Analysis of middle meningeal artery embolization for the treatment of chronic, acute on chronic, and subacute subdural hematomas.

Background: Chronic subdural hematoma (cSDH) is a common sequela of traumatic brain injury. Middle meningeal artery embolization (MMAE) has shown promising results as an emerging minimally invasive alternative treatment. The purpose of this study is to examine the safety and efficacy of MMAE performed in patients with cSDH, acute-on-chronic, and subacute SDH with a traumatic etiology. Methods: This retrospective study included cases performed at a Level II Trauma Center between January 2019 and December 2020 for MMAE of cSDHs. Data collected included patient demographic characteristics and comorbidities, SDH characteristics, complications, and efficacy outcomes. The lesion measurements were collected before the procedure, 4-6 weeks and 3-6 months post-procedure. Results: In our patient population, 78% (39) either had lesions improve or completely resolved. The sample included 50 patients with a mean age of 74 years old. Statistically significant reductions in lesion size were found from pre- to post-procedure in the left lesions, right lesions, and midline shifts. The left lesions decreased from 13.88 ± 5.70 mm to 3.19 ± 4.89 mm at 3-6 months with P < 0.001. The right lesions decreased from 13.74 ± 5.28 mm to 4.93 ± 7.46 mm at 3-6 months with P = 0.02. Midline shifts decreased from 3.78 ± 3.98 mm to 0.48 ± 1.31 mm at 3-6 months with P = 0.02. No complications were experienced for bleeding, hematoma, worsening SDH, pseudoaneurysm, or stroke. Conclusion: Our pilot study from a single center utilizing MMAE demonstrates that MMAE is successful without increasing treatment-related complications not only for cSDH but also in acute-on-cSDH and SDH with a subacute component.

Automated classification of fat-infiltrated axillary lymph nodes on screening mammograms.

OBJECTIVE: Fat-infiltrated axillary lymph nodes (LNs) are unique sites for ectopic fat deposition. Early studies showed a strong correlation between fatty LNs and obesity-related diseases. Confirming this correlation requires large-scale studies, hindered by scarce labeled data. With the long-term goal of developing a rapid and generalizable tool to aid data labeling, we developed an automated deep learning (DL)-based pipeline to classify the status of fatty LNs on screening mammograms. METHODS: Our internal data set included 886 mammograms from a tertiary academic medical institution, with a binary status of the fat-infiltrated LNs based on the size and morphology of the largest visible axillary LN. A two-stage DL model training and fine-tuning pipeline was developed to classify the fat-infiltrated LN status using the internal training and development data set. The model was evaluated on a held-out internal test set and a subset of the Digital Database for Screening Mammography. RESULTS: Our model achieved 0.97 (95% CI: 0.94-0.99) accuracy and 1.00 (95% CI: 1.00-1.00) area under the receiver operator characteristic curve on 264 internal testing mammograms, and 0.82 (95% CI: 0.77-0.86) accuracy and 0.87 (95% CI: 0.82-0.91) area under the receiver operator characteristic curve on 70 external testing mammograms. CONCLUSION: This study confirmed the feasibility of using a DL model for fat-infiltrated LN classification. The model provides a practical tool to identify fatty LNs on mammograms and to allow for future large-scale studies to evaluate the role of fatty LNs as an imaging biomarker of obesity-associated pathologies. ADVANCES IN KNOWLEDGE: Our study is the first to classify fatty LNs using an automated DL approach.

Linking specific biological signatures to different childhood adversities: findings from the HERO project.

BACKGROUND: Although investigations have begun to differentiate biological and neurobiological responses to a variety of adversities, studies considering both endocrine and immune function in the same datasets are limited. METHODS: Associations between proximal (family functioning, caregiver depression, and anxiety) and distal (SES-D; socioeconomic disadvantage) early-life adversities with salivary inflammatory biomarkers (IL-1ß, IL-6, IL-8, and TNF-α) and hair HPA markers (cortisol, cortisone, and dehydroepiandrosterone) were examined in two samples of young U.S. children (N = 142; N = 145). RESULTS: Children exposed to higher SES-D had higher levels of TNF-α (B = 0.13, p = 0.011), IL-1ß (B = 0.10, p = 0.033), and DHEA (B = 0.16, p = 0.011). Higher family dysfunction was associated with higher cortisol (B = 0.08, p = 0.033) and cortisone (B = 0.05, p = 0.003). An interaction between SES-D and family dysfunction was observed for cortisol levels (p = 0.020) whereby children exposed to lower/average levels of SES-D exhibited a positive association between family dysfunction and cortisol levels, whereas children exposed to high levels of SES-D did not. These findings were partially replicated in the second sample. CONCLUSIONS: Our results indicate that these biological response systems may react differently to different forms of early-life adversity. IMPACT: Different forms of early-life adversity have varied stress signatures, and investigations of early-life adversities with inflammation and HPA markers are lacking. Children with higher socioeconomic disadvantage had higher TNF-α, IL-1ß, and DHEA. Higher family dysfunction was associated with higher hair cortisol and cortisone levels, and the association between family dysfunction and cortisol was moderated by socioeconomic disadvantage. Biological response systems (immune and endocrine) were differentially associated with distinct forms of early-life adversities.

Developing an HIV and Faith Ambassador Program in North Carolina.

This report from the field describes the development of the HIV & Faith Ambassadors Program to cultivate a cohort of Black faith leaders/communities and Black medical providers to address HIV-related stigma in African American faith communities in North Carolina.

Traumatic carotid-cavernous fistula: A case report.

Direct carotid-cavernous fistulas are a rare complication of craniofacial trauma that often presents with proptosis, chemosis, and other visual symptoms. Disruption of blood flow from a carotid-cavernous fistula can cause cortical and cranial nerve ischemia which requires emergent intervention. Upon clinical suspicion of a carotid-cavernous fistula, patients should undergo computed tomography angiography (CTA) or magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) if no other etiology is suspected. We present a case of a middle-aged patient with a gunshot wound in the posterior pharynx that resulted in a direct carotid-cavernous fistula of the left internal carotid artery.

Evidence for discrete profiles of children's physiological activity across three neurobiological system and their transitions over time.

The conceptualization of stress-responsive physiological systems as operating in an integrated manner is evident in several theoretical models of cross-system functioning. However, limited empirical research has modeled the complexity of multisystem activity. Moreover few studies have explored developmentally regulated changes in multisystem activity during early childhood when plasticity is particularly pronounced. The current study used latent profile analysis (LPA) to evaluate multisystem activity during fall and spring of children's transition to kindergarten in three biological systems: the parasympathetic nervous system (PNS), sympathetic nervous system (SNS), and hypothalamic pituitary adrenal (HPA) axis. Latent transition analysis (LTA) was then used to examine the stability of profile classification across time. Across both timepoints, three distinct profiles of multisystem activity emerged. One profile was characterized by heightened HPA axis activity (HPA Axis Responders), a second profile was characterized by moderate, typically adaptive patterns across the PNS, SNS, and HPA axis (Active Copers/Mobilizers), and a third profile was characterized by heightened baseline activity, particularly in the PNS and SNS (Anticipatory Arousal/ANS Responders). LTA of fall-to-spring profile classifications indicated higher probabilities that children remained in the same profile over time compared to probabilities of profile changes, suggesting stability in certain patterns of cross-system responsivity. Patterns of profile stability and change were associated with socioemotional outcomes at the end of the school year. Findings highlight the utility of LPA and LTA to detect meaningful patterns of complex multisystem physiological activity across three systems and their associations with early adjustment during an important developmental transition.

Optimality and Limitations of Audio-Visual Integration for Cognitive Systems.

Multimodal integration is an important process in perceptual decision-making. In humans, this process has often been shown to be statistically optimal, or near optimal: sensory information is combined in a fashion that minimizes the average error in perceptual representation of stimuli. However, sometimes there are costs that come with the optimization, manifesting as illusory percepts. We review audio-visual facilitations and illusions that are products of multisensory integration, and the computational models that account for these phenomena. In particular, the same optimal computational model can lead to illusory percepts, and we suggest that more studies should be needed to detect and mitigate these illusions, as artifacts in artificial cognitive systems. We provide cautionary considerations when designing artificial cognitive systems with the view of avoiding such artifacts. Finally, we suggest avenues of research toward solutions to potential pitfalls in system design. We conclude that detailed understanding of multisensory integration and the mechanisms behind audio-visual illusions can benefit the design of artificial cognitive systems.

Socioeconomic Adversity, Negativity in the Parent Child-Relationship, and Physiological Reactivity: An Examination of Pathways and Interactive Processes Affecting Young Children's Physical Health.

OBJECTIVE: We tested the hypothesis that socioeconomic status (SES) would predict children's physical health problems at the end of kindergarten among children whose parent reported greater parent-child relationship (PCR) negativity and/or who exhibited greater parasympathetic (RSA) reactivity. We also tested whether RSA and PCR negativity mediated the SES-health association. METHODS: Data were collected from 338 children (mean [SD] age, 5.32 [.32] years) and their primary caregivers (87% biological mothers) during the fall and subsequent spring of kindergarten. In the fall, parents reported income and education level (SES) and PCR negativity, and RSA reactivity was assessed via a standardized challenge protocol for young children. In the fall and then spring, parents reported children's chronic medical conditions and physical health impairments. Multivariate regression was conducted within a structural equation-modeling framework to test hypotheses. RESULTS: Significant interactions were found between SES and PCR negativity (b = -0.074, p = .035) and between SES and RSA reactivity (b = 0.169, p = .019) as predicts children's spring health impairment, adjusting for health in the preceding fall. Lower SES was associated with greater health impairment among children whose parents reported more PCR negativity (b = -0.110, p = .024) and children who showed greater RSA reactivity (b = -0.106, p = .011). Socioeconomic status was unrelated to physical health at low PCR negativity or RSA reactivity. Mediation models were not supported. CONCLUSION: Parent-child relationship quality and individual differences in stress reactivity may modulate the influence of SES on physical health in childhood.

Welfare state regimes, health and health inequalities in adolescence: a multilevel study in 32 countries.

Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the 'Health Behaviour in School-aged Children' study in 2006, including 11- to 15-year-old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self-rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country-level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross-level interaction effects between welfare regimes and socioeconomic position, no clear regime-specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries.

Screen time and physical violence in 10 to 16-year-old Canadian youth.

OBJECTIVES: To examine the independent associations between television, computer, and video game use with physical violence in youth. METHODS: The study population consisted of a representative cross-sectional sample of 9,672 Canadian youth in grades 6-10 and a 1-year longitudinal sample of 1,861 youth in grades 9-10. The number of weekly hours watching television, playing video games, and using a computer was determined. Violence was defined as engagement in ≥2 physical fights in the previous year and/or perpetration of ≥2-3 monthly episodes of physical bullying. Logistic regression was used to examine associations. RESULTS: In the cross-sectional sample, computer use was associated with violence independent of television and video game use. Video game use was associated with violence in girls but not boys. Television use was not associated with violence after controlling for the other screen time measures. In the longitudinal sample, video game use was a significant predictor of violence after controlling for the other screen time measures. CONCLUSIONS: Computer and video game use were the screen time measures most strongly related to violence in this large sample of youth.

Hybrid convolution kernel: optimized CT of the head, neck, and spine.

OBJECTIVE: Conventional CT requires generation of separate images utilizing different convolution kernels to optimize lesion detection. Our goal was to develop and test a hybrid CT algorithm to simultaneously optimize bone and soft-tissue characterization, potentially halving the number of images that need to be stored, transmitted, and reviewed. MATERIALS AND METHODS: CT images generated with separate high-pass (bone) and low-pass (soft tissue) kernels were retrospectively combined so that low-pass algorithm pixels less than -150 HU or greater than 150 HU are substituted with corresponding high-pass kernel reconstructed pixels. A total of 38 CT examinations were reviewed using the hybrid technique, including 20 head, eight spine, and 10 head and neck scans. Three neuroradiologists independently reviewed all 38 hybrid cases, comparing them to both standard low-pass and high-pass kernel convolved images for characterization of anatomy and pathologic abnormalities. The conspicuity of bone, soft tissue, and related anatomy were compared for each CT reconstruction technique. RESULTS: For the depiction of bone, in all 38 cases, the three neuroradiologists scored the hybrid images as being equivalent to high-pass kernel reconstructions but superior to the low-pass kernel. For depiction of extracranial soft tissues and brain, the hybrid kernel was rated equivalent to the low-pass kernel but superior to that of the high-pass kernel. CONCLUSION: The hybrid convolution kernel is a promising technique affording optimized bone and soft tissue evaluation while potentially halving the number of images needed to be transmitted, stored, and reviewed.

Social capital reduces socio-economic differences in child health: evidence from the Canadian Health Behaviour in School-Aged Children study.

OBJECTIVE: To examine whether adolescents' exposure to neighbourhood social capital, which is defined as levels of trust, cohesion and cooperation, reduces socio-economic differences in physical and psychological health outcomes. METHODS: Survey data were collected from the 9717 Canadian youths in grades 6 to 10 participating in the 2006 Health Behaviour of School-aged Children study. Data analyses tested interaction effects of socio-economic status (SES) and social capital on five outcomes: psychological symptoms, somatic symptoms, injuries, fighting and life satisfaction. RESULTS: SES effects on the five health outcomes varied depending on the level of exposure to neighbourhood social capital. High levels of social capital reduced or eliminated SES differences in health. However, in areas of high social capital, more affluent children reported slightly more somatic symptoms, injuries and fighting than less affluent children. CONCLUSION: Reduction of health inequalities in children and youth is a priority for public policy. Our results suggest that building social capital in neighbourhoods is one avenue for reducing socio-economic disparities in children's physical and psychological health. However, the findings suggest that there might be a downside to social capital in that it appears to reverse socio-economic differences in some outcomes.

Income inequality and school bullying: multilevel study of adolescents in 37 countries.

PURPOSE: To examine the association between income inequality and school bullying in an international sample of preadolescents and to test for mediation of this association by the availability of social support from families, peers, and schools. METHODS: The study used economic data from the 2006 United Nations Development Program Human Development Report and survey data from the 2005/2006 Health Behavior in School-aged Children (HBSC) study which included 66,910 11-year-olds in 37 countries. Ecological correlations tested associations between income inequality and bullying among countries. Multilevel linear and ordinal regression analyses tested the effects of income inequality on perceived social support and bullying others at school. RESULTS: Income inequality was associated with rates of bullying among the 37 countries (r = .62). Multilevel analyses indicated that each standard deviation increase in income inequality corresponded with more frequent bullying by males (odds ratio = 1.17) and females (odds ratio = 1.24), less family support and school support but more peer support. Social support from families and schools was associated with less bullying after differences in wealth were taken into account; however, social support did not account for the association between income inequality and bullying. CONCLUSIONS: Countries with high income inequality have more school bullying among preadolescents than countries with low income inequality. Further study is needed to understand the mechanisms that account for this association. Findings suggest that adolescents in areas of wide income inequality-not only those in deprived schools and neighborhoods- should be a focus of anti-bullying campaigns.

How well protected are sexually active 15-year olds? Cross-national patterns in condom and contraceptive pill use 2002-2006.

OBJECTIVES: To present comparative data on sexual initiation, and condom use and contraceptive pill use at last intercourse among adolescents in Europe, Israel and Canada. METHODS: Data were collected by self-report questionnaire from nationally representative samples of 15 year olds in school classrooms in two cross-national surveys undertaken in 24 countries in 2001/02 and 30 countries in 2005/06. RESULTS: In 2005/06 almost 27% of those surveyed had had sex and almost 86% reported using condoms or the contraceptive pill at last intercourse. This reflects little change since 2001/02 in prevalence of sexual initiation and a general increase in being well-protected at last intercourse. There were wide variations with up to a third of sexually active 15 year olds in some countries at risk for either Sexually Transmitted Infections or pregnancy, or both. CONCLUSIONS: Most adolescents were well protected against Sexually Transmitted Infections and pregnancy, but an important minority remain at risk, with very wide cross-national differences.

The role of behavioural factors in explaining socio-economic differences in adolescent health: a multilevel study in 33 countries.

Attempts to describe and explain socio-economic differences in health have mainly focused on adults. Little is known about the mechanisms of the relationship between socio-economic status (SES) and health in adolescence including inconsistent findings between SES and health among young people. Data were derived from representative samples of 13 and 15-year-old students in 33 European and North American countries (n=97,721) as part of the Health Behaviour in School-aged Children (HBSC) study 2001/2002. Multilevel logistic regression models were used to investigate socio-economic differences in self-rated health among adolescents and the contribution of health-related behaviours to the explanation of such differences. Odds ratios of self-rated health by family affluence were calculated before and after adjustment for behavioural factors (tobacco smoking, physical activity, television use, breakfast intake, consumption of fruits and vegetables). On average, adolescents from low affluent families had an odds ratio for low self-rated health of 1.84 for boys and 1.80 for girls, compared to those from high affluent families. The majority of behavioural factors were significantly associated with family affluence in all countries and explained part of the relationship between self-rated health and family affluence. Smoking, physical activity and breakfast consumption showed the largest independent effect on health. The present study suggests that behavioural factors in early adolescence partly account for the association between self-rated health and socio-economic status. Prevention programmes should target unhealthy behaviours of adolescents from lower socio-economic groups to help prevent future life-course disadvantages in terms of health and social inequalities.

Emotional health of Canadian and Finnish students with disabilities or chronic conditions.

The purpose of this study was to investigate the dimensions of emotional health in two population-based groups (Finland and Canada) of adolescents (ages 13 and 15 years) who self-identify as having a disability or chronic condition, as conceptualized by the WHO International Classification of Functioning, Disability and Health. Data from the 2002 WHO Health Behaviour in School-aged Children survey were used to compare the prevalence of emotional health (items on feeling low, feeling nervous) within and between countries. Eighteen percent of the Canadian and Finnish samples indicated they had a long-time disability, illness or medical condition. Canadian adolescents with disability or chronic conditions felt low significantly more frequently than their classmates without disability or chronic conditions. In both countries, students with disabilities who had more than one functional difficulty were significantly more likely to report feeling low and nervous. These results illustrate that the severity of disability as measured by the number of functional difficulties, and not merely the presence of disability or chronic condition, or particular functional difficulties, may play an important role in the emotional health of adolescents. Health promotion programs may use this information to guide practice to support the emotional health of students with disabilities.

Patterns of adolescent physical activity, screen-based media use, and positive and negative health indicators in the U.S. and Canada.

PURPOSE: To examine: (1) how adolescent physical activity (PA) and screen-based media use (SBM) relate to physical and social health indicators, and (2) crossnational differences in these relationships. METHODS: Essentially identical questions and methodologies were used in the Health Behavior in School-Aged Children cross-sectional surveys of nationally representative samples of American (N = 14,818) and Canadian (N = 7266) students in grades 6 to 10. Items included questions about frequency of PA, SBM, positive health indicators (health status, self-image, quality of life, and quality of family and peer relationships), and negative health indicators (health complaints, physical aggression, smoking, drinking, and marijuana use). RESULTS: In regression analyses controlling for age and gender, positive health indicators were uniformly positively related to PA while two negative health indicators were negatively related to PA. However, PA was positively related to physical aggression. The pattern for SBM was generally the opposite; SBM was negatively related to most positive health indices and positively related to several of the negative health indicators. The notable exception was that SBM was positively related to the quality of peer relationships. Although there were crossnational differences in the strength of some relationships, these patterns were essentially replicated in both countries. CONCLUSIONS: Surveys of nationally representative samples of youth in two countries provide evidence of positive physical and social concomitants of PA and negative concomitants of SBM. These findings suggest potential positive consequences of increasing PA and decreasing SBM in adolescents and provide further justification for such efforts.

Parental occupation, family affluence and adolescent health behaviour in 28 countries.

OBJECTIVES: We explored the association between socioeconomic position and four different aspects of adolescent health behavior in a wide range of European countries, the US, Canada and Israel. METHODS: Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2002. Representative samples of 13 and 15 year olds completed a standardised questionnaire during school hours in each country. Logistic regression analyses were used to investigate the independent effect of parental occupation and family affluence on tobacco and alcohol use, vegetable consumption and TV viewing. RESULTS: Family affluence showed no significant association with regular smoking in most countries, whereas an increase in smoking with decreasing occupational status was found in half of the countries. For alcohol consumption a positive association was found with family affluence in half of the countries, while no relationship with parental occupation was observed. Both measures of socioeconomic position were strong independent predictors for vegetable consumption and television viewing in almost all countries. CONCLUSIONS: The findings suggest that health behaviours that begin to develop in adolescence are less strongly influenced by parental socioeconomic position. Preventive intervention strategies should take the different socioeconomic patterns of health behaviour into account.