A Pilot Randomized Controlled Trial of an mHealth Intervention to Improve PrEP Adherence Among Young Sexual Minority Men.

This randomized controlled study assessed the feasibility, acceptability, and preliminary impact of the PrEP iT! mHealth intervention designed to improve PrEP adherence among young men who have sex with men (YMSM). A national sample of 80 YMSM in the U.S. (Mage = 25 years; 54% racial/ethnic minority), recruited through social media ads, were randomized to either the PrEP iT! or usual PrEP care conditions. Participants completed online surveys and submitted self-collected dried blood sample (DBS) data as measures of PrEP adherence. Differences in PrEP adherence across treatment arms and between participants with high versus low engagement in PrEP iT! were assessed. Retention was high at the three (94%) and six (93%) month assessment, and participants in PrEP iT! reported satisfactory acceptability of the intervention. There were no significant differences in self-reported or DBS-derived PrEP adherence between randomized groups. However, YMSM in the PrEP iT! group with high PrEP adherence (the equivalent of four or more doses/week through self-report and DBS-derived measures) demonstrated significantly higher engagement in the intervention than those with low PrEP adherence (the equivalent of 3 or fewer doses/week). Overall, the PrEP iT! intervention demonstrated strong feasibility and acceptability. The finding that high PrEP iT! intervention engagement was associated with protective levels of PrEP adherence suggests it is a viable adherence support tool that should be further evaluated in definitive trial among YMSM who need basic support, or as part of a more comprehensive adherence support package for those who need greater assistance.Trial registration Clinical Trials # NCT04509076 (registered August 10, 2020).

A longitudinal study of cannabis use and risk for cognitive and functional decline among older adults with HIV.

Cannabis use is rapidly increasing among older adults in the United States, in part to treat symptoms of common health conditions (e.g., chronic pain, sleep problems). Longitudinal studies of cannabis use and cognitive decline in aging populations living with chronic disease are lacking. We examined different levels of cannabis use and cognitive and everyday function over time among 297 older adults with HIV (ages 50-84 at baseline). Participants were classified based on average cannabis use: frequent (> weekly) (n = 23), occasional (≤ weekly) (n = 83), and non-cannabis users (n=191) and were followed longitudinally for up to 10 years (average years of follow-up = 3.9). Multi-level models examined the effects of average and recent cannabis use on global cognition, global cognitive decline, and functional independence. Occasional cannabis users showed better global cognitive performance overall compared to non-cannabis users. Rates of cognitive decline and functional problems did not vary by average cannabis use. Recent cannabis use was linked to worse cognition at study visits when participants had THC+ urine toxicology-this short-term decrement in cognition was driven by worse memory and did not extend to reports of functional declines. Occasional (≤ weekly) cannabis use was associated with better global cognition over time in older adults with HIV, a group vulnerable to chronic inflammation and cognitive impairment. Recent THC exposure may have a temporary adverse impact on memory. To inform safe and efficacious medical cannabis use, the effects of specific cannabinoid doses on cognition and biological mechanisms must be investigated in older adults.

RESUMEN: El consumo de cannabis está aumentando rápidamente entre los adultos mayores en los Estados Unidos, en parte para tratar síntomas de afecciones de salud comunes (p. ej. dolor crónico, problemas de dormir). Actualmente, hay pocos estudios longitudinales sobre el consumo de cannabis y el deterioro cognitivo en poblaciones que envejecen y viven con enfermedades crónicas. Examinamos diferentes niveles del consumo de cannabis y funciones cognitivas a lo largo del tiempo entre 297 adultos mayores con VIH (de 50 a 84 años al principio de la investigación). Los participantes se clasificaron según el consumo promedio de cannabis: consumidores de cannabis frecuentes (> semanal) (n = 23) ocasionales (≤ semanal) (n = 83), y no consumidores de cannabis (n=191) fueron seguidos longitudinalmente hasta por 10 años (promedio = 3,9 años). Los modelos multinivel investigaron los efectos del consumo promedio y reciente de cannabis en la cognición global, el deterioro cognitivo global, y la independencia funcional. Los consumidores ocasionales de cannabis mostraron un mejor rendimiento cognitivo global en comparación con los no consumidores. El nivel de deterioro cognitivo y problemas funcionales no estuvieron asociado con el uso de cannabis. El consumo reciente de cannabis se vinculó con una peor cognición en las visitas del estudio cuando los participantes tenían toxicología de orina de THC positivo­esta disminución a corto plazo de la cognición se debió a una peor memoria, pero no se extendió a los informes de deterioros funcionales. El consumo ocasional (≤ semanal) de cannabis se asoció con una mejor cognición global a lo largo del tiempo en adultos mayores con VIH, un grupo susceptible a la inflamación crónica y la disfunción cognitiva. La exposición reciente al THC puede tener un impacto negativo temporal en la memoria. Los efectos de dosis específicas de cannabinoides en la cognición y sus mecanismos de acción biológicos deben ser investigados en personas mayores con el fin de informar el uso seguro y eficaz del cannabis medicinal.

Repeated Measures ANOVA with Latent Variables to Analyze Interindividual Differences in Contrasts.

Repeated measures analysis of variance (RM-ANOVA) is a broadly used statistical method to analyze data from experimental designs. RM-ANOVA aims at investigating effects of experimental conditions (i.e., factors) and predictors that affect the outcome of interest. It mainly considers contrasts that test standard main and interaction effects, even though more complex contrasts can in principle be used. Analyses, however, only focus on drawing conclusions about average effects and do not take into consideration interindividual differences in these effects. We propose an alternative approach to RM-ANOVA for analyzing repeated measures data, termed latent repeated measures analysis of variance (L-RM-ANOVA). The new approach is based on structural equation modeling and extends the latent growth components approach. L-RM-ANOVA enables the researcher to not only consider mean differences between different experimental conditions (i.e., average effects), but also to investigate interindividual differences in effects. Such interindividual differences are considered with regard to standard main and interactions effects and also with regard to customized contrasts that allow for testing specific hypotheses of interest. Furthermore, L-RM-ANOVA can include a measurement model for latent variables and can be used for the analysis of complex multi-factorial repeated measures designs. We conclude the presentation by demonstrating L-RM-ANOVA using a minimal repeated measures example.

Convergence and divergence in prediction from vocabulary and speed of word processing.

Toddler vocabulary knowledge and speed of word processing are associated with downstream language and cognition. Here, we investigate whether these associations differ across measures. At age two, 101 participants (55 monolingual French-speaking and 46 monolingual English-speaking children) completed a two-alternative forced choice task, yielding measures of decontextualized vocabulary (number of correct responses) and haptic speed of word processing (latency of correct responses). At ages three, four, and five children completed a battery of language assessments and an executive function task. Growth curve models revealed that age-two vocabulary significantly predicted age-three performance (but not growth from age three to four or four to five) across all language assessments but speed of processing did not predict language outcomes in final models. Finally, speed of processing was correlated with executive function at age three whereas vocabulary was not. Results suggest that vocabulary is associated with a range of downstream language abilities whereas haptic speed of processing may be associated with executive control.

Integrating minority stress theory and the tripartite influence model: A model of eating disordered behavior in sexual minority young adults.

Eating disorders are serious mental illnesses associated with high mortality rates and health complications. Prior research has found increased rates of eating pathology in sexual minority (SM; e.g., lesbian, gay, bisexual) individuals compared to sexual majority (i.e., heterosexual) individuals. Two prominent models have potential to explain these differences: the tripartite influence model and minority stress theory. While both models separately have promise for explaining the pathway of eating disordered behavior in SM individuals, research has indicated that both models have unexplained variance. Therefore, a comprehensive, integrative model could further explain unique variance. 479 men and 483 women between 18 and 30 years old were recruited through Qualtrics; all participants endorsed attraction to same-gender partners. Two models were estimated by gender using structural equation modeling. For men and women, community involvement accelerated the positive association of heterosexist discrimination with internalized homophobia. Minority stressors were associated with dissatisfaction and muscularity behavior, indicating the importance of incorporating minority stress. For women, community involvement accelerated both the association of pressures with muscularity internalization and the association of muscularity-based dissatisfaction with muscle building behaviors. If confirmed by prospective studies, this model could help refine prevention and intervention efforts with this vulnerable population.

Analyzing cross-lag effects: A comparison of different cross-lag modeling approaches.

Developmental researchers often have research questions about cross-lag effects-the effect of one variable predicting a second variable at a subsequent time point. The cross-lag panel model (CLPM) is often fit to longitudinal panel data to examine cross-lag effects; however, its utility has recently been called into question because of its inability to distinguish between-person effects from within-person effects. This has led to alternative forms of the CLPM to be proposed to address these limitations, including the random-intercept CLPM and the latent curve model with structured residuals. We describe these models focusing on the interpretation of their model parameters, and apply them to examine cross-lag associations between reading and mathematics. The results from the various models suggest reading and mathematics are reciprocally related; however, the strength of these lagged associations was model dependent. We highlight the strengths and limitations of each approach and make recommendations regarding modeling choice.

Predicting psychosis-spectrum diagnoses in adulthood from social behaviors and neighborhood contexts in childhood.

Research showing that risk for schizophrenia, bipolar disorder with psychosis, and other psychosis-spectrum diagnoses in adulthood is multidetermined has underscored the necessity of studying the additive and interactive factors in childhood that precede and predict future disorders. In this study, risk for the development of psychosis-spectrum disorders was examined in a 2-generation, 30-year prospective longitudinal study of 3,905 urban families against a sociocultural backdrop of changing economic and social conditions. Peer nominations of aggression, withdrawal, and likeability and national census information on neighborhood-level socioeconomic disadvantage in childhood, as well as changes in neighborhood socioeconomic conditions over the lifespan, were examined as predictors of diagnoses of schizophrenia, bipolar disorder, and other psychosis-spectrum disorders in adulthood relative to developing only nonpsychotic disorders or no psychiatric disorders. Individuals who were both highly aggressive and highly withdrawn were at greater risk for other psychosis-spectrum diagnoses when they experienced greater neighborhood disadvantage in childhood or worsening neighborhood conditions over maturation. Males who were highly aggressive but low on withdrawal were at greater risk for schizophrenia diagnoses. Childhood neighborhood disadvantage predicted both schizophrenia and bipolar diagnoses, regardless of childhood social behavior. Results provided strong support for multiple-domain models of psychopathology, and suggest that universal preventive interventions and social policies aimed at improving neighborhood conditions may be particularly important for decreasing the prevalence of psychosis-spectrum diagnoses in the future.

APOE modifies the interaction of entorhinal cerebral blood flow and cortical thickness on memory function in cognitively normal older adults.

OBJECTIVE: The ε4 allele of the apolipoprotein E (APOE) gene increases risk for cognitive decline in normal and pathologic aging. However, precisely how APOE ε4 exerts its negative impact on cognition is poorly understood. The present study aimed to determine whether APOE genotype (ε4+ vs. ε4-) modifies the interaction of medial temporal lobe (MTL) resting cerebral blood flow (CBF) and brain structure (cortical thickness [CT], volume [Vo]) on verbal memory performance. METHODS: Multiple linear regression models were employed to investigate relationships between APOE genotype, arterial spin labeling MRI-measured CBF and FreeSurfer-based CT and Vo in four MTL regions of interest (left and right entorhinal cortex and hippocampus), and verbal memory performance among a sample of 117 cognitively normal older adults (41 ε4+, 76 ε4-) between the ages of 64 and 89 (mean age â€‹= â€‹73). RESULTS: Results indicated that APOE genotype modified the interaction of CBF and CT on memory in the left entorhinal cortex, such that the relationship between entorhinal CBF and memory was negative (lower CBF was associated with better memory) in non-carriers with higher entorhinal CT, positive (higher CBF was associated with better memory) in non-carriers with lower entorhinal CT, and negative (higher CBF was associated with worse memory) in ε4 carriers with lower entorhinal CT. CONCLUSIONS: Findings suggest that older adult APOE ε4 carriers may experience vascular dysregulation and concomitant morphological alterations in the MTL that interact to negatively affect memory even in the absence overt clinical symptoms, providing potential insight into the mechanistic link between APOE ε4 and detriments in cognition. Moreover, findings suggest a distinct multimodal neural signature in ε4 carriers (higher CBF and lower CT in the entorhinal cortex) that could aid in the identification of candidates for future clinical trials aimed at preventing or slowing cognitive decline. Differential findings with respect to ε4 carriers and non-carriers are discussed in the context of neurovascular compensation.

Characterising 'bounce-back' readmissions after radical cystectomy.

OBJECTIVE: To examine predictors of early readmissions after radical cystectomy (RC). Factors associated with preventable readmissions may be most evident in readmissions that occur within 3 days of discharge, commonly termed 'bounce-back' readmissions, and identifying such factors may inform efforts to reduce surgical readmissions. PATIENTS AND METHODS: We utilised the Healthcare Cost and Utilization Project's State Inpatient Databases to examine 1867 patients undergoing RC in 2009 and 2010, and identified all patients readmitted within 30 days of discharge. We assessed differences between patients experiencing bounce-back readmission compared to those readmitted 8-30 days after discharge using logistic regression models and also calculated abbreviated LACE scores to assess the utility of common readmissions risk stratification algorithms. RESULTS: The 30-day and bounce-back readmission rates were 28.4% and 5.6%, respectively. Although no patient or index hospitalisation characteristics were significantly associated with bounce-back readmissions in adjusted analyses, bounce-back patients did have higher rates of gastrointestinal (14.3% vs 6.7%, P = 0.02) and wound (9.5% vs 3.0%, P < 0.01) diagnoses, as well as increased index and readmission length of stay (5 vs 4 days, P = 0.01). Overall, the median abbreviated LACE score was 7, which fell into the moderate readmission risk category, and no difference was observed between readmitted and non-readmitted patients. CONCLUSION: One in five readmissions after RC occurs within 3 days of initial discharge, probably due to factors present at discharge. However, sociodemographic and clinical factors, as well as traditional readmission risk tools were not predictive of this bounce-back. Effective strategies to reduce bounce-back readmission must identify actionable clinical factors prior to discharge.

Role of Post-Acute Care on Hospital Readmission After High-Risk Surgery.

BACKGROUND: Payment models, including the Hospital Readmissions Reduction Program and bundled payments, place pressures on hospitals to limit readmissions. Against this backdrop, we sought to investigate the association of post-acute care after major surgery and readmission rates. METHODS: We identified patients undergoing high-risk surgery (abdominal aortic aneurysm repair, coronary bypass grafting, aortic valve replacement, carotid endarterectomy, esophagectomy, pancreatectomy, lung resection, and cystectomy) from 2005 to 2010 using the Healthcare Cost and Utilization Project's State Inpatient Database. The primary outcome was readmission rates after major surgery. Secondary outcome was readmission length of stay. RESULTS: We identified 135,523 patients of whom 56,720 (42%) received post-acute care. Patients receiving post-acute care had higher readmission rates than those who were discharged home (16% versus 10%, respectively; P < 0.001). The risk-adjusted readmission length of stay was greatest for patients who received care from a skilled nursing facility, followed by those who received home care, and lowest for those who did not receive post-acute care (7.1 versus 5.4 versus 4.8 d, respectively; P < 0.001). CONCLUSIONS: The use of post-acute care was associated with higher readmission rates and higher readmission lengths of stay. Improving the support of patients in post-acute care settings may help reduce readmissions and readmission intensity.

Age-related changes in the dynamics of fear-related regulation in early childhood.

Self-regulation is a dynamic process wherein executive processes (EP) delay, minimize or desist prepotent responses (PR) that arise in situations that threaten well-being. It is generally assumed that, over the course of early childhood, children expand and more effectively deploy their repertoire of EP-related strategies to regulate PR. However, longitudinal tests of these assumptions are scarce in part because self-regulation has been mostly studied as a static construct. This study engages dynamic systems modeling to examine developmental changes in self-regulation between ages 2 and 5 years. Second-by-second time-series data derived from behavioral observations of 112 children (63 boys) faced with novel laboratory-based situations designed to elicit wariness, hesitation, and fear were modeled using differential equation models designed to capture age-related changes in the intrinsic dynamics and bidirectional coupling of PR (fear/wariness) and EP (strategy use). Results revealed that dynamic models allow for the conceptualization and measurement of fear regulation as intrinsic processes as well as direct and indirect coupling between PR and EP. Several patterns of age-related changes were in line with developmental theory suggesting that PR weakened and was regulated more quickly and efficiently by EP at age 5 than at age 2. However, most findings were in the intrinsic dynamics and moderating influences between PR and EP rather than direct influences. The findings illustrate the precision with which specific aspects of self-regulation can be articulated using dynamic systems models, and how such models can be used to describe the development of self-regulation in nuanced and theoretically meaningful ways.

Dorsomedial Prefrontal Activity to Sadness Predicts Later Emotion Suppression and Depression Severity in Adolescent Girls.

The present study used cross-lagged panel analyses to test longitudinal associations among emotion regulation, prefrontal cortex (PFC) function, and depression severity in adolescent girls. The ventromedial and dorsomedial PFC (vmPFC and dmPFC) were regions of interest given their roles in depression pathophysiology, self-referential processing, and emotion regulation. At ages 16 and 17, seventy-eight girls completed a neuroimaging scan to assess changes in vmPFC and dmPFC activation to sad faces, and measures of depressive symptom severity and emotion regulation. The 1-year cross-lagged effects of dmPFC activity at age 16 on expressive suppression at age 17 and depressive symptomatology at age 17 were significant, demonstrating a predictive relation between dmPFC activity and both suppression and depressive severity.

Linking autonomic physiology and emotion regulation in preschoolers: The role of reactivity and recovery.

Physiological recovery from negative emotions may be important for effective self-regulation, but little is known about recovery processes in children. The current study investigated links between autonomic physiology, anger expressions, and emotion regulation in a sample of eighty-three 3.5-year-olds. Respiratory sinus arrhythmia and pre-ejection period were measured during an anger induction task as parasympathetic and sympathetic indices, respectively. We examined whether preschoolers' anger expressions and emotion regulation behaviors were associated with individual differences in physiology. Autonomic changes were more strongly linked with emotion regulation than with expressed anger. Verbalized regulatory strategies were linked with greater sympathetic reactivity and also with greater recovery. In contrast, attention diversion was associated with blunted patterns of sympathetic reactivity followed by increased sympathetic arousal in the recovery phase. Disengaging from an emotional challenge may be linked with reduced physiological arousal in the short term, this behavior but also appears to have delayed consequences for physiological recovery.

Predictors and Cost of Readmission in Total Knee Arthroplasty.

BACKGROUND: The Comprehensive Care for Joint Replacement bundle was created to decrease total knee arthroplasty (TKA) cost. To help accomplish this, there is a focus on reducing TKA readmissions. However, there is a lack of national representative sample of all-payer hospital admissions to direct strategy, identify risk factors for readmission, and understand actual readmission cost. METHODS: We used the Nationwide Readmission Database to examine national readmission rates, predictors of readmission, and associated readmission costs for elective TKA procedures. We fit a multivariable logistic regression model to examine factors associated with readmission. Then, we determined mean readmission costs and calculated the readmission cost when distributed across the entire TKA population. RESULTS: We identified 224,465 patients having TKA across all states participating in the Nationwide Readmission Database. The mean unadjusted 30-day TKA readmission rate was 4%. The greatest predictors of readmission were congestive heart failure (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.62-2.80), renal disease (OR 2.19, 95% CI 2.03-2.37), and length of stay greater than 4 days (OR 2.4, 95% CI 2.25-2.61). The overall median cost for each readmission was $6753 ± 175. Extrapolating the readmission cost for the entire TKA population resulted in the readmission cost being 2% of the overall 30-day procedure cost. CONCLUSIONS: A major focus of the Comprehensive Care for Joint Replacement bundle is improving cost and quality by limiting readmission rates. TKA readmissions are low and comprise a small percentage of total TKA cost, suggesting that they may not be the optimal measure of quality care or a significant driver of overall cost.

On Measuring and Modeling Physiological Synchrony in Dyads.

Physiological synchrony within a dyad, or the degree of temporal correspondence between two individuals' physiological systems, has become a focal area of psychological research. Multiple methods have been used for measuring and modeling physiological synchrony. Each method extracts and analyzes different types of physiological synchrony, where 'type' refers to a specific manner through which two different physiological signals may correlate. Yet, to our knowledge, there is no documentation of the different methods, how each method corresponds to a specific type of synchrony, and the statistical assumptions embedded within each method. Hence, this article outlines several approaches for measuring and modeling physiological synchrony, connects each type of synchrony to a specific method, and identifies the assumptions that need to be satisfied for each method to appropriately extract each type of synchrony. Furthermore, this article demonstrates how to test for between-dyad differences of synchrony via inclusion of dyad-level (i.e., time-invariant) covariates. Finally, we complement each method with an empirical demonstration, as well as online supplemental material that contains Mplus code.

Variation in readmission expenditures after high-risk surgery.

BACKGROUND: The Hospital Readmissions Reduction Program reduces payments to hospitals with excess readmissions for three common medical conditions and recently extended its readmission program to surgical patients. We sought to investigate readmission intensity as measured by readmission cost for high-risk surgeries and examine predictors of higher readmission costs. MATERIALS AND METHODS: We used the Healthcare Cost and Utilization Project's State Inpatient Database to perform a retrospective cohort study of patients undergoing major chest (aortic valve replacement, coronary artery bypass grafting, lung resection) and major abdominal (abdominal aortic aneurysm repair [open approach], cystectomy, esophagectomy, pancreatectomy) surgery in 2009 and 2010. We fit a multivariable logistic regression model with generalized estimation equations to examine patient and index admission factors associated with readmission costs. RESULTS: The 30-d readmission rate was 16% for major chest and 22% for major abdominal surgery (P < 0.001). Discharge to a skilled nursing facility was associated with higher readmission costs for both chest (odds ratio [OR]: 1.99; 95% confidence interval [CI]: 1.60-2.48) and abdominal surgeries (OR: 1.86; 95% CI: 1.24-2.78). Comorbidities, length of stay, and receipt of blood or imaging was associated with higher readmission costs for chest surgery patients. Readmission >3 wk after discharge was associated with lower costs among abdominal surgery patients. CONCLUSIONS: Readmissions after high-risk surgery are common, affecting about one in six patients. Predictors of higher readmission costs differ among major chest and abdominal surgeries. Better identifying patients susceptible to higher readmission costs may inform future interventions to either reduce the intensity of these readmissions or eliminate them altogether.

A Model to Optimize Followup Care and Reduce Hospital Readmissions after Radical Cystectomy.

PURPOSE: Radical cystectomy has one of the highest readmission rates across all surgical procedures at approximately 25%. We developed a mathematical model to optimize outpatient followup regimens for radical cystectomy. MATERIALS AND METHODS: We used delay-time analysis, a systems engineering approach, to maximize the probability of detecting patients susceptible to readmission through office visits and telephone calls. Our data source includes patients readmitted after radical cystectomy from the Healthcare Cost and Utilization Project State Inpatient Databases in 2009 and 2010 as well as from our institutional bladder cancer database from 2007 to 2011. We measured the interval from hospital discharge to the point when a patient first exhibits concerning symptoms. Our primary end point is 30-day hospital readmission. Our model optimized the timing and sequence of followup care after radical cystectomy. RESULTS: The timing of office visits and telephone calls is more important in detecting a patient at risk for readmission than the sequence of these encounters. Patients are most likely to exhibit concerning symptoms between 4 and 5 days after discharge home. An optimally scheduled office visit can detect up to 16% of potential readmissions, which can be increased to 36% with 1 office visit followed by 4 telephone calls. CONCLUSIONS: Our model improves the detection of concerning symptoms after radical cystectomy by optimizing the timing and number of outpatient encounters. By understanding how to design better outpatient followup care for patients treated with radical cystectomy we can help reduce the readmission burden for this population.

Are Executive Functioning Deficits Concurrently and Predictively Associated with Depressive and Anxiety Symptoms in Adolescents?

The central objective of the current study was to evaluate how executive functions (EF), and specifically cognitive flexibility, were concurrently and predictively associated with anxiety and depressive symptoms in adolescence. Adolescents (N = 220) and their parents participated in this longitudinal investigation. Adolescents' EF was assessed by the Wisconsin Card Sorting Test (WCST) during the initial assessment, and symptoms of depressive and anxiety disorders were reported by mothers and youths concurrently and 2 years later. Correlational analyses suggested that youths who made more total errors (TE), including both perseverative errors (PE) and nonperseverative errors (NPE), concurrently exhibited significantly more depressive symptoms. Adolescents who made more TE and those who made more NPE tended to have more anxiety symptoms 2 years later. Structural equation modeling analyses accounting for key explanatory variables (e.g., IQ, disruptive behavior disorders, and attention deficit hyperactive disorder) showed that TE was concurrently associated with parent reports of adolescent depressive symptoms. The results suggest internalizing psychopathology is associated with global (TE) and nonspecific (NPE) EF difficulties but not robustly associated with cognitive inflexibility (PE). Future research with the WCST should consider different sources of errors that are posited to reflect divergent underlying neural mechanisms, conferring differential vulnerability for emerging mental health problems.

Understanding hospital readmission intensity after radical cystectomy.

PURPOSE: Hospital readmissions after radical cystectomy vary with respect to intensity in terms of impact on patients and health care systems. Therefore, we conducted a population based study to examine factors associated with increasing readmission intensity after radical cystectomy for bladder cancer. MATERIALS AND METHODS: Using SEER (Surveillance, Epidemiology, and End Results)-Medicare data we identified 1,782 patients who underwent radical cystectomy from 2003 to 2009. We defined readmission intensity in terms of length of stay (days) divided into quartiles of less than 3 (lowest), 3 to 4, 5 to 7 and more than 7 (highest). We used logistic regression to examine factors associated with readmission intensity. RESULTS: More than half of the patients with the highest intensity readmissions were readmitted within the first week and 77% were readmitted within 2 weeks of discharge. Patients with the highest intensity readmissions were similar in age, gender, race, socioeconomic status, pathological stage, comorbidity, neoadjuvant chemotherapy use and urinary diversion type compared to patients with the lowest intensity readmissions. After multivariable adjustment, complications during the index cystectomy admission (p <0.001), readmission week (p=0.04), and the interaction between index length of stay and discharge to a skilled nursing facility (p=0.04) were associated with the highest readmission intensity. CONCLUSIONS: Readmission intensity differs widely after discharge following radical cystectomy. As postoperative efforts to minimize the readmission burden increase, a better understanding of the factors that contribute to the highest intensity readmissions will help direct limited resources (eg telephone calls, office visits) toward high yield areas.

Behavior and emotion modulation deficits in preschoolers at risk for bipolar disorder.

BACKGROUND: Bipolar disorder (BD) is highly familial, but studies have yet to examine preschoolers at risk for BD using standardized, developmentally appropriate clinical assessment tools. We used such methods to test whether preschoolers at familial risk for BD have more observed difficulty modulating emotions and behaviors than do low-risk preschoolers. Identification of emotional and behavioral difficulties in at-risk preschoolers is crucial for developing new approaches for early intervention and prevention of BD. METHODS: Using the standardized disruptive behavior diagnostic observation schedule (DB-DOS) protocol for preschoolers, we compared 23 preschoolers (M(age): 4.53 ± 0.73 years; 18 males) with a first-degree relative with BD to 21 preschoolers (M(age): 4.65 ± 0.84 years; 11 males) without a family history of BD. We characterized psychopathology in this sample using the Preschool Aged Psychiatric Assessment and behavioral and emotional problems using the Child Behavior Checklist. RESULTS: High-risk preschoolers demonstrated significantly more intense, pervasive, and clinically concerning problems in anger modulation and behavior dysregulation on the DB-DOS than the low-risk group. High-risk relative to low-risk preschoolers, were also more likely to have maternal-reported anxiety and oppositional defiant disorders and internalizing and externalizing problems. CONCLUSIONS: Clinically concerning problems in anger modulation and behavior regulation, measured during standardized laboratory observation, differentiate preschoolers at high familial risk for BD from those at low risk. Investigation in a large longitudinal sample is critical for replication and for determining whether these observed behavioral differences can be reliably used as prodromal indicators of mood disorders.