990 Black and White US adolescents (mean age = 15.6 ± 1.10 years; 48% female) and content analysis of top-grossing films and popular TV shows were analyzed using linear regression models. High levels of impulsivity and sensation seeking were associated with greater exposure to risky media content, and also operated as moderators, exacerbating the impact of media risk exposure on adolescent risk behaviors. Prevention efforts targeting negative effects of media on adolescent health should prioritize youth with high levels of impulsivity and sensation seeking.

Media violence exposure and aggression in adolescents: A risk and resilience perspective.

Media violence exposure (MVE) is associated with aggressive outcomes in adolescents. However, based on the differential susceptibility hypothesis, this risk is expected to vary based on the individual's unique risk and protective factors. Using survey data from 1,990 adolescents (Mean age = 15.6 ± 1.10 years; 48% female) and content analysis of U.S. top-grossing films and popular TV shows, we evaluated the effect of MVE in relation to both risk (i.e., family conflict, impulsivity, sensation seeking) and protective factors (i.e., parental monitoring, parental involvement, parental mediation). Relative weights analyses revealed that MVE was one of the strongest predictors of aggression, after impulsivity and family conflict. The cumulative risk score showed a linear and quadratic relation with the likelihood of aggression, with MVE and family conflict having an interactive relation in predicting aggression. Parental monitoring remained a significant protective factor even when all risk factors were accounted for. Targeted preventive interventions that reduce family conflict, promote parental monitoring, and reduce exposure to violent media may be effective in reducing aggressive tendencies and related negative outcomes.

Adolescent Perceptions of Black-Oriented Media: "The Day Beyoncé Turned Black".

Black-oriented media, content with predominately Black casts and/or racial themes, is marketed primarily toward Black audiences. However, how audiences perceive such targeting is unclear. To investigate this, Black and White adolescents (n=1,990) identified the perceived target audiences of 15 movies (12 Black-oriented). Results from Item Response Theory and multiple regression suggest that Black adolescents, especially those with strong ethnic identity, differentiate Black-oriented from mainstream movies. Black adolescents report higher exposure to Black-oriented films, particularly if they perceive such films as targeted to Black audiences. White adolescents find it more difficult to identify Black-oriented films. This suggests that Black-oriented films might be successfully marketed beyond Black audiences. MANAGEMENT SLANT: Black adolescent audiences perceive Black-oriented media to be targeted toward them, especially those who have strong ethnic identity.White adolescent audiences generally perceive Black-oriented media to be targeted toward anyone.Black-oriented content may find greater mainstream marketing success if advertisers target both Black and White audiences.

Adult males buffer the cortisol response of young guinea pigs: Changes with age, mediation by behavior, and comparison with prefrontal activity.

In the guinea pig, the presence of the mother buffers hypothalamic-pituitary-adrenal (HPA) responses of her young during exposure to a novel environment, and can do so even if she is anesthetized. In contrast, under comparable conditions other conspecifics (siblings, other adult females) are less effective or ineffective in doing so. However, we recently observed that an unfamiliar adult male reduced plasma cortisol elevations and increased Fos in the prefrontal cortex of preweaning pups exposed to a novel enclosure for 120min. Here we found adult males buffered the adrenocortical response of preweaning pups at 60 as well as 120min and of periadolescent guinea pigs if exposure was of 120min. Further, because males vigorously engaged in social interactions with the young during exposure, we examined the effect of behavior by comparing the impact of conscious and unconscious (anesthetized) adult males. When tested with a conscious but not unconscious male, pups exhibited reduced plasma cortisol elevations. Pups, particularly females, had greater Fos induction in the prefrontal cortex when with a conscious versus unconscious adult male. Overall, we found that an unfamiliar adult male can buffer the cortisol response of guinea pigs both before and after weaning, though more-prolonged exposure appears necessary in the older animals. Further, unlike buffering by the biological mother, the effect of the male is mediated by behavioral interactions. Thus, the buffering of the infant guinea pig's cortisol response by the mother and an unfamiliar adult male involve different underlying mechanisms.

The adaptive shaping of social behavioural phenotypes during adolescence.

Developmental behavioural plasticity is a process by which organisms can alter development of their behavioural phenotype to be better adapted to the environment encountered later in life. This 'shaping' process depends on the presence of reliable cues by which predictions can be made. It is now established that cues detected by the mother can be used (primarily via hormones prenatally and maternal behaviour in the early postnatal stage) to shape the behavioural phenotype of her offspring. However, it is becoming increasingly clear that adolescence is another period in which conditions are well-suited for such shaping to occur. We review here how mammalian social behaviour may be shaped in adolescence. We identify limited extant examples, briefly discuss underlying mechanisms, and provide evidence that observed changes are indeed adaptive. We contend that while plasticity diminishes with age, the shaping of the behavioural phenotype in adolescence offers several advantages, including that adolescence is closer to the onset of mating than are earlier phases of life; that unlike earlier phases, information is obtained directly from the environment rather than mediated by the mother; and unlike later in adulthood, there is substantial underlying neural plasticity associated with development to support behavioural change. We also consider conditions that favour the occurrence of social behaviour plasticity during adolescence, including a high degree of sociality and a prolonged developmental period and the implication of these conditions for the occurrence of sex differences in the shaping process.

Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness.

The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology. TRIAL REGISTRATION: clinicaltrials.gov 29 identifier NCT00264823.