Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk. Data come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group. 5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort. Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.

While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. To explore European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation showed how the themes related to each other.

Abstract This paper contributes to the reassessment of the role of Lucretius’ De rerum natura and Epicurean philosophy in early Christian writings by conducting a close study of Carmen 23 composed by the poet Paulinus of Nola. While previous scholarship has examined classical influences on Paulinus’ poetry, especially from Vergil, no existing study has attended to Paulinus’ incorporation of Epicurean elements. This paper argues that in Carmen 23 Paulinus incorporates Epicurean doctrines and Lucretius’ poetic imagery to appeal to an audience familiar with Epicurean ideas. Through the creative fusion of Epicurean physics with Christian metaphysics, Paulinus conjures up a poetic world in which the natural and spiritual realms constantly interact. While using Lucretian imagery to direct his audience’s gaze toward the natural world, Paulinus nevertheless reveals a higher reality in which the invisible operation of God’s spirit governs and perfects the mechanism of nature. In thus stretching his poetic imagination to encompass the working of nature and spirit, Paulinus invents a new eclectic literary form and a kind of physiological miracle account that blends naturalism and mysticism. As such, Carmen 23 attests to Paulinus’ literary achievement in repurposing a classic of Epicurean philosophy and Latin poetry for Christian panegyric and hagiography.

The fetal subarachnoid space size serves as an indicator of normal brain development. The subarachnoid space is commonly measured by an ultrasound examination. Introduction of MR imaging for fetal brain evaluation enables standardization of MR imaging-driven subarachnoid space parameters for a more accurate evaluation. This study aimed to determine the normal range of MR imaging-derived subarachnoid space size in fetuses according to gestational age. A cross-sectional study based on a retrospective assessment of randomly selected brain MR images of apparently healthy fetuses performed between 2012 and 2020 at a large tertiary medical center was performed. Demographic data were collected from the mothers' medical records. Subarachnoid space size was measured at 10 reference points using the axial and coronal planes. Only MR imaging scans obtained between weeks 28 and 37 of pregnancy were included. Scans with low-quality images, multiple pregnancy, and cases with intracranial pathologic findings were excluded. Overall, 214 apparently healthy fetuses were included (mean maternal age, 31.2 [SD, 5.4] years). Good interobserver and intraobserver agreement was observed (intraclass correlation coefficient > 0.75 for all except 1 parameter). For each gestational week, the 3rd, 15th, 50th, 85th, and 97th percentiles of each subarachnoid space measurement were described. MR imaging-derived subarachnoid space values at a specific gestational age provide reproducible measurements, probably due to the high resolution of MR imaging and adherence to the true radiologic planes. Normal values for brain MR imaging could provide valuable reference information for assessing brain development, thus being an important tool in the decision-making process of both clinicians and parents.

Refractive lens exchange (RLE) patients represent a unique population with a different baseline and set of expectations compared to their cataract counterparts. Visual outcomes and patient satisfaction following RLE with bilateral implantation of a trifocal intraocular lens (IOL) were assessed in a cohort of patients with presbyopia and without cataract. Charts of patients with presbyopia who underwent femtosecond laser-assisted RLE with bilateral implantation of the PanOptix trifocal IOL (toric and non-toric) at a single-surgeon, private practice center from September 2019 to August 2020 were retrospectively reviewed. Eyes with prior keratorefractive surgery, amblyopia, or underlying pathology were excluded. Primary endpoints included corrected and uncorrected visual acuity at distance (CDVA and UDVA), intermediate (DCIVA and UIVA), and near (DCNVA and UNVA) at 6months. Secondary endpoints included residual refractive error, patient-reported satisfaction, spectacle independence, and visual disturbance profile as assessed by a validated questionnaire at 6months. Seventy-eight eyes of 39 patients (mean age 56 ± 6years; 79% female) were included. Most eyes were hyperopic (mean SE 2.35 ± 1.81). Postoperatively, 100% and 92% of eyes were within ± 1.00D and ± 0.50D of emmetropia, respectively. One hundred percent, 97%, and 97% of patients achieved UDVA, UNVA, and UIVA of logMAR 0.1 or better. Starbursts were the most frequent (67%) and bothersome (41%) visual disturbance cited, but nearly half (41%) of patients rated them as absent or "not bothersome at all." Overall, 77% of patients reported achieving complete spectacle independence with 87% and 90% of patients stating they were satisfied with their vision and would recommend the same procedure to others, respectively. RLE with bilateral implantation of the PanOptix IOL is a safe and effective procedure with good patient satisfaction. Because of their relatively clear native lenses and visually demanding needs compared to their cataract counterparts, surgeons should take extra precautions to counsel RLE patients on the limitations of trifocal technology.

AbstractSocial determinants of health and sociodemographic differences place some individuals at higher risk for hypertension leading to persisting disparities. While mobile health (mHealth) offers a promising approach to facilitate blood pressure (BP) management, it remains unclear which interventions are most effective for addressing disparities in hypertension control. We reviewed the current literature to examine whether mHealth interventions for BP control are effective in improving BP control in populations vulnerable to disparities in hypertension. We conducted a systematic review using multiple databases from January 1, 2009 through December 31, 2020. For inclusion, participants must have elevated blood pressure and belong to a sociodemographic group with known disparities in hypertension. We also tracked specific characteristics of each intervention. Out of the eight articles that met our eligibility criteria for inclusion, five were published in 2018 to 2020. Only four demonstrated a significant reduction in BP and all those interventions incorporated care teams. Despite some evidence of the effectiveness of mHealth interventions for improving BP control among vulnerable groups, more effective interventions are needed, and the quality of studies is overall low. Further research is needed to find the most effective ways to engage diverse communities with mHealth solutions to improve BP control.

Adolescents experience alarmingly high rates of major depressive disorder (MDD), however, gold-standard treatments are only effective for ~50% of youth. Accordingly, there is a critical need to develop novel interventions, particularly ones that target neural mechanisms believed to potentiate depressive symptoms. Directly addressing this gap, we developed mindfulness-based fMRI neurofeedback (mbNF) for adolescents that aims to reduce default mode network (DMN) hyperconnectivity, which has been implicated in the onset and maintenance of MDD. In this proof-of-concept study, adolescents (n = 9) with a lifetime history of depression and/or anxiety were administered clinical interviews and self-report questionnaires, and each participant’s DMN and central executive network (CEN) were personalized using a resting state fMRI localizer. After the localizer scan, adolescents completed a brief mindfulness training followed by a mbNF session in the scanner wherein they were instructed to volitionally reduce DMN relative to CEN activation by practicing mindfulness meditation. Several promising findings emerged. First, mbNF successfully engaged the target brain state during neurofeedback; participants spent more time in the target state with DMN activation lower than CEN activation. Second, in each of the nine adolescents, mbNF led to significantly reduced within-DMN connectivity, which correlated with post-mbNF increases in state mindfulness. Last, a reduction of within-DMN connectivity mediated the association between better mbNF performance and increased state mindfulness. These findings demonstrate that personalized mbNF can effectively and non-invasively modulate the intrinsic networks associated with the emergence and persistence of depressive symptoms during adolescence.

ABSTRACT Tools for image-based 3D-reconstruction are commonly used for cultural heritage applications; however, wider usage has increased variability in the quality of output 3D models. Geometric variations between 3D models acquired with differing methods make metric conservation applications such as condition monitoring and measuring change over time challenging. This article presents an investigation of wavelength selection using a modified off-the-shelf DSLR camera and bandpass filters to improve input image quality in a 3D-reconstruction study of a wooden sculpture of a coyote and turtle from the Smithsonian American Art Museum. The sculpture has a large crack of concern to conservators, but its curved, dark shiny surface challenges image-based dimensional monitoring. Selecting infrared wavelengths rather than the visible light for 3D reconstruction input images reduced specular surface reflections and improved image contrast resulting in improved recording of the 3D shape. 3D-reconstructions using infrared radiation produce better reconstructions than those using visible light. In this case reconstructed surface discrepancies between visible light are ∼0.6 mm whilst those using infrared are ∼0.3 mm. Results suggest that reflected infrared images are more forgiving and flexible for recording 3D data over time for dark, shiny wooden surfaces and thus improve the reliability and comparability of image-based 3D-reconstruction.

Invasive lobular breast cancer (ILC) may be hard to detect using conventional imaging modalities and usually shows less avidity to 18 F-FDG PET/CT. 68 Ga-fibroblast activation protein inhibitor (FAPI) PET/CT has shown promising results in detecting non- 18 F-FDG-avid cancers. We aimed to assess the feasibility of detecting metastatic disease in patients with non- 18 F-FDG-avid ILC. This prospective study included patients with metastatic ILC, infiltrative to soft tissues, which was not 18 F-FDG avid. The patients underwent 68 Ga-FAPI PET/CT for evaluation, which was correlated with the fully diagnostic CT performed at the same time. Seven women (aged 57 ± 10 years) were included. Among the 30 organs and structures found to be involved by tumor, the number of findings observed by FAPI PET/CT was significantly higher than that observed by CT alone ( P = 0.022), especially in infiltrative soft tissue and serosal locations. This small pilot trial suggests a role for 68 Ga-FAPI PET/CT in ILC, which needs to be confirmed by subsequent trials.