In vivo disentanglement of diffusion frequency-dependence, tensor shape, and relaxation using multidimensional MRI.

Diffusion MRI with free gradient waveforms, combined with simultaneous relaxation encoding, referred to as multidimensional MRI (MD-MRI), offers microstructural specificity in complex biological tissue. This approach delivers intravoxel information about the microstructure, local chemical composition, and importantly, how these properties are coupled within heterogeneous tissue containing multiple microenvironments. Recent theoretical advances incorporated diffusion time dependency and integrated MD-MRI with concepts from oscillating gradients. This framework probes the diffusion frequency, ω $$ \omega $$ , in addition to the diffusion tensor, D $$ \mathbf{D} $$ , and relaxation, R 1 $$ {R}_1 $$ , R 2 $$ {R}_2 $$ , correlations. A D ω - R 1 - R 2 $$ \mathbf{D}\left(\omega \right)-{R}_1-{R}_2 $$ clinical imaging protocol was then introduced, with limited brain coverage and 3 mm3 voxel size, which hinder brain segmentation and future cohort studies. In this study, we introduce an efficient, sparse in vivo MD-MRI acquisition protocol providing whole brain coverage at 2 mm3 voxel size. We demonstrate its feasibility and robustness using a well-defined phantom and repeated scans of five healthy individuals. Additionally, we test different denoising strategies to address the sparse nature of this protocol, and show that efficient MD-MRI encoding design demands a nuanced denoising approach. The MD-MRI framework provides rich information that allows resolving the diffusion frequency dependence into intravoxel components based on their D ω - R 1 - R 2 $$ \mathbf{D}\left(\omega \right)-{R}_1-{R}_2 $$ distribution, enabling the creation of microstructure-specific maps in the human brain. Our results encourage the broader adoption and use of this new imaging approach for characterizing healthy and pathological tissues.

Trans-sacral interbody fixation in long fusions to the sacrum for adult spinal deformity: complications and fusion rates at minimum two years follow-up.

PURPOSE: This study aims to investigate the fusion rate and complications associated with trans-sacral interbody fusion (TSIF) in long fusions to the sacrum for adult spinal deformity (ASD) over a two year follow-up period. Potential predictor variables associated with pseudarthrosis were also examined. METHODS: A retrospective clinical review was conducted on a consecutive series of ASD patients who underwent long fusions to the sacrum, with TSIF performed as a same-day or staged procedure. Patient demographics, bone mineral density, operative details, perioperative and late complications, and fusion rates were reviewed. Univariate analysis was used to identify the risk factors associated with pseudarthrosis. RESULTS: The study included 43 patients with an average age of 55.3 ± 8.9 years. The perioperative complication rate was 28%, with 12% of the complications directly related to TSIF. The late complication rate was 33%, with 16% related to TSIF. The most common complications were pseudarthrosis (14%) and postoperative ileus (7%). The overall radiographic fusion rate at two years was 86%. Univariate analysis revealed that revision surgery was significantly associated with pseudarthrosis (p = 0.027). Over the follow-up period, patients who underwent TSIF during long posterior fusions to the sacrum showed improvement in overall SRS scores, ODI scores, and SF-36 physical health and mental health (p < 0.05). CONCLUSION: TSIF is a relatively safe and minimally invasive method for achieving interbody fusion at the lumbosacral junction in the treatment of ASD, with acceptable fusion rates and a low complication rate. However, TSIF is not recommended for revision reconstruction in ASD.

Laterality Hotspots in the Striatum.

Striatal loci are connected to both the ipsilateral and contralateral frontal cortex. Normative quantitation of the dissimilarity between striatal loci's hemispheric connection profiles and its spatial variance across the striatum, and assessment of how interindividual differences relate to function, stands to further the understanding of the role of corticostriatal circuits in lateralized functions and the role of abnormal corticostriatal laterality in neurodevelopmental and other neuropsychiatric disorders. A resting-state functional connectivity fingerprinting approach (n = 261) identified "laterality hotspots"-loci whose profiles of connectivity with ipsilateral and contralateral frontal cortex were disproportionately dissimilar-in the right rostral ventral putamen, left rostral central caudate, and bilateral caudal ventral caudate. Findings were replicated in an independent sample and were robust to both preprocessing choices and the choice of cortical atlas used for parcellation definitions. Across subjects, greater rightward connectional laterality at the right ventral putamen hotspot and greater leftward connectional laterality at the left rostral caudate hotspot were associated with higher performance on tasks engaging lateralized functions (i.e., response inhibition and language, respectively). In sum, we find robust and reproducible evidence for striatal loci with disproportionately lateralized connectivity profiles where interindividual differences in laterality magnitude are associated with behavioral capacities on lateralized functions.

[Patient Factors in Offender Treatment: Personality, Therapy Motivation and Outcome]. / Patientenfaktoren in der Behandlung von Straftätern: Persönlichkeit, Therapiemotivation und Outcome.

Using a systematic literature review according to the PRISMA criteria, patient factors of offenders were related to forensic outcomes. Searches were conducted in the PsycInfo and PSYNDEX databases; further relevant studies were taken from the bibliographies of studies that met the selection criteria. Only quantitative empirical studies for the period 1990-2021 were included. Findings from 31 studies on patient factors (personality, therapy motivation, therapy expectation, satisfaction with therapy) are reported. Patient factors could not always be consistently associated with outcomes. The clearest correlations were found between the expression of anti- or dissocial personality traits and/or psychopathy and (negative) therapy outcomes. Traits usually associated with antisocial developments (impulsivity, anger, rage, hostility) in some cases also correlated negatively with therapeutically desirable outcomes. Patient motivation for therapy should generally have a positive impact on the likelihood of successful forensic therapies, but not all relevant studies pointed in this direction. No studies were identified on the relationships between therapy expectancy or satisfaction and outcome. Based on general psychotherapy research, we suggest that offender therapy could benefit from broader approaches to studying therapy effectiveness.

External locus of control and cognitive ability independently distinguish men in prison from community living non-offending men.

BACKGROUND: The ability to cope with failure and subsequent feedback is crucial for prisoner rehabilitation. Impaired executive function in prisoners, high trait aggression and external locus of control can undermine the capacity to react to feedback in socially adaptive ways. AIM: To investigate the relationships between aggression, locus of control, and attribution in an experimental task involving feedback about failure and success. METHODS: Two groups were compared: 1. Imprisoned men, 2. Community living men without a history of incarceration. Aggression, locus of control and reasoning ability were assessed by means of psychometric instruments. An experimental task building on cognitive ability and providing performance-related feedback was carried out. Attributions of failure and success were measured using an ad hoc rating scale. RESULTS: Prisoners reported higher levels of aggression and generalised externality, but poorer reasoning ability than the comparison group. Aggression was associated with external locus of control. In the experimental task, the community group showed higher success rates; higher scores on the task were correlated with less external attribution of own performance. Higher external locus of control and lower reasoning ability were independently associated with being a prisoner in a logistic regression model. CONCLUSIONS AND IMPLICATIONS: Men in prison were characterised by greater social and fatalistic externality paired with lower reasoning ability than never incarcerated community men. In-prison rehabilitation strategies should pay early attention to improving reasoning ability and enabling men to recognise likely overuse of externally attributing their difficulties to fate, then helping them to become more realistic in their attributions and make use of realistic feedback.

[Therapeutic Factors in Offender Treatment: A Systematic Review]. / Therapeutische Wirkfaktoren in der Behandlung von Straftätern: ein systematisches Literaturreview.

This paper presents a systematic literature review of international research on therapeutic factors in offender treatment. The review was based on the PRISMA criteria; PsycINFO and PSYNDEX as well as references given in included studies were browsed. Only quantitative empirical studies published between 1990 and 2018 were included. In this paper, evidence for common factors (therapeutic alliance, social climate, feedback) and therapist factors (interpersonal skills/characteristics, personality, therapy expectations) from 19 journal articles are reported. Some tendencies emerged, but there was no conclusive evidence on the effect of common factors and therapist factors on the therapy outcome. This non-conclusive evidence is mostly due to the methodological shortcomings of primary studies, heterogeneity of outcome variables and the low number of studies that looked at each of these variables. In sum, there is not enough evidence to date to show a strong relationship between common factors and therapist factors and a (positive) outcome in the treatment of offenders.

Implementation of targeted screening for lung cancer in a high-risk population within routine NHS practice using low-dose computed tomography.

We report a primary care-based lung cancer targeted screening programme using low-dose CT (LDCT) in South Tyneside and Sunderland. Ever smokers with ≥10 pack-years aged 55-74 years were identified at annual COPD review. 925 individuals attended for LDCT. 2% (n=19/925) had lung cancer diagnosed. 66.7% (n=14/21) had early stage disease and 78.9% (n=15/19) were offered treatment with curative intent. 79.3% of individuals attending for LDCT were ranked in the lowest deprivation quintiles. This approach has been successfully established in routine NHS practice; it is effective with improvements in stage of disease and engages individuals in deprived areas.

Rising inpatient numbers in forensic security hospitals of German federal state of Baden-Württemberg: Background and explanatory approaches.

In this article, we describe critical epidemiological trends in forensic psychiatric care in the German federal state of Baden-Württemberg. For some years, there has been a marked increase in the number of patients with psychoses and with a migration background in the high-security hospitals of Baden-Württemberg. We present a number of studies exploring hypotheses as to why this is the case. Taking into account a set of person-related and non-person (forensic system)-related variables, we suggest that rising treatment figures may be understood in terms of system variables rather than individual patient characteristics. Findings regarding predictors of treatment length and legal outcome, as well as characteristics of migrant patients and patients assigned to forensic aftercare, are discussed.

Budgeting for Results.

Budgeting is a mandatory yet misunderstood function in most organizations because of its current focus on estimating revenues and expenses. A budget should be a roadmap specifying in dollars and cents organizational goals and how management performance will be assessed. Like a roadmap, its value is entirely dependent on whether the plan is followed. Improving treatment and controlling costs require implementing budgets that focus managers' attention on the elements of production systems that they control and lead directly to better results. The choice between using an incremental, flexible, zero-base, program, or activity-based budget to chart the desired path of departments and organizations should be made in light of organizational goals and the role of the manager within the organization.

Evidence of subgroups in smokers as revealed in clinical measures and evaluated by neuroimaging data: a preliminary study.

To date, fractionation of the nicotine addiction phenotype has been limited to that based primarily on characteristics of cigarette use, although it is widely appreciated that a variety of individual factors are associated with tobacco use disorder. Identifying subtypes of tobacco use disorder based on such factors may lead to better understanding of potential treatment targets, individualize treatments and improve outcomes. In this preliminary study, to identify potential subgroups, we applied hierarchical clustering to a broad range of assessments measuring personality, IQ and psychiatric symptoms, as well as various environmental and experiential characteristics from 102 otherwise healthy cigarette smokers. The identified subgroups were further compared on various resting-state fMRI measures from a subset (N = 65) of individuals who also underwent resting-state fMRI scanning. The clustering dendrogram indicated that smokers can be divided into three subgroups. Each subgroup had unique clinical assessment characteristics. The division yielded imaging differences between subgroups in the supplementary motor area/middle cingulate cortex and the cuneus. Regression analyses showed that amplitude of low frequency fluctuations in the supplementary motor area/middle cingulate cortex differed between groups and were negatively correlated with the Toronto Alexithymia Scale subscale Difficulty Describing Feelings.

Aggression, attributional style, and locus of control among imprisoned migrants from the former Soviet Union.

BACKGROUND: In the 1990s, over two million migrants from the former Soviet Union with German ancestry came to Germany, a small number of whom committed offences. AIM: The aim of this study is to investigate aggression, locus of control, and attributional style in these (male) migrants imprisoned in Germany. METHODS: Three groups of men with German ancestry were compared: 1.36 prisoners migrating into Germany from the former Soviet Union (migrant-P), 2.31 migrating into Germany from the former Soviet Union without a history of offending (community sample; C), and 3.40 German prisoners with no migration experience (native-P). RESULTS: Aggression was high among all prisoners relative to nonoffending migrants. Prisoners tended to be under-achievers educationally compared with community living migrants. Imprisoned migrants had scores on locus of control and on attribution scales of feeling more influenced by fate and other external factors than had the community migrants, but in a regression model with aggression as the dependent variable and locus of control and attributional style measures as the independent variables, only external attributional style with respect to failure was significantly related to aggression. IMPLICATIONS: External attributional style appears to be linked to the probability of aggressive behaviours, leading to unlawful acts and imprisonment. Regardless of whether a person has a migration history or not, as attribution of failure among these relatively low-achieving prisoners was associated with aggression, loosening these attributional tendencies in therapy might help to reduce aggression. Migration per se was not problematic in these respects in this sample.

Distress tolerance among substance users is associated with functional connectivity between prefrontal regions during a distress tolerance task.

Distress tolerance (DT), defined as the ability to persist in goal directed behavior while experiencing affective distress, is implicated in the development and maintenance of substance use disorders. While theory and evidence indicate that cortico-limbic neural dysfunction may account for deficits in goal directed behavior while experiencing distress, the neurobiological mechanisms of DT have yet to be examined. We modified a computerized DT task for use in functional magnetic resonance imaging (fMRI), the Paced Auditory Serial Addition Task (PASAT-M), and examined the neural correlates and functional connectivity of DT among a cohort of substance users (n = 21; regular cocaine and nicotine users) and healthy controls (n = 25). In response to distress during the PASAT-M, we found greater activation in a priori cortico-limbic network ROIs, namely the right insula, anterior cingulate cortex (ACC), bilateral medial frontal gyrus (MFG), right inferior frontal gyrus (IFG) and right ventromedial prefrontal cortex (vmPFC) significantly predicted higher DT among substance users, but not healthy controls. In addition, greater task-specific functional connectivity during distress between the right MFG and bilateral vmPFC/sgACC was associated with higher DT among substance users, but not healthy controls. The observed positive relationship between DT and neural activation in cortico-limbic structures, as well as functional connectivity between the rMFG and vmPFC/sgACC, is in line with theory and research suggesting the importance of these structures for persisting in goal directed behavior while experiencing affective distress.

Multivariate classification of smokers and nonsmokers using SVM-RFE on structural MRI images.

Voxel-based morphometry (VBM) studies have revealed gray matter alterations in smokers, but this type of analysis has poor predictive value for individual cases, which limits its applicability in clinical diagnoses and treatment. A predictive model would essentially embody a complex biomarker that could be used to evaluate treatment efficacy. In this study, we applied VBM along with a multivariate classification method consisting of a support vector machine with recursive feature elimination to discriminate smokers from nonsmokers using their structural MRI data. Mean gray matter volumes in 1,024 cerebral cortical regions of interest created using a subparcellated version of the Automated Anatomical Labeling template were calculated from 60 smokers and 60 nonsmokers, and served as input features to the classification procedure. The classifier achieved the highest accuracy of 69.6% when taking the 139 highest ranked features via 10-fold cross-validation. Critically, these features were later validated on an independent testing set that consisted of 28 smokers and 28 nonsmokers, yielding a 64.04% accuracy level (binomial P = 0.01). Following classification, exploratory post hoc regression analyses were performed, which revealed that gray matter volumes in the putamen, hippocampus, prefrontal cortex, cingulate cortex, caudate, thalamus, pre-/postcentral gyrus, precuneus, and the parahippocampal gyrus, were inversely related to smoking behavioral characteristics. These results not only indicate that smoking related gray matter alterations can provide predictive power for group membership, but also suggest that machine learning techniques can reveal underlying smoking-related neurobiology.

Greater externalizing personality traits predict less error-related insula and anterior cingulate cortex activity in acutely abstinent cigarette smokers.

Attenuated activity in performance-monitoring brain regions following erroneous actions may contribute to the repetition of maladaptive behaviors such as continued drug use. Externalizing is a broad personality construct characterized by deficient impulse control, vulnerability to addiction and reduced neurobiological indices of error processing. The insula and dorsal anterior cingulate cortex (dACC) are regions critically linked with error processing as well as the perpetuation of cigarette smoking. As such, we examined the interrelations between externalizing tendencies, erroneous task performance, and error-related insula and dACC activity in overnight-deprived smokers (n = 24) and non-smokers (n = 20). Participants completed a self-report measure assessing externalizing tendencies (Externalizing Spectrum Inventory) and a speeded Flanker task during functional magnetic resonance imaging scanning. We observed that higher externalizing tendencies correlated with the occurrence of more performance errors among smokers but not non-smokers. Suggesting a neurobiological contribution to such suboptimal performance among smokers, higher externalizing also predicted less recruitment of the right insula and dACC following error commission. Critically, this error-related activity fully mediated the relationship between externalizing traits and error rates. That is, higher externalizing scores predicted less error-related right insula and dACC activity and, in turn, less error-related activity predicted more errors. Relating such regional activity with a clinically relevant construct, less error-related right insula and dACC responses correlated with higher tobacco craving during abstinence. Given that inadequate error-related neuronal responses may contribute to continued drug use despite negative consequences, these results suggest that externalizing tendencies and/or compromised error processing among subsets of smokers may be relevant factors for smoking cessation success.

Saturated and mono-unsaturated lysophosphatidylcholine metabolism in tumour cells: a potential therapeutic target for preventing metastases.

BACKGROUND: Metastasis is the leading cause of mortality in malignant diseases. Patients with metastasis often show reduced Lysophosphatidylcholine (LysoPC) plasma levels and treatment of metastatic tumour cells with saturated LysoPC species reduced their metastatic potential in vivo in mouse experiments. To provide a first insight into the interplay of tumour cells and LysoPC, the interactions of ten solid epithelial tumour cell lines and six leukaemic cell lines with saturated and mono-unsaturated LysoPC species were explored. METHODS: LysoPC metabolism by the different tumour cells was investigated by a combination of cell culture assays, GC and MS techniques. Functional consequences of changed membrane properties were followed microscopically by detecting lateral lipid diffusion or cellular migration. Experimental metastasis studies in mice were performed after pretreatment of B16.F10 melanoma cells with LysoPC and FFA, respectively. RESULTS: In contrast to the leukaemic cells, all solid tumour cells show a very fast extracellular degradation of the LysoPC species to free fatty acids (FFA) and glycerophosphocholine. We provide evidence that the formerly LysoPC bound FFA were rapidly incorporated into the cellular phospholipids, thereby changing the FA-compositions accordingly. A massive increase of the neutral lipid amount was observed, inducing the formation of lipid droplets. Saturated LysoPC and to a lesser extent also mono-unsaturated LysoPC increased the cell membrane rigidity, which is assumed to alter cellular functions involved in metastasis. According to that, saturated and mono-unsaturated LysoPC as well as the respective FFA reduced the metastatic potential of B16.F10 cells in mice. Application of high doses of liposomes mainly consisting of saturated PC was shown to be a suitable way to strongly increase the plasma level of saturated LysoPC in mice. CONCLUSION: These data show that solid tumours display a high activity to hydrolyse LysoPC followed by a very rapid uptake of the resulting FFA; a mechanistic model is provided. In contrast to the physiological mix of LysoPC species, saturated and mono-unsaturated LysoPC alone apparently attenuate the metastatic activity of tumours and the artificial increase of saturated and mono-unsaturated LysoPC in plasma appears as novel therapeutic approach to interfere with metastasis.

THE MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL SCALE: PSYCHOMETRIC PROPERTIES AND FORM EQUIVALENCE.

This study examined the psychometric equivalence of Forms A and B of the Multidimensional Health Locus of Control Scale in a sample of college students (N = 370; M = 19.5 yr.; 318 Caucasians; 281 women). Given the dearth of studies that address the issue of form equivalence directly, this study sought to ascertain whether these forms could be used interchangeably by researchers. Subscales on the two forms had fairly high correlations (range of r = .77-.81), and similar alpha and omega reliability coefficients. Additionally, confirmatory factor analysis revealed both forms fit a three-factor model well. However, paired-sample t tests yielded significant mean differences for all three subscales. Furthermore, the two forms yielded inconsistent associations with relevant measures. Although the observed pattern of associations with social desirability and safe swimming behaviors were similar for Forms A and B, the pattern of differences was not identical for smoking groups and bicycle helmet use groups between forms. Overall, these results suggested that Forms A and B do not meet the strict criteria for parallel forms, but instead should be considered alternative forms.

Transient complex I inhibition at the onset of reperfusion by extracellular acidification decreases cardiac injury.

A reversible inhibition of mitochondrial respiration by complex I inhibition at the onset of reperfusion decreases injury in buffer-perfused hearts. Administration of acidic reperfusate for a brief period at reperfusion decreases cardiac injury. We asked if acidification treatment decreased cardiac injury during reperfusion by inhibiting complex I. Exposure of isolated mouse heart mitochondria to acidic buffer decreased the complex I substrate-stimulated respiration, whereas respiration with complex II substrates was unaltered. Evidence of the rapid and reversible inhibition of complex I by an acidic environment was obtained at the level of isolated complex, intact mitochondria and in situ mitochondria in digitonin-permeabilized cardiac myocytes. Moreover, ischemia-damaged complex I was also reversibly inhibited by an acidic environment. In the buffer-perfused mouse heart, reperfusion with pH 6.6 buffer for the initial 5 min decreased infarction. Compared with untreated hearts, acidification treatment markedly decreased the mitochondrial generation of reactive oxygen species and improved mitochondrial calcium retention capacity and inner mitochondrial membrane integrity. The decrease in infarct size achieved by acidic reperfusion approximates the reduction obtained by a reversible, partial blockade of complex I at reperfusion. Extracellular acidification decreases cardiac injury during reperfusion in part via the transient and reversible inhibition of complex I, leading to a reduction of oxyradical generation accompanied by a decreased susceptibility to mitochondrial permeability transition during early reperfusion.

Reverse electron flow-mediated ROS generation in ischemia-damaged mitochondria: role of complex I inhibition vs. depolarization of inner mitochondrial membrane.

BACKGROUND: The reverse electron flow-induced ROS generation (RFIR) is decreased in ischemia-damaged mitochondria. Cardiac ischemia leads to decreased complex I activity and depolarized inner mitochondrial membrane potential (ΔΨ) that are two key factors to affect the RFIR in isolated mitochondria. We asked if a partial inhibition of complex I activity without alteration of the ΔΨ is able to decrease the RFIR. METHODS: Cardiac mitochondria were isolated from mouse heart (C57BL/6) with and without ischemia. The rate of H2O2 production from mitochondria was determined using amplex red coupled with horseradish peroxidase. Mitochondria were isolated from the mitochondrial-targeted STAT3 overexpressing mouse (MLS-STAT3E) to clarify the role of partial complex I inhibition in RFIR production. RESULTS: The RFIR was decreased in ischemia-damaged mouse heart mitochondria with decreased complex I activity and depolarized ΔΨ. However, the RFIR was not altered in the MLS-STAT3E heart mitochondria with complex I defect but without depolarization of the ΔΨ. A slight depolarization of the ΔΨ in wild type mitochondria completely eliminated the RFIR. CONCLUSIONS: The mild uncoupling but not the partially decreased complex I activity contributes to the observed decrease in RFIR in ischemia-damaged mitochondria. GENERAL SIGNIFICANCE: The RFIR is less likely to be a key source of cardiac injury during reperfusion.

International classification of diseases, 10th revision training: what coders are saying.

On September 30, 2014, the US health care system will assign the last International Classification of Diseases, Ninth Revision, Clinical Modification code. The new system, International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System, will become effective on October 1, 2014. A 3-question prepresentation and postpresentation survey was completed by attendants at 11 workshops on the new system; this article discusses the results of the surveys, revealing what coders and billing staff are saying about the new International Classification of Diseases, 10th Revision system.