A Learning Health System Approach to Long COVID Care.

Background: Global initiatives to mitigate COVID-19 transmission have shifted health system priorities to management of patients with prolonged long COVID symptoms. To better meet the needs of patients, clinicians, and systems, a learning health system approach can use rapid-cycle methods to integrate data and real-world experience to iteratively evaluate and adapt models of long COVID care. Observations: Employees in the Veterans Health Administration formed a multidisciplinary workgroup. We sought to develop processes to learn more about this novel long COVID syndrome and innovative long COVID care models that can be applied within and outside of our health care system. We describe our workgroup processes and goals to create a mechanism for cross-facility communication, identify gaps in care and research, and cocreate knowledge on best practices for long COVID care delivery. Conclusions: The learning health system approach will be critical in reimagining health care service delivery after the COVID-19 pandemic.

What happens when romantic couples discuss personal loss? Relational, emotional, and physiological impacts.

Does talking about loss with a romantic partner have salutary personal and relationship effects? Prior evidence reveals the benefits of emotional disclosure in couple relationships, yet disclosure about loss has been overlooked in research on couple communication. Using a novel communication paradigm with young-adult heterosexual romantic partners (N = 114 couples), we investigated emotions, physiological arousal (skin conductance responses [SCR]), and relationship closeness when narrating a personal loss and listening to the partner's loss, and compared these loss discussions to discussions about desired relationship changes. Based on partners' self-reports, narrating loss elicited more vulnerable and, unexpectedly, more antagonistic emotions. Both narrating and listening to loss produced higher self-reported partner closeness, compared to discussing change. In support of the physiological benefits of disclosure, women's SCRs decreased over the discussion when they narrated their own loss. However, both women and men as listeners show a general trend of increasing SCRs over the discussion, suggesting the challenges of being a responsive partner. Moreover, in line with the putative protective effects of partners' biological interdependencies, partner closeness also was higher when both partners showed synchronous decreasing SCR as women narrated their loss. Although limited to young couples in relatively short relationships, these findings reveal some potential benefits of talking about loss in the context of romantic relationships. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal Associations Between Family Aggression, Externalizing Behavior, and the Structure and Function of the Amygdala.

Using longitudinal data from 21 adolescents, we assessed family aggression (via mother, father, and youth report) in early adolescence, externalizing behavior in mid-adolescence, and magnetic resonance imaging (MRI) data in late adolescence. Amygdalae were manually traced, and used as seed regions for resting state analyses. Both family aggression and subsequent externalizing behavior predicted larger right amygdala volumes and stronger amygdala-frontolimbic/salience network connectivity and weaker amygdala-posterior cingulate connectivity. Externalizing behavior in mid-adolescence mediated associations between family aggression in early adolescence and resting state connectivity between the amygdala and the subgenual anterior cingulate cortex, medial prefrontal cortex, orbitofrontal cortex, and posterior cingulate cortex in late adolescence. Family adversity and adolescent behavior problems may share common neural correlates.

Neural correlates of inhibitory spillover in adolescence: associations with internalizing symptoms.

This study used an emotional go/no-go task to explore inhibitory spillover (how intentional cognitive inhibition 'spills over' to inhibit neural responses to affective stimuli) within 23 adolescents. Adolescents were shown emotional faces and asked to press a button depending on the gender of the face. When asked to inhibit with irrelevant affective stimuli present, adolescents recruited prefrontal cognitive control regions (rIFG, ACC) and ventral affective areas (insula, amygdala). In support of the inhibitory spillover hypothesis, increased activation of the rIFG and down-regulation of the amygdala occurred during negative, but not positive, inhibition trials compared with go trials. Functional connectivity analysis revealed coupling of the rIFG pars opercularis and ventral affective areas during negative no-go trials. Age was negatively associated with activation in frontal and temporal regions associated with inhibition and sensory integration. Internalizing symptoms were positively associated with increased bilateral IFG, ACC, putamen and pallidum. This is the first study to test the inhibitory spillover emotional go/no-go task within adolescents, who may have difficulties with inhibitory control, and to tie it to internalizing symptoms.

Corrigendum: Associations between Family Adversity and Brain Volume in Adolescence: Manual vs. Automated Brain Segmentation Yields Different Results.

[This corrects the article on p. 398 in vol. 10, PMID: 27656121.].

Corrigendum: Associations between Family Adversity and Brain Volume in Adolescence: Manual vs. Automated Brain Segmentation Yields Different Results.

[This corrects the article on p. 398 in vol. 10, PMID: 27656121.].

Associations between Family Adversity and Brain Volume in Adolescence: Manual vs. Automated Brain Segmentation Yields Different Results.

Associations between brain structure and early adversity have been inconsistent in the literature. These inconsistencies may be partially due to methodological differences. Different methods of brain segmentation may produce different results, obscuring the relationship between early adversity and brain volume. Moreover, adolescence is a time of significant brain growth and certain brain areas have distinct rates of development, which may compromise the accuracy of automated segmentation approaches. In the current study, 23 adolescents participated in two waves of a longitudinal study. Family aggression was measured when the youths were 12 years old, and structural scans were acquired an average of 4 years later. Bilateral amygdalae and hippocampi were segmented using three different methods (manual tracing, FSL, and NeuroQuant). The segmentation estimates were compared, and linear regressions were run to assess the relationship between early family aggression exposure and all three volume segmentation estimates. Manual tracing results showed a positive relationship between family aggression and right amygdala volume, whereas FSL segmentation showed negative relationships between family aggression and both the left and right hippocampi. However, results indicate poor overlap between methods, and different associations were found between early family aggression exposure and brain volume depending on the segmentation method used.

Basic emotion processing and the adolescent brain: Task demands, analytic approaches, and trajectories of changes.

Early neuroimaging studies suggested that adolescents show initial development in brain regions linked with emotional reactivity, but slower development in brain structures linked with emotion regulation. However, the increased sophistication of adolescent brain research has made this picture more complex. This review examines functional neuroimaging studies that test for differences in basic emotion processing (reactivity and regulation) between adolescents and either children or adults. We delineated different emotional processing demands across the experimental paradigms in the reviewed studies to synthesize the diverse results. The methods for assessing change (i.e., analytical approach) and cohort characteristics (e.g., age range) were also explored as potential factors influencing study results. Few unifying dimensions were found to successfully distill the results of the reviewed studies. However, this review highlights the potential impact of subtle methodological and analytic differences between studies, need for standardized and theory-driven experimental paradigms, and necessity of analytic approaches that are can adequately test the trajectories of developmental change that have recently been proposed. Recommendations for future research highlight connectivity analyses and non-linear developmental trajectories, which appear to be promising approaches for measuring change across adolescence. Recommendations are made for evaluating gender and biological markers of development beyond chronological age.

The UCLA study of Predictors of Cognitive Functioning Following Moderate/Severe Pediatric Traumatic Brain Injury.

OBJECTIVES: Following pediatric moderate-to-severe traumatic brain injury (msTBI), few predictors have been identified that can reliably identify which individuals are at risk for long-term cognitive difficulties. This study sought to determine the relative contribution of detailed descriptors of injury severity as well as demographic and psychosocial factors to long-term cognitive outcomes after pediatric msTBI. METHODS: Participants included 8- to 19-year-olds, 46 with msTBI and 53 uninjured healthy controls (HC). Assessments were conducted in the post-acute and chronic stages of recovery. Medical record review provided details regarding acute injury severity. Parents also completed a measure of premorbid functioning and behavioral problems. The outcome of interest was four neurocognitive measures sensitive to msTBI combined to create an index of cognitive performance. RESULTS: Results indicated that none of the detailed descriptors of acute injury severity predicted cognitive performance. Only the occurrence of injury, parental education, and premorbid academic competence predicted post-acute cognitive functioning. Long-term cognitive outcomes were best predicted by post-acute cognitive functioning. DISCUSSION: The findings suggest that premorbid factors influence cognitive outcomes nearly as much as the occurrence of a msTBI. Furthermore, of youth with msTBI who initially recover to a level of moderate disability or better, a brief cognitive battery administered within several months after injury can best predict which individuals will experience poor long-term cognitive outcomes and require additional services.

Neural mediators of the intergenerational transmission of family aggression.

Youth exposed to family aggression may become more aggressive themselves, but the mechanisms of intergenerational transmission are understudied. In a longitudinal study, we found that adolescents' reduced neural activation when rating their parents' emotions, assessed via magnetic resonance imaging, mediated the association between parents' past aggression and adolescents' subsequent aggressive behavior toward parents. A subsample of 21 youth, drawn from the larger study, underwent magnetic resonance imaging scanning proximate to the second of two assessments of the family environment. At Time 1 (when youth were on average 15.51 years old) we measured parents' aggressive marital and parent-child conflict behaviors, and at Time 2 (≈2 years later), we measured youth aggression directed toward parents. Youth from more aggressive families showed relatively less activation to parent stimuli in brain areas associated with salience and socioemotional processing, including the insula and limbic structures. Activation patterns in these same areas were also associated with youths' subsequent parent-directed aggression. The association between parents' aggression and youths' subsequent parent-directed aggression was statistically mediated by signal change coefficients in the insula, right amygdala, thalamus, and putamen. These signal change coefficients were also positively associated with scores on a mentalizing measure. Hypoarousal of the emotional brain to family stimuli may support the intergenerational transmission of family aggression.

Neural correlates of parent-child HPA axis coregulation.

Parents and children have been found to show coordination or coregulation of the hypothalamic-pituitary-adrenal (HPA) axis. This coordination may be reflected in adolescents' neural activation to parent stimuli, particularly in regions of the brain associated with social information processing. This study reports on 22 adolescents (13 males, mean age 17years), recruited from a longitudinal study to participate in a functional MRI (fMRI) scanning protocol. Approximately 1.5years before the scan, these same adolescents participated in a family conflict discussion in the lab with both parents, and all three family members provided samples of salivary cortisol five times, before and after the discussion. Multilevel models found positive cross-sectional and time-lagged associations between parents' and youth cortisol. Empirical Bayes (EB) coefficients, extracted from these models to reflect the strength of the relationship between parent and adolescent cortisol, were tested in conjunction with adolescents' neural activation to video clips of their parents taken from the conflict discussion. For both mothers and fathers, youth who showed stronger cortisol coregulation with each parent (both in cross-sectional and time-lagged analyses) showed more activation to that same parent in posteromedial regions (precuneus, posterior cingulate, and retrosplenial cortex) that have been linked with social cognition, e.g. mentalizing about others' emotions. Youths' adrenocortical coregulation with their parents may be reflected in their neural processing of stimuli featuring those same parents.

Neural correlates of adolescents' viewing of parents' and peers' emotions: Associations with risk-taking behavior and risky peer affiliations.

Social reorientation from parents to same-age peers is normative in adolescence, but the neural correlates of youths' socioemotional processing of parents and peers have not been explored. In the current study, 22 adolescents (average age 16.98) underwent neuroimaging (functional magnetic resonance imaging) while viewing and rating emotions shown in brief video clips featuring themselves, their parents, or an unfamiliar peer. Viewing self vs. other and parents vs. the peer activated regions in the medial prefrontal cortex, replicating prior findings that this area responds to self-relevant stimuli, including familiar and not just similar others. Viewing the peer compared with parents elicited activation in posterior 'mentalizing' structures, the precuneus, posterior cingulate cortex (PCC), bilateral posterior superior temporal sulcus and right temporoparietal junction, as well as the ventral striatum and bilateral amygdala and hippocampus. Relative activations in the PCC and precuneus to the peer vs. the parent were related both to reported risk-taking behavior and to affiliations with more risk-taking peers. The results suggest neural correlates of the adolescent social reorientation toward peers and away from parents that may be associated with adolescents' real-life risk-taking behaviors and social relationships.