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1.
J Infect Dis ; 227(Suppl 1): S16-S29, 2023 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-36930637

RESUMO

Before the introduction of antiretroviral therapy, human immunodeficiency virus (HIV) infection was often accompanied by central nervous system (CNS) opportunistic infections and HIV encephalopathy marked by profound structural and functional alterations detectable with neuroimaging. Treatment with antiretroviral therapy nearly eliminated CNS opportunistic infections, while neuropsychiatric impairment and peripheral nerve and organ damage have persisted among virally suppressed people with HIV (PWH), suggesting ongoing brain injury. Neuroimaging research must use methods sensitive for detecting subtle HIV-associated brain structural and functional abnormalities, while allowing for adjustments for potential confounders, such as age, sex, substance use, hepatitis C coinfection, cardiovascular risk, and others. Here, we review existing and emerging neuroimaging tools that demonstrated promise in detecting markers of HIV-associated brain pathology and explore strategies to study the impact of potential confounding factors on these brain measures. We emphasize neuroimaging approaches that may be used in parallel to gather complementary information, allowing efficient detection and interpretation of altered brain structure and function associated with suboptimal clinical outcomes among virally suppressed PWH. We examine the advantages of each imaging modality and systematic approaches in study design and analysis. We also consider advantages of combining experimental and statistical control techniques to improve sensitivity and specificity of biotype identification and explore the costs and benefits of aggregating data from multiple studies to achieve larger sample sizes, enabling use of emerging methods for combining and analyzing large, multifaceted data sets. Many of the topics addressed in this article were discussed at the National Institute of Mental Health meeting "Biotypes of CNS Complications in People Living with HIV," held in October 2021, and are part of ongoing research initiatives to define the role of neuroimaging in emerging alternative approaches to identifying biotypes of CNS complications in PWH. An outcome of these considerations may be the development of a common neuroimaging protocol available for researchers to use in future studies examining neurological changes in the brains of PWH.


Assuntos
Complexo AIDS Demência , Doenças do Sistema Nervoso Central , Infecções por HIV , Infecções Oportunistas , Humanos , HIV , Encéfalo/patologia , Complexo AIDS Demência/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/patologia
2.
Child Psychiatry Hum Dev ; 54(1): 232-240, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34519945

RESUMO

Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 youth receiving a family-based intervention for early-onset OCD. FA, symptom severity and functional impairment were assessed at baseline, week 5, week 9, and post-treatment (week 14). Results suggested that changes in FA in the beginning stages of treatment preceded global symptom improvement (but not OCD specific improvement) whereas changes in functional impairment preceded changes in FA. In the latter half of treatment, changes in FA preceded improvement in global and OCD specific symptom severity as well as functional impairment. These findings highlight the importance of reducing FA, especially in the later stages of treatment, in order to optimize treatment outcomes in early-onset OCD.


Assuntos
Transtorno Obsessivo-Compulsivo , Pais , Adolescente , Humanos , Criança , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/terapia , Resultado do Tratamento
3.
Clin Infect Dis ; 73(7): e2303-e2310, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33053187

RESUMO

BACKGROUND: Age, human immunodeficiency virus (HIV) infection, illicit drug use, and central nervous system (CNS) opportunistic infections can affect brain structure, with the striatum being particularly sensitive to HIV effects. Nevertheless, the impact of non-CNS AIDS-defining illness (ADI) on brain structure has been less investigated. We examined ADI and HIV effects on brain volume. METHODS: In a cross-sectional study, including 95 virally suppressed seropositive and 84 demographically matched, seronegative participants, we examined serostatus and ADI effects. Cortical and subcortical gray matter volume (GMV) regions of interest were estimated with computational neuroanatomy techniques applied to high-resolution, T1-weighted magnetic resonance imaging data. Linear regression was used to model HIV serostatus and ADI effects on global and regional GMV, adjusting for age, sex, CD4 nadir, drug use, and total intracranial volume. RESULTS: While HIV serostatus was associated with lower striatal volume (B = -.59 [95% confidence interval {CI}, -1.08 to -.10]), co-occurring ADI was independently associated with lower striatal volume (B = -.73 [95% CI, -1.36 to -.09]). ADI was also associated with lower global (B = -19.35 [95% CI, -32.42 to -6.29]) and regional GMV. CONCLUSIONS: While HIV infection is associated with a localized effect on striatal structure, having a prior ADI is a strong predictor of smaller global and regional GMV. The lack of interaction between HIV serostatus or ADI with age suggests that chronic HIV infection and ADI have independent effects on brain structure, without associated accelerated lower volume with age. ADI history should be incorporated into statistical adjustments in HIV neuroimaging analysis. These findings also lend support to current HIV treatment guidelines urging prompt antiretroviral therapy initiation after HIV diagnosis.


Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Encéfalo/diagnóstico por imagem , Estudos Transversais , Substância Cinzenta/diagnóstico por imagem , Infecções por HIV/complicações , Humanos , Imageamento por Ressonância Magnética , Neuroimagem
4.
Neuroimage ; 245: 118703, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34736996

RESUMO

Modern neuroimaging studies frequently combine data collected from multiple scanners and experimental conditions. Such data often contain substantial technical variability associated with image intensity scale (image intensity scales are not the same in different images) and scanner effects (images obtained from different scanners contain substantial technical biases). Here we evaluate and compare results of data analysis methods without any data transformation (RAW), with intensity normalization using RAVEL, with regional harmonization methods using ComBat, and a combination of RAVEL and ComBat. Methods are evaluated on a unique sample of 16 study participants who were scanned on both 1.5T and 3T scanners a few months apart. Neuroradiological evaluation was conducted for 7 different regions of interest (ROI's) pertinent to Alzheimer's disease (AD). Cortical measures and results indicate that: (1) RAVEL substantially improved the reproducibility of image intensities; (2) ComBat is preferred over RAVEL and the RAVEL-ComBat combination in terms of regional level harmonization due to more consistent harmonization across subjects and image-derived measures; (3) RAVEL and ComBat substantially reduced bias compared to analysis of RAW images, but RAVEL also resulted in larger variance; and (4) the larger root mean square deviation (RMSD) of RAVEL compared to ComBat is due mainly to its larger variance.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neuroimagem/métodos , Idoso , Algoritmos , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
5.
Mult Scler ; 26(2): 165-176, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31573837

RESUMO

BACKGROUND: Autopsy data suggest a causative link between meningeal inflammation and cortical lesions (CLs) in multiple sclerosis (MS). OBJECTIVE: To use leptomeningeal enhancement (LME) and CLs on 7-Tesla (7T) magnetic resonance imaging (MRI) to investigate associations between meningeal inflammation and cortical pathology. METHODS: Forty-one participants with MS underwent 7T MRI of the brain. CLs and foci of LME were quantified. RESULTS: All MS participants had CLs; 27 (65.8%) had >1 focus of LME. Except for hippocampal CL count (ρ = 0.32 with spread/fill-sulcal pattern LME, p = 0.042), no significant correlations were seen between LME and CLs. Mean cortical thickness correlated with the number of LME foci (ρ = -0.43, p = 0.005). Participants with relapsing-remitting multiple sclerosis (RRMS) showed no correlation with neocortical CLs, but significant correlations were seen between LME and hippocampal lesion count (ρ = 0.39, p = 0.030), normalized cortical gray matter (GM) volume (ρ = -0.49, p = 0.005), and mean cortical thickness (ρ = -0.59, p < 0.001). CONCLUSION: This study supports a relationship between LME and cortical GM atrophy but does not support an association of LME and neocortical CLs. This may indicate that meningeal inflammation is involved with neurodegenerative inflammatory processes, rather than focal lesion development.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Meninges/diagnóstico por imagem , Meninges/patologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/patologia , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos
6.
J Clin Psychol ; 76(7): 1390-1407, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32060945

RESUMO

OBJECTIVE: Parental accommodation contributes to the maintenance of child anxiety and related symptoms. The current study examines the contributions of parent and child factors to parental accommodation in a sample of anxious youth. METHODS: Sixty-four treatment-seeking youth (6-16 years) and their mothers, as well as a subset of fathers (N = 41) reported on parental accommodation, parental distress and emotion regulation, child psychopathology, child externalizing behaviors, and child intolerance of uncertainty. RESULTS: Parental accommodation was not related to parental distress or emotion regulation. Parents who viewed their child as being more symptomatic (e.g., anxious, externalizing, and intolerant of uncertainty) were more likely to engage in accommodation. For mothers, child anxiety and externalizing symptoms were notable predictors of accommodation. CONCLUSIONS: Parent perceptions of child symptomology is an important factor significantly related to accommodation behaviors. This finding can be used to inform programming designed to target parental responses to child anxiety and related disorders.


Assuntos
Ansiedade/fisiopatologia , Comportamento Infantil/fisiologia , Relações Pais-Filho , Poder Familiar , Angústia Psicológica , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino
7.
J Neurovirol ; 25(4): 480-495, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31028692

RESUMO

The age of the HIV-infected population is increasing. Although many studies document gray matter volume (GMV) changes following HIV infection, GMV also declines with age. Findings have been inconsistent concerning interactions between HIV infection and age on brain structure. Effects of age, substance use, and inadequate viral suppression may confound identification of GMV serostatus effects using quantitative structural measures. In a cross-sectional study of HIV infection, including 97 seropositive and 84 seronegative, demographically matched participants, ages 30-70, we examined serostatus and age effects on GMV and neuropsychological measures. Ninety-eight percent of seropositive participants were currently treated with anti-retroviral therapies and all were virally suppressed. Gray, white, and CSF volumes were estimated using high-resolution T1-weighted MRI. Linear regression modeled effects of serostatus, age, education, comorbidities, and magnetic field strength on brain structure, using both a priori regions and voxel-based morphometry. Although seropositive participants exhibited significant bilateral decreases in striatal GMV, no serostatus effects were detected in the thalamus, hippocampus, or cerebellum. Age was associated with cortical, striatal, thalamic, hippocampal, and cerebellar GMV reductions. Effects of age and serostatus on striatal GMV were additive. Although no main effects of serostatus on neuropsychological performance were observed, serostatus moderated the relationship between pegboard performance and striatal volume. Both HIV infection and age were associated with reduced striatal volume. The lack of interaction of these two predictors suggests that HIV infection is associated with premature, but not accelerated, brain age. In serostatus groups matched on demographic and clinical variables, there were no observed differences in neuropsychological performance. Striatal GMV measures may be promising biomarker for use in studies of treated HIV infection.


Assuntos
Envelhecimento/patologia , Corpo Estriado/patologia , Substância Cinzenta/patologia , Infecções por HIV/patologia , Hipocampo/patologia , Lobo Temporal/patologia , Tálamo/patologia , Adulto , Fatores Etários , Idoso , Envelhecimento/efeitos dos fármacos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Mapeamento Encefálico , Estudos de Casos e Controles , Corpo Estriado/diagnóstico por imagem , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/virologia , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/efeitos dos fármacos , Substância Cinzenta/virologia , Infecções por HIV/diagnóstico por imagem , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Hipocampo/diagnóstico por imagem , Hipocampo/efeitos dos fármacos , Hipocampo/virologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Testes Neuropsicológicos , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/efeitos dos fármacos , Lobo Temporal/virologia , Tálamo/diagnóstico por imagem , Tálamo/efeitos dos fármacos , Tálamo/virologia , Substância Branca/diagnóstico por imagem , Substância Branca/efeitos dos fármacos , Substância Branca/patologia , Substância Branca/virologia
8.
J Clin Psychol ; 75(4): 710-725, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30368805

RESUMO

OBJECTIVE: This study investigates where parents learn about, and what parents know about child mental health services. Parents who are better informed about mental health services may be more likely to utilize services for their children. METHODS: In a national online survey, 196 parents of children between the ages of 4 and 17 years reported on their information-seeking behaviors and their familiarity and experience with psychosocial approaches. RESULTS: Parents reported utilizing multiple information sources with mental health providers, pediatricians, and social networks being the most prominent. Parents' trust in different sources varied, with parents generally trusting healthcare professionals the most. Parents exposed to mental health services were more aware of specific therapeutic approaches. CONCLUSIONS: Data on how parents receive and understand mental health-related information contributes to ongoing dissemination and implementation efforts.


Assuntos
Serviços de Saúde do Adolescente , Serviços de Saúde da Criança , Informação de Saúde ao Consumidor , Pessoal de Saúde , Serviços de Saúde Mental , Pais , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Am J Community Psychol ; 56(1-2): 101-19, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26099299

RESUMO

This paper examines whether three dimensions of school climate-leadership, accountability, and safety/respect-moderated the impacts of the INSIGHTS program on students' social-emotional, behavioral, and academic outcomes. Twenty-two urban schools and N = 435 low-income racial/ethnic minority students were enrolled in the study and received intervention services across the course of 2 years, in both kindergarten and first grade. Intervention effects on math and reading achievement were larger for students enrolled in schools with lower overall levels of leadership, accountability, and safety/respect at baseline. Program impacts on disruptive behaviors were greater in schools with lower levels of accountability at baseline; impacts on sustained attention were greater in schools with lower levels of safety/respect at baseline. Implications for Social-Emotional Learning program implementation, replication, and scale-up are discussed.


Assuntos
Emoções , Serviços de Saúde Escolar , Instituições Acadêmicas/organização & administração , Meio Social , Aprendizado Social , Estudantes/psicologia , Logro , Criança , Pré-Escolar , Etnicidade , Feminino , Humanos , Liderança , Masculino , Grupos Minoritários , Cultura Organizacional , Pobreza , Segurança , Autocontrole , Responsabilidade Social , População Urbana
10.
Attach Hum Dev ; 16(6): 590-612, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25056807

RESUMO

The current study investigated associations between early mother-child attachment, as well as mother-child and teacher-child relationships, and internalizing and externalizing behaviors in middle childhood. Data from the NICHD Study of Early Child Care and Youth Development were used. Findings from a series of individual growth curve analyses revealed that attachment security was negatively related to internalizing and externalizing behaviors, while insecure/other and avoidant attachment were positively related to internalizing behaviors. In addition, longitudinal associations were found between mother-child and teacher-child relationships and internalizing and externalizing behaviors across middle childhood. Implications for attachment theory are discussed.


Assuntos
Transtornos do Comportamento Infantil , Docentes , Relações Interpessoais , Relações Mãe-Filho , Apego ao Objeto , Criança , Comportamento Infantil/psicologia , Feminino , Humanos , Masculino , Modelos Teóricos , Inquéritos e Questionários
11.
Am J Case Rep ; 24: e938431, 2023 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-37533236

RESUMO

BACKGROUND The differential diagnosis for a parotid mass is broad, including infectious, autoimmune, and neoplastic etiologies. In people with HIV, regardless of viral suppression or immune status, neoplastic causes are more common. This report describes the evaluation of a woman with a large parotid mass, with an ultimate diagnosis of multiple myeloma with extramedullary plasmacytoma. CASE REPORT A 51-year-old woman with HIV infection presented with headache, weight loss, and right facial mass that was present for 5 years but more rapidly enlarging in the prior year. CD4 count was 234 cells/mL, and HIV RNA was 10 810 copies/mL. Physical examination was significant for a large deforming right-sided facial mass, decreased sensation in the V1 and V2 distributions, and right-sided ophthalmoplegia and ptosis. MRI and PET/CT scan confirmed a metabolically active large parotid mass with extension into the cavernous sinus. An IgG kappa monoclonal spike was present on serum protein electrophoresis. Incisional biopsy of the facial mass showed atypical lymphoid cells with plasmablastic and plasmacytic morphology with a high mitotic rate and proliferation index. She was diagnosed with R-ISS stage II IgG kappa multiple myeloma with extramedullary plasmacytoma, and initiated on chemotherapy, radiation, and antiretroviral therapy. CONCLUSIONS A rapidly enlarging parotid mass should prompt timely evaluation and biopsy for definitive diagnosis, particularly in immunocompromised patients, including people with HIV. Extramedullary plasmacytomas have a more aggressive disease process in people with HIV and are associated with high-risk multiple myeloma and progression, as seen in this patient.


Assuntos
Infecções por HIV , Mieloma Múltiplo , Plasmocitoma , Feminino , Humanos , Pessoa de Meia-Idade , Plasmocitoma/diagnóstico , Plasmocitoma/patologia , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/patologia , Infecções por HIV/complicações , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Hipertrofia , Imunoglobulina G
12.
Attach Hum Dev ; 14(3): 265-88, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22537524

RESUMO

The purposes of the current study were: (1) to examine the roles of early maternal attachment relationships and teacher-child relationships during childhood for externalizing and internalizing behaviors in late childhood, and (2) to investigate teacher-child relationships, as well as externalizing and internalizing behaviors in early childhood as possible mechanisms linking early maternal attachment relationships to behavior problems in late childhood. Longitudinal data from the National Institute of Child Health and Human Development Early Child Care Research Network Study of Early Child Care and Youth Development (N = 1140 mothers and children) were used in this investigation. There were three main findings. First, insecure/other maternal attachment relationships in early childhood (i.e., 36 months) were associated with externalizing and internalizing behaviors in late childhood (Grade 5). Second, elevated levels of teacher-child conflict during childhood were associated with externalizing behaviors in late childhood whereas low levels of teacher-child closeness were associated with internalizing behaviors. Third, the effects of insecure/other attachment on externalizing and internalizing behaviors in late childhood were mediated through teacher-child relationships during childhood and early externalizing and internalizing behaviors. Implications for attachment theory are discussed.


Assuntos
Transtornos do Comportamento Infantil/epidemiologia , Psiquiatria Infantil , Docentes , Relações Mãe-Filho , Apego ao Objeto , Estudantes/psicologia , Fatores Etários , Criança , Transtornos do Comportamento Infantil/psicologia , Análise por Conglomerados , Conflito Psicológico , Humanos , Estudos Longitudinais , Modelos Psicológicos , Teoria Psicológica , Psicometria , Análise de Regressão , Fatores de Risco , Estatística como Assunto
13.
PM R ; 14(3): 329-336, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33728742

RESUMO

BACKGROUND: Strategy training, a rehabilitation intervention, reduces disability and improves functional skills associated with goal-directed behavior. Stroke lesions impacting selected ventromedial regions of interest associated with initiation of goal-directed behavior may attenuate intervention response. If so, strategy training may not be optimal for people with stroke lesions in these regions. OBJECTIVE: To examine whether ventromedial regions of interest attenuate changes in disability status attributed to strategy training. DESIGN: Secondary analysis of data from two randomized controlled clinical trials. SETTING: Inpatient stroke rehabilitation. PARTICIPANTS: People with acute stroke diagnosis and available diagnostic studies enrolled in inpatient rehabilitation randomized controlled studies between 2009 and 2017. INTERVENTION: Participants were randomized to strategy training or a control condition in addition to the usual care during inpatient rehabilitation. MAIN OUTCOME MEASURES: Diagnostic magnetic resonance imaging studies were retrieved from electronic medical records, and stroke lesion location was characterized by a neuroradiologist. Intervention response was defined by Functional Independence Measure change scores of 22 points or greater. RESULTS: Only 186 of 275 participants had diagnostic studies available; 13 patients showed no apparent lesion on their diagnostic study. Among 173 cases, 156 had complete data at discharge (strategy training n = 71, control n = 85). Twenty-five cases had a lesion within a region of interest (strategy training n = 14, control n = 11). Intervention response was attenuated in the strategy training group for those with lesions in regions of interest [χ2 (1, n = 71) = 4.60, P = .03], but not for those in the control group [Fisher exact test, n = 85, P = .19). CONCLUSIONS: Lesions in the ventromedial regions of interest may attenuate response to strategy training.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Humanos , Pacientes Internados , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Reabilitação do Acidente Vascular Cerebral/métodos
14.
medRxiv ; 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36172134

RESUMO

Background: Recovery after SARS-CoV-2 infection is extremely variable, with some individuals recovering quickly, and others experiencing persistent long-term symptoms or developing new symptoms after the acute phase of infection, including fatigue, poor concentration, impaired attention, or memory deficits. Many existing studies reporting cognitive deficits associated with SARS-CoV-2 infection are limited by the exclusive use of self-reported measures or a lack of adequate comparison groups. Methods: Forty-five participants, ages 18-70, (11 Long-COVID, 14 COVID, and 20 No-COVID) underwent behavioral testing with the NIH Toolbox Neuro-Quality of Life survey and selected psychometric tests, including a flanker interference task and the d2 Test of Attention. Results: We found greater self-reported anxiety, apathy, fatigue, emotional dyscontrol, sleep disturbance and cognitive dysfunction in COVID compared No-COVID groups. After categorizing COVID patients according to self-reported concentration problems, we observed declining performance patterns in multiple attention measures across No-COVID controls, COVID and Long-COVID groups. COVID participants, compared to No-COVID controls, exhibited worse performance on NIH Toolbox assessments, including the Eriksen Flanker, Nine-Hole Pegboard and Auditory Verbal Learning tests. Conclusion: This study provides convergent evidence that previous SARS-CoV-2 infection is associated with impairments in sustained attention, processing speed, self-reported fatigue and concentration. The finding that some patients have cognitive and visuomotor dysfunction in the absence of self-reported problems suggests that SARS-CoV-2 infection can have unexpected and persistent subclinical consequences.

15.
J Neuroimmune Pharmacol ; 16(2): 334-345, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32323137

RESUMO

AIMS: Cognitive impairment may be greater in HIV-positive (HIV+) women than in HIV+ men. Whether sex-specific differences exist in brain microstructure of HIV+ individuals is unknown and was evaluated. METHOD: 39 HIV+ (21 men, 18 women) and 45 seronegative (SN, 20 men, 25 women) participants were assessed with brain diffusion tensor imaging and cognitive assessments (7 neuropsychological domains). Fractional anisotropy (FA) and mean diffusivity (MD) were measured with an automated atlas in selected brain regions. Group comparisons were assessed with linear mixed effects models, with sub-regions and hemisphere (left/right) as repeated factors for each region. RESULTS: HIV+ women, but not HIV+ men, were slower than sex-matched SN controls on sensorimotor function (Dominant-hand: interaction-p = 0.007; Non-dominant hand: interaction-p = 0.039). Similarly, only HIV+ women had lower FA in the globus pallidus (GP, interaction-p = 0.011). Additionally, regardless of sex, the HIV+ group had poorer Fluency, Speed, and Attention than SN-controls (p = 0.006-0.008), as well as lower FA and higher MD in multiple brain regions (p = <0.001-0.044). Across all participants, performance on Attention was predicted by uncinate-FA (p < 0.001, r = 0.5) and corpus callosum (CC)-FA (p = 0.038, r = 0.23), while the Speed of Information Processing was predicted by CC-FA (p = 0.009, r = 0.3). Furthermore, faster sensorimotor function correlated with higher CC-FA and uncinate-FA in men but not in women (Sex*DTI-interaction-p = 0.03-0.06). CONCLUSIONS: The relatively poorer sensorimotor function and abnormally lower GP_FA, suggesting lesser neuronal integrity, in HIV+ women demonstrate sex-specific effects from HIV-infection on these measures. These findings may be related to the greater immune activation and neuroinflammation in HIV+ women compared to HIV+ men. Graphical Abstract.


Assuntos
Complexo AIDS Demência/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Globo Pálido/fisiopatologia , Caracteres Sexuais , Adulto , Anisotropia , Disfunção Cognitiva/virologia , Imagem de Tensor de Difusão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Dev Behav Pediatr ; 42(2): 114-121, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32976228

RESUMO

OBJECTIVE: Sleep-related problems, defined as sleep patterns atypical for the child's developmental stage, are common in children with elevated anxiety symptoms and linked to significant mental and physical health consequences. Despite the consequences of sleep-related problems, it remains unclear how these problems are initiated and maintained in children with elevated anxiety symptoms. The current study examines the relationship between sleep-related problems and parental accommodation (e.g., co-sleeping) to determine whether higher levels of accommodation are associated with more frequent sleep-related problems in a sample of children with elevated anxiety symptoms. METHODS: Participants were 122 children aged 8 to 17 years old (M = 11.97, SD = 2.68; 57% female) and their parents who presented to a university-based anxiety specialty clinic for assessment and treatment. Children completed the Multidimensional Anxiety Scale for Children, and their parents completed the Children's Sleep Habits Questionnaire and Family Accommodation Checklist and Interference Scale. Multiple regression analyses were performed to examine variance in sleep-related problems explained by parental accommodation. RESULTS: Parental accommodation accounted for a significant amount of variance in sleep-related problems over and above child anxiety and age for both mother report (19%) and father report (15%). When individual accommodation items were examined, parental sleep accommodations (e.g., slept in my child's bed) and nonsleep accommodations (e.g., came home early) were significant predictors for mother-reported sleep-related problems, but only sleep accommodations (e.g., let my child sleep with the lights on) were significant for father-reported sleep-related problems. CONCLUSION: Parents of children with elevated anxiety symptoms and sleep-related problems engage in accommodation related to their child's sleep (e.g., co-sleeping). Future research elucidating the potential bidirectional and causal links between parental accommodation and sleep-related problems is a necessary step in adapting sleep treatments for this population.


Assuntos
Transtornos do Sono-Vigília , Adolescente , Ansiedade/epidemiologia , Transtornos de Ansiedade , Criança , Feminino , Humanos , Masculino , Pais , Sono , Transtornos do Sono-Vigília/epidemiologia
17.
Proc IEEE Int Symp Biomed Imaging ; 2021: 650-654, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34909112

RESUMO

We consider a model-agnostic solution to the problem of Multi-Domain Learning (MDL) for multi-modal applications. Many existing MDL techniques are model-dependent solutions which explicitly require nontrivial architectural changes to construct domain-specific modules. Thus, properly applying these MDL techniques for new problems with well-established models, e.g. U-Net for semantic segmentation, may demand various low-level implementation efforts. In this paper, given emerging multi-modal data (e.g., various structural neuroimaging modalities), we aim to enable MDL purely algorithmically so that widely used neural networks can trivially achieve MDL in a model-independent manner. To this end, we consider a weighted loss function and extend it to an effective procedure by employing techniques from the recently active area of learning-to-learn (meta-learning). Specifically, we take inner-loop gradient steps to dynamically estimate posterior distributions over the hyperparameters of our loss function. Thus, our method is model-agnostic, requiring no additional model parameters and no network architecture changes; instead, only a few efficient algorithmic modifications are needed to improve performance in MDL. We demonstrate our solution to a fitting problem in medical imaging, specifically, in the automatic segmentation of white matter hyperintensity (WMH). We look at two neuroimaging modalities (T1-MR and FLAIR) with complementary information fitting for our problem.

18.
Proc IEEE Int Symp Biomed Imaging ; 2021: 1047-1051, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34909113

RESUMO

Typical machine learning frameworks heavily rely on an underlying assumption that training and test data follow the same distribution. In medical imaging which increasingly begun acquiring datasets from multiple sites or scanners, this identical distribution assumption often fails to hold due to systematic variability induced by site or scanner dependent factors. Therefore, we cannot simply expect a model trained on a given dataset to consistently work well, or generalize, on a dataset from another distribution. In this work, we address this problem, investigating the application of machine learning models to unseen medical imaging data. Specifically, we consider the challenging case of Domain Generalization (DG) where we train a model without any knowledge about the testing distribution. That is, we train on samples from a set of distributions (sources) and test on samples from a new, unseen distribution (target). We focus on the task of white matter hyperintensity (WMH) prediction using the multi-site WMH Segmentation Challenge dataset and our local in-house dataset. We identify how two mechanically distinct DG approaches, namely domain adversarial learning and mix-up, have theoretical synergy. Then, we show drastic improvements of WMH prediction on an unseen target domain.

19.
Neuroimage Clin ; 28: 102436, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33383609

RESUMO

BACKGROUND: Numerous studies have used magnetic resonance spectroscopy (MRS) neurometabolite measurements to study HIV infection effects. While many have reported differences in total N-Acetylaspartate (tNAA), myo-Inositol (mI), and total Choline (tCho), there have been no meta-analyses performed to evaluate concordance across studies. PURPOSE: To evaluate the consistency of HIV serostatus effects on brain metabolites. STUDY SELECTION: The sample included studies conducted between 1993 and 2019 reporting HIV infection effects measured using proton MRS. tNAA/tCr ratios (21 papers), tCho/tCr ratios (21 papers), mI/tCr ratios (17 papers) and quantitative tCr (9 papers), sampling from basal ganglia (BG), gray matter (GM), and white matter (WM) were included. DATA ANALYSIS: Random effects meta-analysis using inverse variance weighting and bias corrected standardized mean differences (SMDs) was used. Meta-regression examined effects of publication year and data acquisition technique differences. DATA SYNTHESIS: BG SMDs related to positive serostatus were -0.10 [-0.39; 0.18] tNAA/tCr, 0.27 [0.05; 0.49] tCho/tCr, 0.60 [0.31; 0.90] mI/tCr, and -0.26 [-0.59; 0.06] tCr. GM SMDs related to serostatus were -0.29 [-0.49; -0.09] tNAA/tCr, 0.37 [0.19; 0.54] tCho/tCr, 0.41 [0.15; 0.68] mI/tCr, and -0.24 [-0.45; -0.03] tCr. WM SMDs related to serostatus were -0.52 [-0.79; -0.25] tNAA/tCr, 0.41 [0.21; 0.61] tCho/tCr, 0.59 [0.24; 0.94] mI/tCr, and -0.03 [-0.25; 0.19] tCr. WM regions showed larger serostatus effect sizes than BG and GM. I2 ranged from 52 to 88% for the metabolite ratios. Both GM and WM tNAA/tCr SMDs were lower with increasing calendar year. LIMITATIONS: Many studies pooled participants with varying treatment, infection, and comorbidity durations. CONCLUSIONS: HIV neurometabolite studies showed consistently lower tNAA/tCr, higher tCho/tCr and higher mI/tCr ratios associated with chronic HIV infection. Substantial between-study variation may have resulted from measurement technique variations, study population differences and HIV treatment changes over time. Higher WM tCho/tCr and mI/tCr may reflect reactive gliosis or myelin turnover. Neurometabolite measurements can reliably detect chronic HIV infection effects and may be useful in understanding the pathophysiology of cognitive and sensorimotor decline following HIV infection. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence of neurometabolite differences in chronic HIV infection.


Assuntos
Infecções por HIV , Ácido Aspártico , Encéfalo/diagnóstico por imagem , Colina , Creatina , Humanos , Inositol , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética
20.
J Anxiety Disord ; 74: 102260, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32603994

RESUMO

Parental accommodation plays a key role in the maintenance of child anxiety, yet much of the research to date has been correlational, making it difficult to draw conclusions about underlying mechanisms. Given preliminary evidence that parental beliefs play a role in parental accommodation, the present study sought to experimentally reduce accommodation by targeting parental attitudes about child anxiety. Mothers of children ages 4-9 (N = 47) were randomly assigned to either receive brief instruction in cognitive reappraisal (EXP) or to a control intervention in which they received no instruction (CON). At pre- and post-intervention mothers were presented with bogus information that their child was experiencing varying levels of distress while completing a task in a nearby room. Maternal distress, negative affect and perceived likelihood of accommodation in the context of child distress were measured pre- and post-intervention. EXP mothers reported greater pre- to post-intervention decreases in distress and perceived likelihood of accommodation, compared to CON mothers. EXP and CON mothers showed similar changes in negative affect. Findings from this study provide preliminary experimental evidence that targeting maternal beliefs about child anxiety can result in changes in maternal distress and behavior following exposure to child distress. Implications for prevention and treatment are discussed.


Assuntos
Transtornos de Ansiedade/psicologia , Ansiedade/psicologia , Cognição , Educação em Saúde , Mães/educação , Mães/psicologia , Relações Pais-Filho , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino
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