Effective connectivity relates seizure outcome to electrode placement in responsive neurostimulation.

Responsive neurostimulation is a closed-loop neuromodulation therapy for drug resistant focal epilepsy. Responsive neurostimulation electrodes are placed near ictal onset zones so as to enable detection of epileptiform activity and deliver electrical stimulation. There is no standard approach for determining the optimal placement of responsive neurostimulation electrodes. Clinicians make this determination based on presurgical tests, such as MRI, EEG, magnetoencephalography, ictal single-photon emission computed tomography and intracranial EEG. Currently functional connectivity measures are not being used in determining the placement of responsive neurostimulation electrodes. Cortico-cortical evoked potentials are a measure of effective functional connectivity. Cortico-cortical evoked potentials are generated by direct single-pulse electrical stimulation and can be used to investigate cortico-cortical connections in vivo. We hypothesized that the presence of high amplitude cortico-cortical evoked potentials, recorded during intracranial EEG monitoring, near the eventual responsive neurostimulation contact sites is predictive of better outcomes from its therapy. We retrospectively reviewed 12 patients in whom cortico-cortical evoked potentials were obtained during stereoelectroencephalography evaluation and subsequently underwent responsive neurostimulation therapy. We studied the relationship between cortico-cortical evoked potentials, the eventual responsive neurostimulation electrode locations and seizure reduction. Directional connectivity indicated by cortico-cortical evoked potentials can categorize stereoelectroencephalography electrodes as either receiver nodes/in-degree (an area of greater inward connectivity) or projection nodes/out-degree (greater outward connectivity). The follow-up period for seizure reduction ranged from 1.3-4.8 years (median 2.7) after responsive neurostimulation therapy started. Stereoelectroencephalography electrodes closest to the eventual responsive neurostimulation contact site tended to show larger in-degree cortico-cortical evoked potentials, especially for the early latency cortico-cortical evoked potentials period (10-60 ms period) in six out of 12 patients. Stereoelectroencephalography electrodes closest to the responsive neurostimulation contacts (≤5 mm) also had greater significant out-degree in the early cortico-cortical evoked potentials latency period than those further away (≥10 mm) (P < 0.05). Additionally, significant correlation was noted between in-degree cortico-cortical evoked potentials and greater seizure reduction with responsive neurostimulation therapy at its most effective period (P < 0.05). These findings suggest that functional connectivity determined by cortico-cortical evoked potentials may provide additional information that could help guide the optimal placement of responsive neurostimulation electrodes.

Narratives Shape Cognitive Representations of Immigrants and Immigration-Policy Preferences.

Scholars from across the social and media sciences have issued a clarion call to address a recent resurgence in criminalized characterizations of immigrants. Do these characterizations meaningfully impact individuals' beliefs about immigrants and immigration? Across two online convenience samples (total N = 1,054 adult U.S. residents), we applied a novel analytic technique to test how different narratives-achievement, criminal, and struggle-oriented-impacted cognitive representations of German, Russian, Syrian, and Mexican immigrants and the concept of immigrants in general. All stories featured male targets. Achievement stories homogenized individual immigrant representations, whereas both criminal and struggle-oriented stories racialized them along a White/non-White axis: Germany clustered with Russia, and Syria clustered with Mexico. However, criminal stories were unique in making our most egalitarian participants' representations as differentiated as our least egalitarian participants'. Narratives about individual immigrants also generalized to update representations of nationality groups. Most important, narrative-induced representations correlated with immigration-policy preferences: Achievement narratives and corresponding homogenized representations promoted preferences for less restriction, and criminal narratives promoted preferences for more.

Attaining interprofessional competencies by connecting oral health to overall health.

PURPOSE: The purpose of this study was to evaluate the effectiveness of an annual oral-systemic health interprofessional education (IPE) clinical simulation and case study experience with nurse practitioner/midwifery (NP/MW), dental (DDS), medical (MD), and pharmacy (PharmD) students. METHODS: The Interprofessional Collaborative Competency Attainment Scale (ICCAS) was used to measure students' self-reported attainment of interprofessional competencies before and after the IPE experience. Pre- and post-test surveys were completed by NP/MW, DDS, MD, and PharmD student cohorts from 2017 to 2019. Students also had the opportunity to provide qualitative feedback about their experience at post-test. Data were collected from IPE faculty facilitators to assess their perception of the value of the Teaching Oral-Systemic Health (TOSH) program. RESULTS: Student ICCAS results demonstrated statistically significant improvement in self-reported interprofessional competencies among all types of students across all 3 years (P < 0.001); qualitative student comments reflected positive experiences with the TOSH program. Survey data from IPE faculty facilitators supported the value of the IPE experience for all students. CONCLUSIONS: The findings demonstrate the effectiveness of the TOSH program in using oral-systemic health as a clinical exemplar to develop interprofessional competencies. The 2017-2019 data reinforce the credibility of scaling the TOSH model for developing interprofessional competencies with students from different health professions.

Primary CNS lymphoma initially diagnosed as vasculitis.

PURPOSE OF REVIEW: A vasculitic pattern of injury seen on brain biopsy can be attributed to a multitude of primary or secondary disorders, leading to diagnostic challenges for clinicians. RECENT FINDINGS: This report describes the clinical presentation and histopathologic findings in 2 patients who initially received a diagnosis of primary CNS vasculitis, but did not show long-term response to treatment. In both cases, a second biopsy was performed, and the final diagnosis was primary CNS lymphoma (PCNSL). SUMMARY: Analyzing diagnostically challenging cases can increase recognition of PCNSL and improve outcomes in this rare condition.

Patient management conference: Correlating pre-surgical data.

The epilepsy surgery patient management conference is a fundamental part of the presurgical evaluation. This article reviews the literature and describes a single center's approach. Case examples highlight how patient management conferences may influence clinical care.

Does cognitive dissonance occur in older age? A study of induced compliance in a healthy elderly population.

Does cognitive dissonance change as people age? Although cognitive dissonance has been one of the most widely studied theories in psychology, scant research has investigated the experience of dissonance over the life span and, to our knowledge, no prior research has investigated its effects in healthy older adults. The current study is the 1st empirical test of cognitive dissonance in an elderly population. We found that, consistent with dissonance theory, older adults showed effects of cognitive dissonance as measured by attitude differences in the direction of attitude-discrepant behavior in a classic induced compliance paradigm. Implications for the development of prohealth, dissonance-based interventions are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurologic manifestations associated with cryoglobulinemia: A single center experience.

INTRODUCTION: Limited information is available describing the spectrum of neurological complications of cryoglobulinemia. METHODS: Single center retrospective review of patients with neurologic symptoms and elevated serum cryoglobulins, with their potential association being classified as definite, possible, or unlikely using defined criteria. RESULTS: Among 492 patients, 131 (87 classified as definite and 44 as possible) had neurologic symptoms associated with cryoglobulinemia. Common comorbidities included hepatitis C (N = 43), monoclonal gammopathy of undetermined significance (N = 20), Sjogren's syndrome (N = 17), membranoproliferative glomerulonephritis (N = 17), and systemic lupus erythematosus (N = 10). Features supporting an association between cryoglobulinemia and neurological symptoms were the presence of purpura (p < .001), positive rheumatoid factor (p = .001) and low C4 (p = .002). Common peripheral neurological diagnoses were symmetric polyneuropathy (N = 84), small fiber neuropathy (N = 25), and mononeuritis multiplex (N = 16). Central neurological manifestations were infrequent and included seizures (N = 3), posterior reversible encephalopathy syndrome (N = 2), intracerebral hemorrhage (N = 1), vasculitis (N = 1), rapidly progressive dementia (N = 1), lymphoma (N = 1), and myelitis/meningitis (N = 1). Treatments utilized included corticosteroids (N = 74), rituximab (N = 42), cyclophosphamide (N = 27), methotrexate, azathioprine, or mycophenolate mofetil (N = 28), anti-viral therapy (N = 20), plasmapheresis (N = 16), and intravenous immunoglobulin (N = 20). Neurologic symptoms associated with cryoglobulinemia remained stable or improved in 86% of patients. CONCLUSION: This study describes a wide spectrum of patients with neurologic symptoms attributed to cryoglobulinemia and provides a framework to approach this challenging diagnosis.

Influencing Republicans' and Democrats' attitudes toward Obamacare: Effects of imagined vicarious cognitive dissonance on political attitudes.

The field of experimental social psychology is appropriately interested in using novel theoretical approaches to implement change in the social world. In the current study, we extended cognitive dissonance theory by creating a new framework of social influence: imagined vicarious dissonance. We used the framework to influence attitudes on an important and controversial political attitude: U.S. citizens' support for the Affordable Care Act (ACA). 36 Republicans and 84 Democrats were asked to imagine fellow Republicans and Democrats, respectively, making attitude discrepant statements under high and low choice conditions about support for the ACA. The data showed that vicarious dissonance, established by imagining a group member make a counterattitudinal speech under high-choice conditions (as compared to low-choice conditions), resulted in greater support for the Act by Republicans and marginally diminished support by Democrats. The results suggest a promising role for the application of vicarious dissonance theory to relevant societal issues and for further understanding the relationship of dissonance and people's identification with their social groups.

Evaluating subjective cognitive impairment in the adult epilepsy clinic: Effects of depression, number of antiepileptic medications, and seizure frequency.

OBJECTIVE: Subjective cognitive complaints are a frequent concern of patients with epilepsy. The Aldenkamp-Baker Neuropsychological Assessment Schedule (ABNAS) is a patient-reported scale validated to measure adverse cognitive effects of antiepileptic drugs (AEDs). The goals of this study were to identify predictors of patient-reported cognitive dysfunction and to assess the relationship between subjective and objective cognitive impairment. METHODS: The Cleveland Clinic Knowledge Program Data Registry was used to identify adult patients seen in outpatient epilepsy clinic from January to May 2015 and who completed the following scales: ABNAS for subjective cognitive impairment, Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder 7-item (GAD-7) scale, Quality of Life in Epilepsy (QOLIE-10), and EuroQOL five dimensions questionnaire (EQ-5D) for health-related quality of life. Topiramate (TPM) was considered a high-risk medication for cognitive impairment. Patients were categorized into groups based on total ABNAS score: subjective cognitive impairment (ABNAS>15; N=270) and no subjective cognitive impairment (ABNAS≤15; N=400). Multivariable logistic regression models were constructed to identify independent predictors of subjective cognitive impairment. In a subset of patients who had neuropsychological testing within 6months of completing the ABNAS (N=60), Pearson correlations and multivariable logistic regression models, controlling for number of AEDs, depression, and anxiety, assessed the relationship between subjective cognitive impairment and objective cognitive performance on measures of intelligence, attention/working memory, verbal fluency, naming, processing speed, manual dexterity, visuomotor processing, and verbal memory. RESULTS: Forty percent of patients in the overall sample (N=270/670) reported cognitive impairment. The variables most strongly associated with subjective cognitive impairment were PHQ-9 score, number of AEDs, and seizure frequency. In the subset of patients with neuropsychological testing, ABNAS score was correlated with anxiety (r=0.44), depression (r=0.38), and attention/working memory (r=-0.31). After adjusting for depression and anxiety, patients who endorsed subjective cognitive impairment scored significantly lower on measures of nonverbal intelligence and attention/working memory, but not on other cognitive measures. CONCLUSIONS: Subjective cognitive impairment as reported on the ABNAS is most strongly associated with depressive symptomatology, number of AEDs, and seizure frequency, but not with most objective cognitive measures. Identifying these three predictors provides a clear framework to understand and address subjective cognitive complaints in adult patients with epilepsy.

Is There Any Hope? How Climate Change News Imagery and Text Influence Audience Emotions and Support for Climate Mitigation Policies.

Using a national sample, this study experimentally tests the effects of news visuals and texts that emphasize either the causes and impacts of climate change or actions that can be taken to address climate change. We test the effects of variations in text and imagery on discrete emotions (i.e., hope, fear, and anger) and, indirectly, on support for climate mitigation policies. Political ideology is examined as a moderator. The findings indicate that news images and texts that focus on climate-oriented actions can increase hope and, in the case of texts, decrease fear and anger, and these effects generally hold across the ideological spectrum. In turn, the influence of emotions on policy support depends on ideology: Hope and fear increase support for climate policies for all ideological groups but particularly conservatives, whereas anger polarizes the opinions of liberals and conservatives. Implications for climate change communication that appeals to emotions are discussed.

Polarizing news? Representations of threat and efficacy in leading US newspapers' coverage of climate change.

This study examines non-editorial news coverage in leading US newspapers as a source of ideological differences on climate change. A quantitative content analysis compared how the threat of climate change and efficacy for actions to address it were represented in climate change coverage across The New York Times, The Wall Street Journal, The Washington Post, and USA Today between 2006 and 2011. Results show that The Wall Street Journal was least likely to discuss the impacts of and threat posed by climate change and most likely to include negative efficacy information and use conflict and negative economic framing when discussing actions to address climate change. The inclusion of positive efficacy information was similar across newspapers. Also, across all newspapers, climate impacts and actions to address climate change were more likely to be discussed separately than together in the same article. Implications for public engagement and ideological polarization are discussed.

The Influence of Climate Change Efficacy Messages and Efficacy Beliefs on Intended Political Participation.

Using an online survey experiment with a national sample, this study examined how changing the type and valence of efficacy information in news stories discussing global climate change may impact intended political participation through the mediators of perceived internal, external, and response efficacy. Overall, the results revealed that after a single exposure to a news story, stories including positive internal efficacy content increased perceived internal efficacy, while stories including negative external efficacy content lowered perceived external efficacy. There were limited impacts of other types of efficacy content on perceived efficacy. Perceived internal, external, and response efficacy all offered unique, positive associations with intentions to engage in climate change-related political participation. The results suggest that news stories including positive internal efficacy information in particular have the potential to increase public engagement around climate change. The implications for science communication are discussed.

Variables Affecting General Anesthesia Time for Pediatric Dental Cases.

PURPOSE: The purpose of this study was to identify variables affecting procedural times for dental treatments performed in the operating room (OR) under general anesthesia. METHODS: A total of 2,264 OR cases at Boston Children's Hospital were included in the study. A series of patient, provider, and operational variables were studied, including: patient age, gender, American Society of Anesthesiologists (ASA) class, need for intraoperative radiographs, intubation type, provider type, referring provider type, referral date, waiting time between referral and OR, and symmetry of caries pattern. Analysis of variance, z test, t test, Pearson correlations, and regression modeling were used. RESULTS: Provider inexperience, need for obtaining radiographs, older age, higher ASA class, and oral intubation significantly increased surgical case times. Using the current OR case estimation resulted in an overestimation of 14.6 hours per month. Application of our regression model improved the accuracy of case time estimation by 7.9 hours per month. CONCLUSIONS: Overestimation of pediatric dental operating room cases exists, and identification of variables associated with these inaccuracies can aid providers in recapturing underutilized operating room times.

An attack on science? Media use, trust in scientists, and perceptions of global warming.

There is a growing divide in how conservatives and liberals in the USA understand the issue of global warming. Prior research suggests that the American public's reliance on partisan media contributes to this gap. However, researchers have yet to identify intervening variables to explain the relationship between media use and public opinion about global warming. Several studies have shown that trust in scientists is an important heuristic many people use when reporting their opinions on science-related topics. Using within-subject panel data from a nationally representative sample of Americans, this study finds that trust in scientists mediates the effect of news media use on perceptions of global warming. Results demonstrate that conservative media use decreases trust in scientists which, in turn, decreases certainty that global warming is happening. By contrast, use of non-conservative media increases trust in scientists, which, in turn, increases certainty that global warming is happening.

Homozygous DNA ligase IV R278H mutation in mice leads to leaky SCID and represents a model for human LIG4 syndrome.

DNA ligase IV (LIG4) is an essential component of the nonhomologous end-joining (NHEJ) repair pathway and plays a key role in V(D)J recombination. Hypomorphic LIG4 mutations in humans are associated with increased cellular radiosensitivity, microcephaly, facial dysmorphisms, growth retardation, developmental delay, and a variable degree of immunodeficiency. We have generated a knock-in mouse model with a homozygous Lig4 R278H mutation that corresponds to the first LIG4 mutation reported in humans. The phenotype of homozygous mutant mice Lig4(R278H/R278H) (Lig4(R/R)) includes growth retardation, a decreased life span, a severe cellular sensitivity to ionizing radiation, and a very severe, but incomplete block in T and B cell development. Peripheral T lymphocytes show an activated and anergic phenotype, reduced viability, and a restricted repertoire, reminiscent of human leaky SCID. Genomic instability is associated with a high rate of thymic tumor development. Finally, Lig4(R/R) mice spontaneously produce low-affinity antibodies that include autoreactive specificities, but are unable to mount high-affinity antibody responses. These findings highlight the importance of LIG4 in lymphocyte development and function, and in genomic stability maintenance, and provide a model for the complex phenotype of LIG4 syndrome in humans.

Alternative end-joining catalyzes robust IgH locus deletions and translocations in the combined absence of ligase 4 and Ku70.

Class switch recombination (CSR) in B lymphocytes is initiated by introduction of multiple DNA double-strand breaks (DSBs) into switch (S) regions that flank immunoglobulin heavy chain (IgH) constant region exons. CSR is completed by joining a DSB in the donor S mu to a DSB in a downstream acceptor S region (e.g., S gamma1) by end-joining. In normal cells, many CSR junctions are mediated by classical nonhomologous end-joining (C-NHEJ), which employs the Ku70/80 complex for DSB recognition and XRCC4/DNA ligase 4 for ligation. Alternative end-joining (A-EJ) mediates CSR, at reduced levels, in the absence of C-NHEJ, even in combined absence of Ku70 and ligase 4, demonstrating an A-EJ pathway totally distinct from C-NHEJ. Multiple DSBs are introduced into S mu during CSR, with some being rejoined or joined to each other to generate internal switch deletions (ISDs). In addition, S-region DSBs can be joined to other chromosomes to generate translocations, the level of which is increased by absence of a single C-NHEJ component (e.g., XRCC4). We asked whether ISD and S-region translocations occur in the complete absence of C-NHEJ (e.g., in Ku70/ligase 4 double-deficient B cells). We found, unexpectedly, that B-cell activation for CSR generates substantial ISD in both S mu and S gamma1 and that ISD in both is greatly increased by the absence of C-NHEJ. IgH chromosomal translocations to the c-myc oncogene also are augmented in the combined absence of Ku70 and ligase 4. We discuss the implications of these findings for A-EJ in normal and abnormal DSB repair.