Aberrant adapting of beliefs under stress: a mechanism relevant to the formation of paranoia?

BACKGROUND: Difficulties in the ability to adapt beliefs in the face of new information are associated with psychosis and its central symptom - paranoia. As cognitive processes and psychotic symptoms are both known to be sensitive to stress, the present study investigated the exact associations between stress, adapting of beliefs [reversal learning (RL), bias against disconfirmatory evidence (BADE), and jumping to conclusions (JTC)] and paranoia. We hypothesized that paranoia would increase under stress and that difficulties in adapting of beliefs would mediate or moderate the link between stress and paranoia. Furthermore, we hypothesized that the investigated effects would be strongest in the group of individuals diagnosed with a psychotic disorder. METHODS: We exposed 155 participants (38 diagnosed with a psychotic disorder, 40 individuals with attenuated psychotic symptoms, 39 clinical controls diagnosed with an obsessive-compulsive disorder, and 38 healthy controls) to a control condition and a stress condition, in which we assessed their levels of paranoia and their ability to adapt beliefs. We applied multilevel models to analyze the data. RESULTS: Paranoia was higher in the stress condition than in the control condition, b = 1.142, s.e. = 0.338, t(150) = 3.381, p < 0.001. RL, BADE, and JTC did not differ between conditions and did not mediate or moderate the association between stress and paranoia (all ps > 0.05). CONCLUSIONS: The results support the assumption that stress triggers paranoia. However, the link between stress and paranoia does not seem to be affected by the ability to adapt beliefs.

Structural Study of Diketopyrrolopyrrole Derivative Thin Films: Influence of Deposition Method, Substrate Surface, and Aging.

We report the morphology and microstructure of n-dialkyl side-chain-substituted thiophene DPP end-capped with phenyl groups (Ph-TDPP-Ph) thin films and compare the influence of deposition method and substrate surface using thermally oxidized Si and graphene substrates as well as monolayer graphene surfaces with an underlying self-assembled octadecyltrichlorosilane monolayer, complemented by an aging study of spin-coated films over a 2 weeks aging period. A distinct difference in morphology was observed between spin-coated and vacuum-deposited thin films, which formed a fiber-like morphology and a continuous layer of terraced grains, respectively. After an initial film evolution, all combinations of deposition method and substrate type result in well-ordered thin films with almost identical crystalline phases with slight variations in crystallinity and mosaicity. These findings point toward strong intermolecular forces dominating during growth, and the templating effect observed for other oligomer films formed on graphene is consequently ineffective for this material type. Upon aging of spin-coated films, a noticeable evolution involving two different morphologies and crystalline phases were observed. After several days, the thin film evolved into a more stable crystal phase and a fiber-like morphology. Moreover, slight variation in optical spectra were elucidated on the basis on density functional theory calculations. These results demonstrate that thin-film properties of DPP derivatives can be tailored by manipulating the film formation process.

Ambimodal Bispericyclic [6 + 4]/[4 + 6] Transition State Competes with Diradical Pathways in the Cycloheptatriene Dimerization: Dynamics and Experimental Characterization of Thermal Dimers.

The thermal dimerization of cycloheptatriene is predicted to occur by a concerted [6 + 4] cycloaddition via an ambimodal [6 + 4]/[4 + 6] transition state (TS) and a competing stepwise diradical (6 + 2) cycloaddition; both dimers subsequently undergo intramolecular [4 + 2] cycloadditions to afford thermally stable tetracyclic products. The ambimodal TS is the 10π-electron version of the prototype bispericyclic dimerization of cyclopentadiene discovered by Caramella et al. in 2002. Quantum mechanical studies using several common DFT functionals and post-HF methods, ωB97X-D, M06-2X, DLPNO-CCSD(T), NEVPT2, and PWPB95-D3(BJ), and quasiclassical molecular dynamics simulations provide details of bond timing and bifurcation pathways. By comparing the ambimodal [6 + 4]/[4 + 6] TS for cycloheptatriene dimerization with the ambimodal [4 + 2]/[2 + 4] TS of cyclopentadiene dimerization, we found that the high distortion energy in cycloheptatriene dimerization is the key to its relatively high energy barrier. The computational investigations were coupled with experimental studies of the cycloheptatriene dimerization, which resulted in the isolation of the two tetracyclic dimers. At lower temperature, the product from the predicted exo-[6 + 4]/[4 + 6] cycloaddition, followed by a subsequent intramolecular [4 + 2] cycloaddition, predominantly forms, while at higher temperature, the diradical (6 + 2) cycloadduct is the major product.

Multiple-day high-dose beetroot juice supplementation does not improve pulmonary or muscle deoxygenation kinetics of well-trained cyclists in normoxia and hypoxia.

Dietary nitrate (NO3-) supplementation via beetroot juice (BR) has been reported to lower oxygen cost (i.e., increased exercise efficiency) and speed up oxygen uptake (VO2) kinetics in untrained and moderately trained individuals, particularly during conditions of low oxygen availability (i.e., hypoxia). However, the effects of multiple-day, high dose (12.4 mmol NO3- per day) BR supplementation on exercise efficiency and VO2 kinetics during normoxia and hypoxia in well-trained individuals are not resolved. In a double-blinded, randomized crossover study, 12 well-trained cyclists (66.4 ± 5.3 ml min-1∙kg-1) completed three transitions from rest to moderate-intensity (~70% of gas exchange threshold) cycling in hypoxia and normoxia with supplementation of BR or nitrate-depleted BR as placebo. Continuous measures of VO2 and muscle (vastus lateralis) deoxygenation (ΔHHb, using near-infrared spectroscopy) were acquired during all transitions. Kinetics of VO2 and deoxygenation (ΔHHb) were modeled using mono-exponential functions. Our results showed that BR supplementation did not alter the primary time constant for VO2 or ΔHHb during the transition from rest to moderate-intensity cycling. While BR supplementation lowered the amplitude of the VO2 response (2.1%, p = 0.038), BR did not alter steady state VO2 derived from the fit (p = 0.258), raw VO2 data (p = 0.231), moderate intensity exercise efficiency (p = 0.333) nor steady state ΔHHb (p = 0.224). Altogether, these results demonstrate that multiple-day, high-dose BR supplementation does not alter exercise efficiency or oxygen uptake kinetics during normoxia and hypoxia in well-trained athletes.

Surface-Controlled Crystal Alignment of Naphthyl End-Capped Oligothiophene on Graphene: Thin-Film Growth Studied by in Situ X-ray Diffraction.

We report on the microstructure, morphology, and growth of 5,5'-bis(naphth-2-yl)-2,2'-bithiophene (NaT2) thin films deposited on graphene, characterized by grazing incidence X-ray diffraction (GIXRD) and complemented by atomic force microscopy (AFM) measurements. NaT2 is deposited on two types of graphene surfaces: custom-made samples where chemical vapor deposition (CVD)-grown graphene layers are transferred onto a Si/SiO2 substrate by us and common commercially transferred CVD graphene on Si/SiO2. Pristine Si/SiO2 substrates are used as a reference. The NaT2 crystal structure and orientation depend strongly on the underlying surface, with the molecules predominantly lying down on the graphene surface (face-on orientation) and standing nearly out-of-plane (edge-on orientation) on the Si/SiO2 reference surface. Post growth GIXRD and AFM measurements reveal that the crystalline structure and grain morphology differ depending on whether there is polymer residue left on the graphene surface. In situ GIXRD measurements show that the thickness dependence of the intensity of the (111) reflection from the crystalline edge-on phase does not intersect zero at the beginning of the deposition process, suggesting that an initial wetting layer, corresponding to 1-2 molecular layers, is formed at the surface-film interface. By contrast, the (111) reflection intensity from the crystalline face-on phase grows at a constant rate as a function of film thickness during the entire deposition.

Chronic high-dose beetroot juice supplementation improves time trial performance of well-trained cyclists in normoxia and hypoxia.

Dietary nitrate (NO3-) supplementation via beetroot juice (BR) is known to improve endurance performance in untrained and moderately trained individuals. However, conflicting results exist in well-trained individuals. Evidence suggests that the effects of NO3- are augmented during conditions of reduced oxygen availability (e.g., hypoxia), thereby increasing the probability of performance improvements for well-trained athletes in hypoxia vs. normoxia. This randomized, double-blinded, counterbalanced-crossover study examined the effects of 7 days of BR supplementation with 12.4 mmol NO3- per day on 10-km cycling time trial (TT) performance in 12 well-trained cyclists in normoxia (N) and normobaric hypoxia (H). Linear mixed models for repeated measures revealed increases in plasma NO3- and NO2- after supplementation with BR (both p < 0.001). Further, TT performance increased with BR supplementation (∼1.6%, p < 0.05), with no difference between normoxia and hypoxia (p = 0.92). For respiratory variables there were significant effects of supplementation on VO2 (p < 0.05) and VE (p < 0.05) such that average VO2 and VE during the TT increased with BR, with no difference between normoxia and hypoxia (p ≥ 0.86). We found no effect of supplementation on heart rate, oxygen saturation or muscle oxygenation during the TT. Our results provide new evidence that chronic high-dose NO3- supplementation improves cycling performance of well-trained cyclists in both normoxia and hypoxia.

Subcutaneous botulinum toxin type A injections for provoked vestibulodynia: a randomized placebo-controlled trial and exploratory subanalysis.

BACKGROUND: Previous studies using botulinum toxin type A (BT) to treat provoked vestibulodynia (PVD) reported conflicting findings, possibly attributable to singular injections or low doses. We assessed PVD treatment effectiveness with high-dose single injections of BT (50 or 100 units) versus placebo, and then repeat BT 100 U injections over 6 months. METHODS: This was a randomized, double-blind, three-arm, placebo-controlled study with 33 PVD patients. BT 50 U (arm A), 100 U (arm B) or saline (arm C) were injected subcutaneously into the dorsal vulvar vestibulum and pain was assessed after 3 months. The investigation proceeded as an unblinded exploratory analysis, in which symptomatic patients received a BT 100 U injection. Symptomatic patients in arm C received a second BT 100 U injection at the 6-month visit. Symptoms were measured at 3-month cycles using: (1) cotton swab-provoked visual analogue scale (VAS), (2) von Frey filaments, and (3) Marinoff dyspareunia scale. RESULTS: The three groups were comparable in terms of demographics and baseline clinical characteristics. Three months after the initial injection, no significant differences in pain were observed among the study arms, yet significant improvements occurred within all groups using the von Frey filaments test. Results from the exploratory analyses showed repeat injections of 100 U BT over 6 months led to significant pain reduction (VAS and von Frey filaments). Fifty-eight percent (7/12) of patients assessable after repeat injections were symptom-free or had ≥ 2 VAS reduction. Adverse events were minor and no serious adverse events occurred during the RCT or exploratory analysis. CONCLUSIONS: PVD symptoms after one subcutaneous injection of BT (50 or 100 units) did not significantly differ compared to placebo, yet all three study arms experienced a reduction in pain 3 months after a single injection. Exploratory analyses indicated that repeat high-dose BT injections may significantly reduce pain over 6 months. TRIAL REGISTRATION: This trial was registered with the Swiss Medical Agency (reference number: 2007DR2102) in 2007.

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy.

PURPOSE: Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. METHODS: The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. RESULTS: Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. CONCLUSIONS: In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.

Social Distance and Community Attitudes Towards People with Psycho-Social Disabilities in Uttarakhand, India.

Stigma is an important contributor to the large treatment gap for people with mental and psycho-social disabilities (PPSD) in India. Social distance as assessed by willingness to engage in relationships with PPSD is a proxy measure of stigma and potential discrimination. In North India, investigations of community attitudes towards PPSD have been limited. To describe attitudes towards people with depression and psychosis, a community sample of 960 adults in Dehradun district, India from 30 randomised clusters, was surveyed using a validated tool to assess social distance, beliefs and attitudes related to mental illness. Participants preferred greater social distance from a person with psychosis than a person with depression. Beliefs and attitudes around mental illness were diverse reflecting a wide spread of belief frameworks. After controlling for confounding, there was increased social distance among people who believed PPSD were dangerous. Factors that reduced social distance included familiarity with PPSD, and belief that PPSD can recover. Attitudes to PPSD, stigma and social distance are complex and likely to require complex responses that include promoting awareness of mental health and illness, direct contact with PPSD and increasing access to care for PPSD.

Sensory Hyperinnervation Distinguishes Bladder Pain Syndrome/Interstitial Cystitis from Overactive Bladder Syndrome.

PURPOSE: Pain is the key symptom that distinguishes bladder pain syndrome/interstitial cystitis from overactive bladder syndrome but overlap occurs. To find a discriminating marker for these bladder diseases we examined sensory hyperinnervation and neurotrophin receptor expression in bladder biopsies as well as nerve growth factor levels in urine. MATERIALS AND METHODS: Bladder biopsies from patients with bladder pain syndrome/interstitial cystitis, including 12 with and 19 without Hunner lesions, 13 with overactive bladder syndrome and 12 healthy controls, were analyzed by immunohistochemistry with antibodies to the nerve cell marker PGP9.5 (neuron-specific protein gene product 9.5), p75NTR (p75 neurotrophin receptor), the B-lymphocyte marker CD20 and mast cell tryptase. Urinary nerve growth factor was quantified by enzyme-linked immunosorbent assay. RESULTS: Subepithelial sensory hyperinnervation on PGP9.5 staining had 97% sensitivity and 76% specificity, increased lymphocytic infiltration had 90% sensitivity and 80% specificity, and urothelial defects had 97% sensitivity and 76% specificity to distinguish bladder pain syndrome/interstitial cystitis with and without Hunner lesions from overactive bladder syndrome and healthy controls. Increased sensory innervation was associated with submucosal mast cell localization. Staining of p75NTR in basal urothelial cells was indicative of bladder pain syndrome/interstitial cystitis. Urinary nerve growth factor levels were below the detection level and did not differentiate bladder diseases from healthy controls. CONCLUSIONS: Sensory hyperinnervation and basal urothelial p75NTR staining together with assessment of inflammatory lymphocytes and urothelial integrity allow for the differentiation of bladder pain syndrome/interstitial cystitis and overactive bladder syndrome even in the absence of Hunner lesions. Furthermore, these histopathological criteria enable the identification of early disease stages or oligosymptomatic/asymptomatic cases and may permit timely treatment to prevent disease progress.

Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion.

AIMS: Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes. METHODS: One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria. RESULTS: Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility (P < 0.0001), relative tape position (P = 0.0003), and tape-urethra distance (P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates (P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm. CONCLUSIONS: The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group.

Risk factors for emergency caesarean section in planned vaginal breech delivery.

PURPOSE: To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term. METHODS: Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared. RESULTS: Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95 % CI 1.09-3.84; p = 0.025), nulliparity (OR 2.82; 95 % CI 1.87-4.25; p < 0.001), high birth weight (OR 1.17; 95 % CI 1.04-1.30; p = 0.006) and induction of labour (OR 1.56; 95 % CI 1.003-2.44; p = 0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58-83 %, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights >3250 g. Complication rates were low in the cohort. CONCLUSIONS: Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.

Decarboxylative [4+2] Cycloaddition by Synergistic Palladium and Organocatalysis.

A novel reaction based on synergistic catalysis, combining palladium- and organocatalysis has been developed. The palladium catalyst activates vinyl benzoxazinanones via a decarboxylation to undergo a [4+2] cycloaddition with iminium-ion activated α,ß-unsaturated aldehydes. The reaction is demonstrated to proceed for a number of combinations of vinyl benzoxazinanones reacting with α,ß-unsaturated aldehydes, providing highly substituted vinyl tetrahydroquinolines in good to high yields, and excellent enantio- and diastereoselectivities (>98 % ee and >20:1 d.r.). The palladium catalyst used in the synergistic catalysis can be re-used in a one-pot sequential coupling reaction with an aromatic boronic acid forming the coupling product in 95 % yield, >20:1 d.r. and 99 % ee.

The effect of pH on fatigue during submaximal isometric contractions of the human calf muscle.

PURPOSE: This study examined whether changes in pH throughout the physiologic range would have a differential effect on central and peripheral factors associated with fatigue and force production during submaximal lower limb isometric exercise to task failure. METHODS: Eight males completed three experimental trials [0.2 g kg(-1) ammonia chloride (ACD); 0.3 g kg(-1) calcium carbonate (PLA); or 0.3 g kg(-1) sodium bicarbonate (ALK)], each consisting of submaximal calf contractions at 55% of maximal voluntary contraction (MVC) to task failure. Every minute of the task subjects performed an MVC, coupled with stimulation of the tibial nerve during and immediately post MVC. RESULTS: Time to task failure was not different between trials (ACD 531 ± 166 s, PLA 592 ± 163 s, ALK 596 ± 150 s; p = 0.31). MVC force in all trials declined 29 % from the start of exercise to the fifth minute (mean decline of 371 ± 26 N; p < 0.001), however was not different between trials (p = 0.21). Fatigue was mediated in all trials by central and peripheral factors, as declines in voluntary activation, V/M-wave in the soleus and the potentiated resting twitch amplitudes were evident throughout the task (p < 0.05). Central fatigue appeared to be muscle specific, as reductions in central drive (V/M-wave and rate of sEMG rise) persisted in the soleus but not the medial gastrocnemius. CONCLUSIONS: These data suggest that calf fatigue associated with intermittent, isometric contractions to task failure is unaffected by alterations in pH; however, central drive reductions may be muscle specific.

Bone marrow micrometastases do not impact disease-free and overall survival in early stage sentinel lymph node-negative breast cancer patients.

BACKGROUND: The presence of lymph node metastases is the most important prognostic factor in early stage breast cancer. Whether bone marrow micrometastases (BMM) impact the prognosis in sentinel lymph node (SLN)-negative breast cancer patients remains a matter of debate. Therefore, the objective of this study was to assess the impact of BMM on 5-year disease-free and overall survival among those patients. METHODS: We analyzed 410 patients with early stage breast cancer (pT1 and pT2 ≤ 3 cm, cN0) who were prospectively enrolled into the Swiss Multicenter Sentinel Lymph Node Study in Breast Cancer between January 2000 and December 2003. All patients underwent bone marrow aspiration followed by SLN biopsy. All SLN were stained with hematoxylin and eosin and immunohistochemistry (Lu-5, CK-22). Cancer cells in the bone marrow were identified after staining with monoclonal antibodies A45-B/B3 against CK-8, -18, and -19. RESULTS: Negative SLN were found in 67.6% (277 of 410) of the enrolled patients. Of those, BMM status was negative in 75.8% (210 of 277) and positive in 24.2% (67 of 277) patients. Median follow-up was 61 (range 11-96) months. Five-year disease-free survival was 93.6% (95% confidence interval [CI] 89.1-96.0) in BMM-negative and 92.2% (95% CI 82.5-96.2) in BMM-positive patients (p = 0.50). Five-year overall survival was 92.7% (95% CI 87.9-95.8) for the BMM-negative and 92.5% (95% CI 83.4-96.2) for the BMM-positive group (p = 0.85). CONCLUSIONS: This is one of the first prospective studies to examine 5-year disease-free and overall survivals in SLN-negative patients in correlation to their BMM status. Although BMM are identified in one of four SLN-negative patients, they do not impact disease-free and overall survival.

The role of hydrolases in the loss of firmness and of the changes in sugar content during the post-harvest maturation of Carica papaya L. var solo 8.

Fruit ripening is associated with many hydrolase activities involved in the softening of the fruit during the maturation. This study investigates the relationship between the loss of firmness along with the changes of sugar content and the enzymatic activities in Carica papaya L.var solo 8 during post-harvest storage. Three maturation stages (green immature: the fruit is entirely green, green mature: the fruit shows 1/32 yellow skin and fully mature: the fruit shows 1/8 yellow skin) have been selected and stored at 15, 22 and 28 °C. The reduction of fruit firmness, total sugar contents, refractive index (% Brix) and enzymatic activities were measured. Low enzymatic activities (0.035 µmol/min/mg) were recorded in fruit harvested at the green immature stage with no significant (p ≥ 0.05) effect on the softening while fruit harvested at the green mature and fully mature stages showed enzymatic activities 7 times as high as those of the green immature stage. These high enzymatic activities were responsible for the loss of firmness of the fruit. Accordingly, papayas at the green mature and fully mature stages displayed higher maxima of sugar content (4.8 g/100 g at 28 °C at day 12, and 10.2 g/100 g at 22 °C at day 8, respectively) at higher temperatures. Meanwhile in green immature papayas, the maximum was only 4.3 g/100 g at 22 °C and day 12 of storage. The results show that the loss of firmness of the papaya was highly related to the hydrolytic enzyme activities and the sweet taste to the presence of simple sugars such as galactose liberated from the polysaccharide complexes.

Sleep spindle activity and psychotic experiences: Examining the mediating roles of attentional performance and perceptual distortions in a daytime nap study.

Decreased sleep spindle activity in individuals with psychotic disorders is well studied, but its contribution to psychotic symptom formation is not well understood. This study explored potential underlying mechanisms explaining the association between decreased sleep spindle activity and psychotic symptoms. To this end, we analysed the links between sleep spindle activity and psychotic experiences and probed for the mediating roles of attentional performance and perceptual distortions in a community sample of young adults (N = 70; 26.33 ± 4.84 years). Polysomnography was recorded during a 90-min daytime nap and duration, amplitude, and density from slow (10-13 Hz) and fast (13-16 Hz) spindles were extracted. Attentional performance was assessed via a test battery and with an antisaccadic eye movement task. Psychotic experiences (i.e., paranoid thoughts; hallucinatory experiences) and perceptual distortions (i.e., anomalous perceptions; sensory gating deficits) were assessed via self-report questionnaires. We conducted sequential mediation analyses with spindle activity as predictor, psychotic experiences as dependent variable, and attentional performance and perceptual distortions as mediators. We found reduced right central spindle amplitude to be associated with paranoid thoughts. Increased antisaccadic error rate was associated with anomalous perceptions and perceptual distortions were associated with psychotic experiences. We did not find significant mediation effects. The findings support the notion that reduced sleep spindle activity is involved in the formation of paranoid thoughts and that decreased antisaccadic performance is indicative of perceptual distortions as potential precursors for psychotic experiences. However, further research is needed to corroborate the proposed mediation hypothesis.

A framework for language technologies in behavioral research and clinical applications: Ethical challenges, implications, and solutions.

Technological advances in the assessment and understanding of speech and language within the domains of automatic speech recognition, natural language processing, and machine learning present a remarkable opportunity for psychologists to learn more about human thought and communication, evaluate a variety of clinical conditions, and predict cognitive and psychological states. These innovations can be leveraged to automate traditionally time-intensive assessment tasks (e.g., educational assessment), provide psychological information and care (e.g., chatbots), and when delivered remotely (e.g., by mobile phone or wearable sensors) promise underserved communities greater access to health care. Indeed, the automatic analysis of speech provides a wealth of information that can be used for patient care in a wide range of settings (e.g., mHealth applications) and for diverse purposes (e.g., behavioral and clinical research, medical tools that are implemented into practice) and patient types (e.g., numerous psychological disorders and in psychiatry and neurology). However, automation of speech analysis is a complex task that requires the integration of several different technologies within a large distributed process with numerous stakeholders. Many organizations have raised awareness about the need for robust systems for ensuring transparency, oversight, and regulation of technologies utilizing artificial intelligence. Since there is limited knowledge about the ethical and legal implications of these applications in psychological science, we provide a balanced view of both the optimism that is widely published on and also the challenges and risks of use, including discrimination and exacerbation of structural inequalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy.

Importance: Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown. Objective: To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node. Design, Setting, and Participants: In this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis. Exposure: Omission of ALND after SLNB or TAD. Main Outcomes and Measures: The primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed. Results: A total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2 (formerly HER2)-positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P = .01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P < .001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P < .001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P = .55). Conclusions and Relevance: The results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.