Prevention of Post-Mastectomy Pain Syndrome: A Review of Recent Literature on Perioperative Interventions.

PURPOSE OF REVIEW: Up to 60% of breast cancer patients continue to experience pain three months or more after surgery, with 15 to 25% reporting moderate to severe pain. Post-mastectomy pain syndrome (PMPS) places a high burden on patients. We reviewed recent studies on perioperative interventions to prevent PMPS incidence and severity. RECENT FINDINGS: Recent studies on pharmacologic and regional anesthetic interventions were reviewed. Only nine of the twenty-three studies included reported a significant improvement in PMPS incidence and/or severity, sometimes with mixed results for similar interventions. Evidence for prevention of PMPS is mixed. Further investigation of impact of variations in dosing is warranted. In addition, promising newer interventions for prevention of PMPS such as cryoneurolysis of intercostal nerves and stellate ganglion block need confirmatory studies.

Impact of community-based technology training with low-income older adults.

OBJECTIVES: Compared with younger and middle-aged adults, older adults are less likely to adopt new computer technology, potentially limiting access to healthcare and many other important resources available online. This limitation could impact cognitive abilities, well-being, and mental health outcomes of older adults. The aims of the present study were to increase access to online county and healthcare resources, while also assessing the impact of technology access on cognitive functioning and multiple well-being domains. METHODS: A pilot community collaboration provided a two-month tablet training intervention, focused on increasing digital independence via tablet navigation, resources access, and fraud and scam prevention, to 20 low-income older adult participants (75% female, Mage = 70.85). Pre- and post-test phone interviews were conducted to measure any changes in digital independence, cognitive abilities, well-being, mental health, and mindset. RESULTS: Linear mixed effects models revealed no significant changes in outcome measures from pre- to post-test. However, we found effects of digital independence on several well-being measures, providing important information for the impact of technology access and training for low-income older adults. CONCLUSION: This pilot intervention offers limited but promising results, inspiring further investigations that may inform public health and policy services to address barriers to access and potentially improve psychological health.

A first-in-human phase 1 study of nofazinlimab, an anti-PD-1 antibody, in advanced solid tumors and in combination with regorafenib in metastatic colorectal cancer.

BACKGROUND: We assessed nofazinlimab, an anti-PD-1 antibody, in solid tumors and combined with regorafenib in metastatic colorectal cancer (mCRC). METHODS: This phase 1 study comprised nofazinlimab dose escalation (phase 1a) and expansion (phase 1b), and regorafenib dose escalation (80 or 120 mg QD, days 1-21 of 28-day cycles) combined with 300-mg nofazinlimab Q4W (part 2a) to determine safety, efficacy, and RP2D. RESULTS: In phase 1a (N = 21), no dose-limiting toxicity occurred from 1 to 10 mg/kg Q3W, with 200 mg Q3W determined as the monotherapy RP2D. In phase 1b (N = 87), 400-mg Q6W and 200-mg Q3W regimens were found comparable. In part 2a (N = 14), both regimens were deemed plausible RP2Ds. Fatigue was the most frequent treatment-emergent adverse event (AE) in this study. Any-grade and grade 3/4 nofazinlimab-related AEs were 71.4% and 14.3%, 56.3% and 5.7%, and 57.1% and 21.4% in phases 1a, 1b, and part 2a, respectively. ORRs were 14.3% and 25.3% in phases 1a and 1b, respectively. In part 2a, no patients had radiological responses. CONCLUSIONS: Nofazinlimab monotherapy was well tolerated and demonstrated preliminary anti-tumor activity in multiple tumor types. Regorafenib plus nofazinlimab had a manageable safety profile but was not associated with any response in mCRC. CLINICAL TRIAL REGISTR ATION: Clinicaltrials.gov (NCT03475251).

Synthetic dyes: A mass spectrometry approach and applications.

Synthetic dyes are found in a wide variety of applications today, including but not limited to textiles, foods, and medicine. The analysis of these molecules is pertinent to several fields such as forensics, environmental monitoring, and quality control, all of which require the sensitivity and selectivity of analysis provided by mass spectrometry (MS). Recently, there has been an increase in the implementation of MS evaluation of synthetic dyes by various methods, with the majority of research thus far falling under electrospray ionization and moving toward direct ionization methods. This review covers an overview of the chemistry of synthetic dyes needed for the understanding of MS sample preparation and spectral results, current fields of application, ionization methods, and fragmentation trends and works that have been reported in recent years.

Prevalence and incidence of type 1 diabetes in children aged 0-14 years old in New Zealand in 2021.

AIM: National prevalence and incidence data are important for understanding population trends and allocating health-care resources. We aimed to provide a current national snapshot of prevalence and annual incidence rates for children aged 0-14 with type 1 diabetes (T1D) in Aotearoa New Zealand and to identify differences associated with demographic variables. METHODS: Paediatric diabetes centres across Aotearoa were invited to record anonymised demographic and diabetes data on children under their services between 1 October 2020 and 30 September 2021. National prevalence and incidence were calculated using usually resident population counts from the 2018 census. The effect of ethnicity on prevalence and incidence was assessed using Poisson regression. RESULTS: There were 1209 children aged 0-14 with T1D in October 2021. The national prevalence was 131/100 000 (95% confidence interval (CI) 124-139). European children had twice the prevalence as those of Maori or Pacific ethnicity (P < 0.001). There was no effect by gender (P = 0.3) and prevalence predictably increased with age. The annualised incidence of T1D was 23/100 000 (95% CI 20-26). European children were 2.6 times as likely as Maori children to be diagnosed with T1D in that year (incidence rate ratio = 2.6, 95% CI 1.7-4.2). Regional differences in prevalence and incidence were noted, potentially due to the ethnicity differences across regions. Unadjusted prevalence and incidence decreased with lower socio-economic status, likely due to an over-representation of non-Europeans living in the most deprived areas. CONCLUSIONS: T1D affects an ethnically diverse population in Aotearoa and important regional differences exist that may impact workforce planning.

One-year cognitive outcomes from a multiple real-world skill learning intervention with older adults.

OBJECTIVES: Novel skill learning has been shown to have cognitive benefits in the short-term (up to a few months). Two studies expanded on prior research by investigating whether learning multiple novel real-world skills simultaneously (e.g. Spanish, drawing, music composition), for a minimum of six hours a week, would yield 1-year cognitive gains. METHOD: Following a 3-month multi-skill learning intervention, Study 1 (N = 6, Mage = 66 years, SDage = 6.41) and Study 2 (N = 27, Mage = 69 years, SDage = 7.12) participants completed follow-up cognitive assessments 3 months, 6 months, and one year after the intervention period. Cognitive assessments tested executive function (working memory and cognitive control) and verbal episodic memory. RESULTS: Linear mixed-effects models revealed improvements in multiple cognitive outcomes from before the intervention to the follow-up timepoints. Specifically, executive function increased from pre-test to the 1-year follow-up for both studies (an effect driven mostly by cognitive control scores). DISCUSSION: Our findings provide evidence that simultaneously learning real-world skills can lead to long-term improvements in cognition during older adulthood. Future work with diverse samples could investigate individual differences in gains. Overall, our findings promote the benefits of lifelong learning, namely, to improve cognitive abilities in older adulthood.

Cognitive and Functional Improvement via Novel Skill Learning for Low-Income Minoritized Middle-Aged and Older Adults.

Prior research has demonstrated beneficial outcomes for learning new skills in older adulthood, including increased cognitive and functional abilities, which help prevent age-related declines and foster healthy aging. However, these studies largely have included participants not typically considered at risk for cognitive and functional decline (i.e., White, highly educated, higher income). Cognitive and functional disparities exist among minoritized racial and ethnic individuals, particularly Black and Latinx populations, because of a lifetime of inequalities associated with low socioeconomic status, low education, and discrimination. This theoretical paper proposes a potential pathway in which such disparities could be mitigated by increasing cognitive and functional abilities via novel skill learning in these at-risk populations in middle and later life to prevent decline. We also discuss indirect barriers (e.g., financial and health issues), direct barriers (e.g., limited learning opportunities), and motivational barriers (e.g., self-beliefs, values) that these adults may encounter. We further highlight that addressing these barriers to novel skill learning by providing appropriate resources is necessary to maximize the feasibility and potential effectiveness of this pathway. Lastly, we encourage future research to test this pathway and help inform policymakers and existing learning programs to implement better ways of promoting lifelong learning in an inclusive and equitable manner to prevent decline.

Organization and Performance of US Health Systems.

Importance: Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance. Objective: To (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. Evidence Review: Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare & Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area. Findings: A total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with >100 beds), as were system physician practices (74% vs 12% with >100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large. Conclusions and Relevance: In 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.

Long-Term Effects of a Real-World Multi-Skill Intervention on Older Adults' Growth Mindset.

Although there have been interventions to increase growth mindset, little is known about their effectiveness over a longer period, especially for older adults. This study with older adults investigated the long-term effects of a learning intervention that included growth mindset lectures and discussions on growth mindset. In Study 1 (n = 27), participants were tracked for one year after a 12-week intervention. We found that an increased growth mindset did not last beyond the intervention. In Study 2 (n = 71), the COVID-19 pandemic interrupted the intervention after only two months. Participants were followed up for two years, and their growth mindset at one year was greater than at the pretest (Week 0) but declined from the 1- to 2-year follow-up. Taken together, interventions incorporating growth mindset messages can increase growth mindset in the short term but may require booster sessions to retain effects, especially during disruptive life events.

Growth Mindset Predicts Cognitive Gains in an Older Adult Multi-Skill Learning Intervention.

Growth mindset (belief in the malleability of intelligence) is a unique predictor of young learners' increased motivation and learning, and may have broader implications for cognitive functioning. Its role in learning in older adulthood is unclear. As part of a larger longitudinal study, we examined growth mindset and cognitive functioning in older adults engaged in a 3-month multi-skill learning intervention that included growth mindset discussions. Before, during, and after the intervention, participants reported on their growth mindset beliefs and completed a cognitive battery. Study 1 indicated that intervention participants, but not control participants, increased their growth mindset during the intervention. Study 2 replicated these results and found that older adults with higher preexisting growth mindsets showed larger cognitive gains at posttest compared to those with lower preexisting growth mindsets. Our findings highlight the potential role of growth mindset in supporting positive learning cycles for cognitive gains in older adulthood.

Neural target selection as a marker of real-world familiarity during search for perceptually distinct objects.

Prior studies have shown that behavioral performance is better when detecting specific familiar items based on real-world experience (e.g., an own-age face, a specific bird for bird experts), compared to less familiar items (e.g., an other-age face). These biases emerge from exposure to and interactions with initially less familiar items, which allow for better discrimination and search (e.g., finding an other-age face in a crowd). However, many broad categories in the natural environment (e.g., vintage objects, exotic fruit) contain perceptually distinct items that people can accurately search for individually, even if the objects are not as familiar. How might real-world familiarity impact search in these cases? Recent studies suggest that the N2pc event-related potential (ERP, neural marker of target selection) may be more sensitive than behavioral performance in reflecting prior knowledge, and perhaps familiarity, during visual search. In two experiments, the present study investigated the behavioral effects (Experiment 1) and N2pc effects (Experiment 2) of searching for distinct familiar (modern) versus less familiar (vintage) objects in younger adults. Experiment 1 also included a sample of older adults, who were familiar with both types of objects. Overall, the behavioral results did not reveal robust differences in searching for modern versus vintage objects. However, the N2pc in younger adults was present when searching for modern objects, but not for vintage objects. The N2pc results suggest that this neural marker may be more sensitive than behavioral measures in reflecting familiarity from real-world experiences with object categories.

An interdisciplinary framework examining culture and adaptation in migrant children and adolescents.

With increasing rates of globalization, understanding the cultural factors that promote positive adaptation in migrant children and adolescents is vital. In prior research, acculturation and enculturation frameworks often rely on unidimensional or bidimensional conceptions of culture to study the effects of migration on child and adolescent development. However, the contemporary strategies that migrant children and adolescents utilize to navigate multicultural contexts remain undertheorized. Therefore, we advance an interdisciplinary framework that describes the factors and processes that affect migrant child and adolescent development across four contexts: global, macrosystem, microsystem, and the individual level. Additionally, conceptualizations of cultural adaptation are broadened in our framework by examining the intersections of community cultural wealth, cultural preservation, and cultural restoration. We highlight the importance of prioritizing the culture and experiential knowledge of migrant children and adolescents in the development of policy, research, and practice, to support their positive adaptation in a globalized society.

Do Local Tobacco-21 Laws Reduce Smoking Among 18 to 20 Year-Olds?

INTRODUCTION: States and municipalities are increasingly restricting tobacco sales to those under age 21, in an effort to reduce youth and young adult smoking. However, the effectiveness of such policies remains unclear, particularly when implemented locally. METHODS: Analyses use 2011-2016 data from the Behavioral Risk Factor Surveillance System's Selected Metropolitan/Micropolitan Area Risk Trends dataset. Difference-in-differences and triple-difference regressions estimate the relationship between local tobacco-21 policies and smoking among 18- to 20-year-olds living in MMSAs (metropolitan/micropolitan statistical areas and metropolitan divisions). RESULTS: Current smoking rates fell from 16.5% in 2011 to 8.9% in 2016 among 18- 20-year-olds in these data. Regressions indicate that a tobacco-21 policy covering one's entire MMSA yields an approximately 3.1 percentage point reduction in 18- to 20-year-olds' likelihoods of smoking (confidence interval [CI] = -0.0548 to -0.0063). Accounting for partial policy exposure-tobacco-21 laws implemented in some but not all jurisdictions within an MMSA-this estimate implies that the average exposed 18- to 20-year-old experienced a 1.2 percentage point drop in their likelihood of being a smoker at interview relative to unexposed respondents of the same age, all else equal. CONCLUSIONS: Local tobacco-21 policies yield a substantive reduction in smoking among 18- to 20-year-olds living in MMSAs. This finding provides empirical support for efforts to raise the tobacco purchasing age to 21 as a means to reduce young adult smoking. Moreover, it suggests that state laws preempting local tobacco-21 policies may impede public health. IMPLICATIONS: Although states and municipalities are increasingly restricting tobacco sales to under 21-year-olds, such policies' effectiveness remains unclear, particularly when implemented locally. Using quasi-experimental methods, this article provides what may be the first evidence that sub-state tobacco-21 laws reduce smoking among 18- to 20-year-olds. Specifically, considering metropolitan and micropolitan areas from 2011 to 2016, the average 18- to 20-year-old who was exposed to these policies exhibited a 1.2 percentage point drop in their likelihood of being a current established smoker, relative to those who were unexposed. These findings validate local tobacco-21 laws as a means to reduce young adult smoking.

Development of the Broad Learning Adult Questionnaire.

Infants and children experience an intense form of intellectual engagement associated with learning a variety of new skills. A recent theory proposes that such broad learning experiences may be the key to maximal cognitive development not just during infancy and childhood but also during adulthood. To begin investigating this possibility, the present questionnaire on broad learning in adulthood builds on prior research on need for cognition, intellectual engagement, personal growth, and leisure activities. After several rounds with preliminary versions of the questionnaire, the final version consists of 28 items. Responses were gathered from two mTurk samples to measure scale reliability and to assess model fit. In the end, we obtained a satisfactory measure of broad learning that consists of six separate reliable scales. Once this questionnaire is validated in future studies, perhaps it could be used as a predictor for cognitive development during adulthood and for interventions inducing broad learning.

Learning What to Attend to: From the Lab to the Classroom.

Research in adult cognitive neuroscience addresses the bidirectional relationship between attentional selection and prior knowledge gained from learning and experience. This research area is ready for integration with developmental cognitive neuroscience, in particular with educational neuroscience. We review one aspect of this research area, learning what to attend to, to propose a path of integration from highly controlled experiments based on developmental and adult cognitive theories to inform cognitive interventions for learners across the lifespan. In particular, we review the research program that we have developed over the last few years, describe the constraints that we have faced in integrating adult and developmental paradigms, and delineate suggested next steps to inform educational neuroscience in more applied ways. Our proposed path of integration transitions from basic to applied research, while also suggesting that input from education could inform new basic research avenues that may more likely yield outcomes meaningful for education.

Infants Rely More on Gaze Cues From Own-Race Than Other-Race Adults for Learning Under Uncertainty.

Differential experience leads infants to have perceptual processing advantages for own- over other-race faces, but whether this experience has downstream consequences is unknown. Three experiments examined whether 7-month-olds (range = 5.9-8.5 months; N = 96) use gaze from own- versus other-race adults to anticipate events. When gaze predicted an event's occurrence with 100% reliability, 7-month-olds followed both adults equally; with 25% (chance) reliability, neither was followed. However, with 50% (uncertain) reliability, infants followed own- over other-race gaze. Differential face race experience may thus affect how infants use social cues from own- versus other-race adults for learning. Such findings suggest that infants integrate online statistical reliability information with prior knowledge of own versus other race to guide social interaction and learning.

The "item" as a window into how prior knowledge guides visual search.

We challenge the central idea proposed in Hulleman & Olivers (H&O) by arguing that the "item" is still useful for understanding visual search and for developing new theoretical frameworks. The "item" is a flexible unit that represents not only an individual object, but also a bundle of objects that are grouped based on prior knowledge. Uncovering how the "item" is represented based on prior knowledge is essential for advancing theories of visual search.

Cortical activation to action perception is associated with action production abilities in young infants.

The extent to which perception and action share common neural processes is much debated in cognitive neuroscience. Taking a developmental approach to this issue allows us to assess whether perceptual processing develops in close association with the emergence of related action skills within the same individual. The current study used functional near-infrared spectroscopy (fNIRS) to investigate the perception of human action in 4- to 6-month-old human infants. In addition, the infants' manual dexterity was assessed using the fine motor component of The Mullen Scales of Early Learning and an in-house developed Manual Dexterity task. Results show that the degree of cortical activation, within the posterior superior temporal sulcus--temporoparietal junction (pSTS-TPJ) region, to the perception of manual actions in individual infants correlates with their own level of fine motor skills. This association was not fully explained by either measures of global attention (i.e., looking time) or general developmental stage. This striking concordance between the emergence of motor skills and related perceptual processing within individuals is consistent with experience-related cortical specialization in the developing brain.

Rapid Attentional Selection of Non-native Stimuli despite Perceptual Narrowing.

Visual experiences increase our ability to discriminate environmentally relevant stimuli (native stimuli, e.g., human faces) at the cost of a reduced sensitivity to irrelevant or infrequent stimuli (non-native stimuli, e.g., monkey/ape faces)-a developmental progression known as perceptual narrowing. One possible source of the reduced sensitivity in distinguishing non-native stimuli (e.g., one ape face vs. another ape face) could be underspecified attentional search templates (i.e., working memory representations). To determine whether perceptual narrowing stems from underspecified attentional templates for non-native exemplars, this study used ERP (the N2pc component) and behavioral measures in a visual search task, where the target was either an exemplar (e.g., a specific ape face) or a category (e.g., any ape face). The N2pc component, an ERP marker of early attentional selection emerging at 200 msec poststimulus, is typically modulated by the specificity of the target and, therefore, by the attentional template-the N2pc is larger for specific items versus categories. In two experiments using both human and ape faces (i.e., native and non-native stimuli), we found that perceptual narrowing affects later response selection (i.e., manual RT and accuracy), but not early attentional selection relying on attentional templates (i.e., the N2pc component). Our ERP results show that adults deploy exemplar level attentional templates for non-native stimuli (as well as native stimuli), despite poor downstream behavioral performance. Our findings suggest that long-term previous experience with reduced exemplar level judgments (i.e., perceptual narrowing) does not appear to eliminate early attentional selection of non-native exemplars.