Intra-individual comparison of prostate-specific membrane antigen positron emission tomography/computed tomography versus bone scan in detecting skeletal metastasis at prostate cancer diagnosis.

OBJECTIVES: To compare the diagnostic performance and radiological staging impact of 68 Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) compared to 99 Tc whole-body bone scan (WBBS) for the detection of skeletal metastasis in the primary staging of prostate cancer (PCa). PATIENTS AND METHODS: A prospective institutional database was retrospectively examined for patients who underwent both PSMA PET and WBBS within a 1 week interval for PCa primary staging. Lesions were categorised as 'negative', 'equivocal', or 'definite' based on nuclear medicine physician interpretation. Metastatic burden was characterised for each imaging modality according to three groups: (i) local disease (no skeletal metastases), (ii) oligometastatic disease (three or fewer skeletal metastases), or (iii) polymetastatic disease (more than three skeletal metastases). RESULTS: There were 667 patients included. The median (interquartile range) prostate-specific antigen level was 9.2 (6.2-16) ng/mL and 60% of patients were high risk according to a modified D'Amico risk classification. The overall distribution of skeletal metastasis detection changed across the two scans overall (P = 0.003), being maintained within high-risk (P = 0.030) and low-risk (P = 0.018) groups. PSMA PET/CT identified more definite skeletal metastases compared to WBBS overall (10.3% vs 7.3%), and according to risk grouping (high: 12% vs 9%, intermediate: 4% vs 1%). Upstaging was more common with PSMA PET/CT than WBBS (P = 0.001). The maximum standardised uptake value (SUVmax ) of the primary tumour was associated with upstaging of skeletal metastases on PSMA PET/CT (P = 0.025), while age was associated with upstaging on WBBS (P = 0.021). The SUVmax of the primary tumour and metastases were both higher according to extent of metastatic disease (P = 0.001 and P < 0.001, respectively). CONCLUSIONS: More skeletal metastases were detected with PSMA PET/CT than WBBS, resulting in a higher upstaging rate mostly in high-risk patients. The SUVmax of the primary tumour and metastases was associated with upstaging.

Substance use treatment services for older adults in five states in the Southern United States: a state-by-state comparison of available treatment services.

Objectives: Substance use disorders (SUD) among older adults have become a serious public health concern. The purpose of this study was to assess which states in the Southern U.S. are more responsive to SUD treatment needs of older adults.Methods: This study is a secondary data analysis of the N-SSATS-2019 dataset.Results: There were 1,215 substance treatment facilities in the five states. Kentucky had the highest number of substance use treatment facilities (n = 449, 37%), followed by Georgia (357, 29%), Alabama (153, 13%), Louisiana (146, 12%) and then Mississippi (110, 9%). Out of the 1,215 facilities, only 20% (n = 244) indicated that they had programs specifically tailored for older adults. Kentucky had the largest number of facilities per 1 million older adults while Mississippi had the highest number of facilities per 1 million older adults offering detoxification services. Alabama had the lowest number of services per 1 million adults in all categories examined.Conclusion: Across the U.S., most adults with SUD do not have access to substance use treatment; in the southeastern region of the country, higher rates of poverty, rural geography and stigma, and lack of treatment availability may further complicate individuals' ability to access substance use-related medical care.

Contextual Use of Protective Behavioral Strategies for College Drinking.

Background: Alcohol use on college campuses in the United States is a public health concern. Some students engage in protective behavioral strategies (PBS) before, during, or after their alcohol consumption (e.g., designated driver) to try to mitigate negative alcohol-related negative consequences. There is a gap in the literature on the use of different PBS in different situations commonly experienced by students (e.g., game day). The goal of the present study was to determine whether students would use different PBS for different situations, and to determine which PBS they would encourage their peers to use in these same situations. Objectives: A total of 182 undergraduate students were presented with three different hypothetical drinking scenarios (i.e., a friend's 21st birthday celebration, football game day, and a house party) and asked which PBS they would use (i.e., limit drinking, change their manner of drinking, serious harm reduction strategies) and which they would recommend to their friends. They were also given the option to not drink at all. Results: Overall, students chose different strategies for different situations: they chose to limit their drinking at their friend's 21st birthday or the game day tailgating event, to alter the manner of their drinking for the game day tailgating event, to reduce the potential of harm at the house party, and to not drink at their friend's 21st birthday or the house party event. Students' personal choices matched their recommended choices for their friends. Conclusions: Results may have implications for prevention programs that teach harm reduction strategies such as PBS.

Substance use and opioid-related stigma among Black communities in the rural South.

PURPOSE: This study examined perceived substance use, opioid knowledge, and barriers to Black people accessing treatment for substance and opioid use disorder (SUD/OUD). METHODS: Thirty-nine participants completed the community survey and The Brief Opioid Overdose Knowledge questionnaire. Qualitative interviews were conducted with 18 stakeholders and 9 people with SUD/OUD. FINDINGS: Out of 39 participants, <50 % knew where to refer someone for treatment and fewer knew where to access naloxone. Majority of the stakeholders and people with SUD/OUD reported stigma as a treatment barrier. CONCLUSION: Studies related to provider anti-stigma trainings and psychoeducation for Black people living in the rural South are warranted.

Facial Affect Sensitivity Training for Young Children with Emerging CU Traits: An Experimental Therapeutics Approach.

OBJECTIVE: This article delineates best practices in the application of the experimental therapeutics framework for evaluating interventions within the context of randomized controlled trials (RCTs), offering a methodological primer and guiding framework for this approach. We illustrate these practices using an ongoing clinical trial conducted within the framework of a National Institute of Mental Health exploratory phased-innovation award for the development of psychosocial therapeutic interventions for mental disorders (R61/R33), describing the implementation of a novel "Facial Affect Sensitivity Training" (FAST) intervention for children with callous-unemotional (CU) traits. CU traits (e.g., lack of guilt or remorse, low empathy, shallow affect) are an established risk factor for persistent and severe youth misconduct, which reflect impairment in identified neurocognitive mechanisms that interfere with child socialization, and predict poor treatment outcomes, even with well-established treatments for disruptive behavior. METHOD: We outline the stages, goals, and best practices for an experimental therapeutics framework. In the FAST trial, we assert that impaired sensitivity for emotional distress cues (fear and/or sadness) is mechanistically linked to CU traits in children, and that by targeting sensitivity to facial affect directly via a computerized automated feedback and incentive system, we can exert downstream effects on CU traits. RESULTS: In the context of an open pilot trial, we found preliminary support for feasibility and mechanism engagement using FAST. CONCLUSIONS: We summarize pilot study limitations and how they are being addressed in the R61/R33 RCTs, as well as challenges and future directions for psychosocial experimental therapeutics.

The Effects of Race and Socioeconomics on the Relationship Between Gestational Diabetes Mellitus and Birth Outcomes: An Analysis of Southern US PRAMS data.

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Uncontrolled GDM increases the risk of negative pregnancy outcomes for both the pregnant individual and the infant. African Americans (AAs) have higher maternal morbidity and infant mortality rates than non-Hispanic whites (NHWs). The goal of the current study was to examine racial differences in the effect of GDM on birth outcomes. The data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed with a focus on four states in the southern U.S. (Alabama, Georgia, Louisiana, and Mississippi). The results presented suggest that AAs are at lower risk of GDM than NHW individuals. Even with the lower risk of GDM, AAs are at higher risk of pre-term births. In addition, socioeconomic factors and access to prenatal care play a role in birth outcomes including moderating the effect of GDM on outcomes. A discussion of potential policy interventions that may improve pregnancy outcomes is discussed including increased use of doulas to support pregnant people.

Minority stress process among older Black Americans: the role of age, perceived discrimination, and anxiety.

Objective: Prolonged experiences of discrimination can be a major source of physical and health-related stress, particularly in older Black Americans. However, there is limited information on the relation between discrimination and anxiety, particularly within the context of other constructs that influence the manifestation of anxiety symptoms. For example, several studies have suggested that ethnic identification may provide psychological and social resources to deal with the effects of discrimination. This study aims to further understand these processes.Method: This study utilized structural equation modeling (SEM) to examine predictors of anxiety symptom severity in a sample of African American and Afro-Caribbean adults aged 55 and older from the National Survey of American Life (N = 1,032).Results: The final structural regression model revealed acceptable fit indices, and was successful in measuring latent anxiety symptom severity, showing that more experienced discrimination was related to higher anxiety and anxiety was directly related to mental health rating. While higher experience of discrimination was associated with higher anxiety, it was not directly related to mental health rating. However, contrary to expectation, ethnic identification did not serve as a protective factor between experienced discrimination and anxiety. As individuals aged, they experienced less discrimination and reported poorer self-rated mental health.Conclusions: While age served as a protective factor for perceived discrimination and anxiety symptom severity, ethnic identification did not. Implications for those working to reduce anxiety symptoms among Black Americans are discussed.

Does group membership affect children's judgments of social transgressions?

Children judge in-group members more favorably than out-group members. They also judge moral transgressions as more serious and more worthy of punishment than conventional transgressions. Here we asked whether children's judgments of moral and conventional transgressions vary by the group membership of the transgressor (in-group, neutral, out-group, or self). In addition, we asked whether judgments of the transgressions would extend to the transgressors themselves, including cases in which the self was the transgressor. Results show that transgressions committed by out-group members were judged as being more serious and more punish-worthy than those committed by members of other groups. In addition, children judged out-group transgressors more harshly, and the self more leniently, than other group members. Overall, results suggest that group membership does affect judgments of transgressions and transgressors, with out-group members consistently judged the most negatively and the self consistently judged the least negatively. However, when judging the transgressor or the seriousness of the transgression, domain distinctions do persist even as group membership varies. Although, when assigning punishment, domain distinctions persist only when judging the transgressions of out-group members and neutral individuals. These findings demonstrate the powerful effect of group membership on the judgments of both acts and actors, indicating that when judging transgressions children consider not only the moral or conventional status of the act but also the group membership of the actor.

Group versus individual format of intervention for aggressive children: Moderators and predictors of outcomes through 4 years after intervention.

This study originated in collaboration with Thomas Dishion because of concerns that a group format for aggressive children might dampen the effects of cognitive-behavioral intervention. Three hundred sixty aggressive preadolescent children were screened through teacher and parent ratings. Schools were randomized to receive either an individual or a group format of the child component of the same evidence-based program. The results indicate that there is variability in how group-based cognitive-behavioral intervention can affect aggressive children through a long 4-year follow-up after the end of the intervention. Aggressive children who have higher skin conductance reactivity (potentially an indicator of poorer emotion regulation) and who have a variant of the oxytocin receptor gene that may be associated with being hyperinvolved in social bonding have better outcomes in their teacher-rated externalizing behavior outcomes over time if they were seen individually rather than in groups. Analyses also indicated that higher levels of the group leaders' clinical skills predicted reduced externalizing behavior problems. Implications for group versus individual format of cognitive-behavioral interventions for aggressive children, and for intensive training for group therapists, informed by these results, are discussed.

Gastric Schwannoma Demonstrated on 18 F FDG PET/CT With Pathological Correlation.

ABSTRACT: A 66-year-old man with background hypertension and type 2 diabetes presented with 1 month history of epigastric pain for investigation. Abdominal CT and MRI identified round homogeneously enhancing mass arising from the lesser curvature of the stomach. On 18 F-FDG PET/CT, the gastric mass demonstrated intense FDG uptake (SUV max , 9.6). The patient subsequently underwent partial gastrectomy, with pathological features and immunohistochemical patterns consistent with gastric schwannoma.

Incidental Prostate-Specific Membrane Antigen-Avid Vestibular Schwannoma Detected on 68 Ga-Prostate-Specific Membrane Antigen PET/CT.

ABSTRACT: A 62-year-old man was referred for a 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for newly diagnosed prostate cancer (ISUP grade 5), on the background of left vestibular schwannoma treated with surgical excision 25 years ago. PSMA PET study confirmed the presence of PSMA-avid malignancy in the left prostate lobe with no evidence of PSMA-avid nodal or distant metastasis. An incidental PSMA-avid focus (SUV max , 4.3) was identified in the region of the left cerebellopontine angle, which corresponded to a homogeneous enhancing lesion centered at the left internal acoustic canal and left cerebellopontine angle on MRI. The combined PSMA PET findings and MRI characteristics were consistent with recurrent vestibular schwannoma.

The association between discourse production and schizotypal personality traits.

Discourse abnormalities are a prominent feature in schizophrenia spectrum disorders, including poor lexical diversity, and have been found to differentiate patients from healthy subjects. However, discourse processing in individuals with high schizotypal personality traits is less understood and is often overshadowed by research on clinical psychotic symptoms. In the present study, we examined schizotypal traits at a non-clinical threshold and their association with lexical diversity and discourse coherence using two automated Natural Language Processing (NLP) tools - Type-Token-Ratio (TTR) measures from the Tool for the Automatic Analysis of Lexical Diversity (TAALED) and discourse coherence using sentence-level average cosign similarity with FastText to assess sentence similarity. 276 college students completed the full assessment including the Schizotypal Personality Questionnaire- Brief Revised (SPQ-BR) and recorded a speech sample describing a detailed painting. Results revealed that high schizotypal traits, specifically positive traits, were associated with lower lexical diversity and higher sentence similarity. Our findings suggest that even when clinically significant symptoms are not present, discourse abnormalities are present in healthy populations with high ST. The stronger association with positive traits suggests that theories of perseveration and top-down processing may warrant further investigation in schizophrenia-spectrum disorders.

False-Positive Metastatic Bone Disease on FDG PET/CT Due to Multilevel Tophaceous Gout of the Spine.

ABSTRACT: A 74-year-old woman was referred for 18 F-FDG PET/CT for the evaluation of incidental CT finding of expansile destruction of left L4/5 facet joint with associated soft tissue mass concerning for a metastatic deposit. The FDG PET/CT revealed variable abnormally increased FDG activity involving multiple facet joints in all regions of the spine with corresponding expansile "punched-out" lytic lesions with sclerotic rims and overhanging margins on CT, raising the possibility of inflammatory polyarthropathy, including gout, as a differential diagnosis. Dual-energy CT of lumbar spine and CT-guided biopsy and culture of the left L4/5 facet joint demonstrated the presence of urate crystal deposition with no evidence of malignancy or infection, confirming the diagnosis of multilevel tophaceous gout of the spine.

Self-Reported Chronic Stress Is Unique Across Lifetime Periods: A Test of Competing Structural Equation Models.

BACKGROUND AND OBJECTIVES: Chronic stress can have deleterious effects on physical and mental health. However, self-report measures of chronic stress typically only assess stress recently, ignoring ongoing or repeated stress throughout the life span. The present study tested whether retrospective judgments of stress across different lifetime periods offer unique information that cannot be ascertained by measures of recent chronic stress. RESEARCH DESIGN AND METHODS: A survey was given to 271 adults aged 46-81 using Amazon's Mechanical Turk. The questions assessed self-reported stress across multiple domains (e.g., general stress, financial stress, interpersonal stress) from well-known and validated surveys. Also, items were added to assess different lifetime periods of self-reported stress, including one's childhood, 20s/30s, and 50s/60s. Using structural equation modeling, we tested competing models for how lifetime periods and stress domains might relate to one another. RESULTS: The best fitting model revealed that different domains of stress (discrimination, loneliness, personal, and general stress) were highly correlated with one another within a given lifetime period but that the different lifetime periods (childhood, 20s/30s, 50s/60s, and current) were relatively independent. DISCUSSION AND IMPLICATIONS: Current measures assessing the frequency or strength of "chronic stress" are misleading because they do not capture ongoing or repeated stress throughout the life span. Past experiences convey unique information about one's chronic stress, offering a new perspective on the meaning of "chronic stress" from a life-course perspective, consistent with previous stress accumulation models.

Factors Affecting Hospice Use Among Adolescents and Young Adult Cancer Patients.

Background/Objective: Compared to existing studies on end-of-life care of mid- to older-aged patients diagnosed with cancer, there is a paucity of research on adolescents and young adult (AYA) patients. Guided by the Anderson's Behavioral Model for Healthcare Utilization, this study examined predisposing/enabling/need factors associated with hospice referral/enrollment among AYA patients diagnosed with cancer. Methods: Data were drawn from medical records of AYA patients who died of cancer between January 2013 and December 2016 at three academic sites in the United States and were 15-39 years old at the time of death. Logistic regression was conducted (N = 224). Results: Findings showed that hospice referral was strongly associated with hospice enrollment (odds ratio [OR] = 69.68, p < 0.0001). White patients were more likely to be referred to hospice care than non-White patients; the effect was, however, significant only among patients with private insurance (OR = 3.44, p = 0.040). Patients with public insurance were more likely to be referred to hospice than those with private insurance; the effect was, however, significant only among non-White patients (OR = 5.66, p = 0.005). Among those not receiving cancer treatment in the last month of life (LML), patients with hematologic malignancies were less likely to be referred to hospice than those with solid tumors (OR = 0.19). Among patients with solid tumors, receiving cancer treatment in the LML lowered the odds of hospice referral (OR = 0.50, p = 0.043). Conclusion: Further research efforts are needed to investigate the role of race, insurance, cancer types, and treatments in hospice use among bigger samples of AYA patients diagnosed with cancer.

Incidental Adiposis Dolorosa (Dercum's Disease) Detected on 18 F-DCFPyL PET/CT.

ABSTRACT: A 64-year-old man with recently diagnosed prostate adenocarcinoma and Gleason score 4 + 3 = 7 with a mildly elevated prostate-specific antigen of 5.17 µg/L was referred for 18 F-DCFPyL PET/CT for primary staging. The scan demonstrated incidental innumerable moderately avid subcutaneous nodules due to adiposis dolorosa (Dercum's disease), which is a rare adipose tissue disease.

Assessing wound closure in mice using skin-punch biopsy.

Defects in myofibroblast function may cause wound healing defects in a variety of tissue types. Here we describe a simple skin-punch biopsy approach to screen mouse models for defects in wound closure that does not require extensive surgical training or expensive equipment. Experimental results may serve as an initial proof of concept to determine whether further investigation is necessary or if defects in myofibroblast function observed in other systems also result in reduced skin wound healing.

FDG PET/CT Imaging of Severe Polymyalgia Rheumatica.

ABSTRACT: A 68-year-old woman was referred for an 18 F-FDG PET/CT for evaluation of arthralgia and raised inflammatory markers, which demonstrated intense FDG activity (SUV max , 25.5) at numerous periarticular and extra-articular sites including the cervical and lumbar interspinous bursae, lumbar facet joints, bilateral ischial tuberosities, and greater trochanters and the aorta consistent with active polymyalgia rheumatica.

Associations between self-reported symptoms of SARS-CoV-2 and dietary supplement use over the previous year during the first pandemic wave.

During the initial wave of the COVID-19 pandemic, symptoms of infection varied widely among adults younger than 60 years. This cross-sectional investigation of adults ages 18-59 years explored associations between SARS-CoV-2 symptomatology and supplementation of micronutrients involved in immune function, such as multivitamins, vitamin D, vitamin C, vitamin E and zinc. Between August and December 2020, an online survey was completed by 287 respondents, averaging 33⋅3 ± 10⋅5 years, who recovered from SARS-CoV-2 infection within the previous 4 months. In regression models, intake of supplements over the previous year was not protective against number of symptoms or symptom severity. Despite higher rates of supplementation over the previous year, smokers experienced more symptoms and greater symptom severity than non-smokers. Micronutrient supplementation did not protect young adults from experiencing symptoms of SARS-CoV-2, but our results suggest that smoking cessation may be a more effective modifiable lifestyle factor.

Peritoneal Carcinomatosis From Metastatic Prostate Cancer Identified on 68 Ga-Prostate-Specific Membrane Antigen PET/CT.

ABSTRACT: A 69-year-old man with locally advanced prostate adenocarcinoma (Gleason score 9), who had completed hormone therapy and definitive radiotherapy, presented to hospital with abdominal pain and distension. A CT scan of the abdomen and pelvis revealed ascites and extensive peritoneal/omental nodules. Serum prostate-specific antigen was not raised (0.07 µg/L). 68 Ga-prostate-specific membrane antigen (PSMA) PET/CT demonstrated PSMA-avid disease in the prostate and widespread PSMA-avid peritoneal/omental and liver metastases but with no PSMA-avid bony metastases. Peritoneal nodule biopsy confirmed metastatic prostate cancer.