Initial Session Research Articles

Repeatability of Radiomic Features of Brown Adipose Tissue.

The aim of this study was to assess the repeatability of activated brown adipose tissue (BAT) radiomic features. To decipher radiomic features that may provide useful information on BAT, the impact of reconstruction methods and imaging modality choice was also evaluated. Methods: Twenty-seven healthy adults enrolled in this study. After a cooling procedure to activate BAT, volunteers underwent 18F-FDG imaging. Participants underwent repeat imaging using the same imaging protocols and a similar 18F-FDG dose within 14 d. Active BAT was segmented using the BARCIST 1.0 methods. Radiomic features were extracted from each region of interest on high-definition PET (HD PET), non-HD PET, and CT images. Lin's concordance correlation coefficient was used to estimate the repeatability of the extracted radiomic features. To determine whether BAT radiomic feature repeatability correlates with BAT SUVmax repeatability, participants were stratified based on the relative difference in SUVmax between sessions. Non-HD PET repeatable features were clustered together using hierarchical clustering, and the normalized dynamic range of each feature was computed to identify the most informative feature within each cluster. Results: Eighteen of the 27 volunteers had sufficient BAT activity for radiomic analysis. Sixty-six HD PET, 66 non-HD PET, and 6 CT features showed high repeatability (concordance correlation coefficient ≥ 0.80). Feature repeatability was significantly higher for PET than for CT, but there was no statistically significant difference between HD and non-HD PET in radiomic feature repeatability. The repeatability of radiomic features extracted from each modality and reconstruction method type followed the trend in SUVmax, as participants with lower relative differences in SUVmax between initial and repeated imaging sessions had higher radiomic feature repeatability. Hierarchical clustering of the high-repeatability PET features resulted in 10 highly correlated clusters (R2 ≥ 0.95). Seven features, including SUVmax, did not cluster with any other features. Conclusion: Several clusters of highly repeatable BAT radiomic features derived from 18F-FDG PET/CT appear to provide information regarding BAT activity distinct from SUVmax These features might be explored as quantitative imaging biomarkers of BAT activity in future studies.

Assessment of Factors Affecting Breastfeeding Performance and Latch Score: A Prospective Cohort Study.

To determine the risk factors that may affect LATCH scores. We prospectively evaluated the LATCH scores and any relevant risk factors of patients who delivered at our institution during April and May 2020. All examinations were performed by the same physicians during the study period. LATCH scores were determined at initial breastfeeding session, and postnatal days 1 and 2. We analyzed 338 patients in this prospective study. Patients with high-risk pregnancies were found to have lower LATCH scores at each measurement (p: 0.002, 0.001, and 0.09, respectively). Skin-to-skin contact immediately after delivery and breastfeeding longer than 20 min in the first session did not improve LATCH scores (p>0.05). Breastfeeding within 30 min after delivery significantly improved LATCH scores at each session (p<0.01 for all). Odds ratios of having a LATCH score lower than 8 was 10.9 (95% CI: 4.22-28.37) for the patients breastfed after more than 30 min, while this ratio was 2.17 (95% CI: 1.34-3.50) and 6.5 (95% CI: 3.46-12.58) for the patients having a high-risk pregnancy and cesarean section, respectively. Furthermore, we also determined a positive statistically significant association between parity and all LATCH scores according to regression analyses (p: 0.005, 0.028, and 0.035 for LATCH scores at initial breastfeeding, postnatal day 1 and 2, respectively) CONCLUSION: High-risk pregnancies, patients who delivered by cesarean section, and patients not attempting to breastfeed within 30 min tend to have lower LATCH scores.

Per-oral pancreatoscopy with intraductal lithotripsy for difficult pancreatic duct stones: a systematic review and meta-analysis.

Background and study aims Per-oral pancreatoscopy (POP) with intraductal lithotripsy via electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) facilitates optically-guided stone fragmentation of difficult pancreatic stones refractory to conventional endoscopic therapy. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of POP with intraductal lithotripsy for difficult pancreatic duct stones. Methods Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, complete or partial stone fragmentation success, complete duct clearance after initial lithotripsy session, and adverse events (AEs). Results Ten studies (n = 302 patients; 67.72 % male; mean age 55.10 ± 3.22 years) were included with mean stone size of 10.66 ± 2.19 mm. The most common stone location was in the pancreatic head (66.17 %). Pooled technical success was 91.18 % with an overall fragmentation success of 85.77 %. Single lithotripsy session stone fragmentation and pancreatic duct clearance occurred in 62.05 % of cases. Overall, adverse events were reported in 14.09 % of patients with post-procedure pancreatitis developing in 8.73 %. Of these adverse events, 4.84 % were classified as serious. Comparing POP-EHL vs POP-LL, there was no significant difference in technical success, fragmentation success, single session duct clearance, or AEs ( P > 0.0500). Conclusions Based on this systematic review and meta-analysis, POP with intraductal lithotripsy appears to be an effective and relatively safe procedure for patients with difficult to remove pancreatic duct stones.

Outpatient Ultrafiltration to Prevent Hospital Readmission During Covid 19 Pandemic in Diuretic Intolerant Patient: Case Study

IntroductionHeart Failure (HF) is the leading cause of hospitalization among adults greater than 65 years of age in the U.S. and results in over 1,000,000 hospitalizations annually. Despite advances in medical therapeutics, mortality remains high. Adjustments in workflow across hospital systems have been instituted to reduce HF hospitalizations. Ambulatory HF clinics have helped in this regard. In the current COVID-19 pandemic, the need to minimize utilization of hospital resources and limit patient hospital admissions is paramount. Inpatient ultrafiltration (UF) has been utilized to improve congestion in patients with acute decompensated heart failure (ADHF). Less is known of outpatient utilization of UF in the ambulatory HF patient. We present a case of outpatient UF to reduce congestion in an ambulatory HF patient to minimize hospitalization in the era of COVID-19 pandemic.CaseA 70-year-old female with HF preserved ejection fraction, combined pre and post pulmonary capillary hypertension, with chronic dyspnea on continuous home oxygen, who presented to the HF clinic. The patient had previous multiple hospitalizations due to recurrent congestion, with therapies limited by dermatologic biopsy proven allergy to sulfa based diuretics. She had failed various diuretic regimens with recurrent desquamating whole body rash. She had recurrent weight gain during the COVID-19 pandemic, and again was refractory to outpatient therapies. Given her co-morbidities, she was deemed high risk for COVID-19 exposure. A decision to proceed with outpatient UF was made. The day of outpatient HF clinic visit, we placed a brachial dual lumen 16-gauge extended length catheter. A heparin drip was initiated thirty minutes prior to the start of UF per protocol. Baseline serum creatinine was 1.24 mg/dl and estimated GFR was 44. Initial outpatient session was performed over a total of 4-hours with isolated veno-venous UF utilizing the Aquadex Flex Flow system at a rate of 200 cc/hr fluid removal. The patient completed a total of 4 sessions, and total fluid removal was 4950mL. (Table 1) The patient had immediate improvement in symptoms.DiscussionUF is a method of decongestion that can be used as an alternative to loop diuretics. Simplified UF devices can utilize peripheral venous access, low blood flows, and small extracorporeal blood volume. Previous experience with intermittent outpatient UF utilizing peritoneal dialysis and hemofiltration has been reported, though not widely utilized. This is the first case to report the use of the Aquadex Flex Flow system to provide outpatient UF therapies in the COVID-19 era.ConclusionsPre-existing cardiac and pulmonary disease, including congestive HF, increase risk of serious complications from exposure to SARS-COVID-2 virus. We report a novel case of minimizing exposure risk of a congested HF patient using outpatient isolated veno-venous UF in the ambulatory setting.

Effect of dynamic and static strength training on hormonal activity in elite boxers

The aim of this study was to determine hormonal responses to acute and chronic exposure to static and dynamic strength training programs using resistance bands in boxers. 19 male national boxers participated in the study. Boxers were instructed to perform strength exercises with resistance bands for 3 days a week for 8 weeks involving either dynamic (n=10) or static (n=9) resistance exercises. Blood samples were taken before exercise, immediately after the initial exercise session, and 8 weeks later following the last exercise session. Cortisol, growth hormone, adrenocorticotropic hormone adrenaline and noradrenaline levels were measured. Statistical analyses involved non-parametric analysis with an alpha level of .05. Dynamic strength exercises were effective stimuli to growth hormone, adrenaline and noradrenaline, while static strength exercises provoked cortisol, growth hormone, adrenaline and noradrenaline responses both initially after exercise and after 8 weeks of chronic training. Neither dynamic nor static strength exercises were effective in prompting adrenocorticotropic changes after an exercise session or after 8 weeks of training. We showed that dynamic and static strength exercise protocols using resistance bands both could provoke acute and chronic hormonal responses in boxers similar to more traditional modes of such exercise.

Task Feedback Processing Differs Between Young and Older Adults in Visuomotor Rotation Learning Despite Similar Initial Adaptation and Savings

Ageing has been suggested to affect sensorimotor adaptation by impairing explicit strategy use. Here we recorded electrophysiological (EEG) responses during visuomotor rotation in both young (n = 24) and older adults (n = 25), to investigate the neural processes that underpin putative age-related effects on adaptation. We measured the feedback related negativity (FRN) and the P3 in response to task-feedback, as electrophysiological markers of task error processing and outcome evaluation. The two age groups adapted similarly and showed comparable after effects and savings when re-exposed to the same perturbation several days after the initial session. Older adults, however, had less distinct EEG responses (i.e., reduced FRN amplitudes) to negative and positive task feedback. The P3 did not differ between age groups. Both young and older adults also showed a sustained late positivity following task feedback. Measured at the frontal electrode Fz, this sustained activity was negatively associated with both the amount of voluntary disengagement of explicit strategy and savings. In conclusion, despite preserved task performance, we find clear differences in neural responses to errors in older people, which suggests that there is a fundamental decline in this aspect of sensorimotor brain function with age.

The retention of fall-resisting behavior derived from treadmill slip-perturbation training in community-dwelling older adults.

The purpose of this study was to determine whether and to what extent the immediate generalization of treadmill slip-perturbation training could be retained over 6months to resist overground slip-induced falls. Four protocols (Tc: treadmill control; Tt: treadmill slip-perturbation training; Oc: overground control; Ot: overground slip-perturbation training) from two randomized controlled trials were compared in which two training protocols were executed with single-session repeated slip-perturbation training on the treadmill or overground context, while two control protocols were executed without repeated training. A total of 152 community-dwelling older adults (≥ 65years) who were trained by one of the four protocols and tested by an overground slip in the initial session attended a retest session 6months later. Falls were detected by a load cell. Data collected from motion analysis system and force plates were used to calculate stability. Tt group had no significant change in fall incidence from initial post-training test to retest. Tt group had significantly lower fall incidence (p < 0.05) and higher reactive stability (p < 0.05) than Tc group in retest. Tt group had significantly higher fall incidence (p < 0.05) and lower reactive stability (p < 0.01) than Ot group. The generalization of a single session of treadmill slip-perturbation training to overground slip resulted in inferior outcomes compared with overground slip-perturbation training (absolute retention), although the training generalization could be retained over 6months (relative retention). Thus, treadmill slip-perturbation training could be more convenient to use if future dose-response studies indicate better or equal efficacy to overground slip-perturbation training.

The past as a resource for the bereaved: nostalgia predicts declines in distress

ABSTRACT Nostalgia, a sentimental longing for one’s past, can serve as a resource for individuals coping with discomforting experiences. The experience of bereavement poses psychological and physical risks. In a longitudinal study, we examined whether dispositional nostalgia predicted reductions in distress associated with the death of a loved one. Undergraduate students (N = 133) provided information regarding their loss (time elapsed since loss, expectedness) and levels of initial grief, nostalgia, and distress (hyperarousal, intrusion, avoidance) at three time points over a one-month period (Times 2 and 3 occurred one week and one month after the initial session, respectively). Individuals experiencing higher nostalgia reported a decrease in intrusive thoughts across time, whereas those experiencing lower nostalgia reported no change in intrusive thoughts across time. Hyperarousal (physical symptoms, negative feelings) decreased across time among individuals with higher initial grief who experienced greater nostalgia, but increased across time among those with higher initial grief who experienced lesser nostalgia. No changes occurred in avoidance. Nostalgia can palliate bereavement.

Effort-reward balance and work motivation in rats: Effects of context and order of experience

Being motivated means exerting effort toward a goal. The ‘law of least work’ emphasizes a preference for exerting relatively less effort. The law crosses boundaries among species and between physical and mental work. Organisms should be highly sensitive to shifts in effort-reward balance (ERB) in order to make optimal choices. We used a free operant-foraging task to investigate changes in ERB on choice between options requiring more or less effort. Results showed a consistent preference for the option with less effort and insensitivity to shifts in ERB. A second aim explored the influence of order of experience on effort choice. Choice for the more effortful option significantly increased after experiencing an equal effort-reward relationship during the initial free operant-foraging session. This relative increase in choice for the effortful option persisted even after effort-reward imbalance. The findings highlight the importance of contextual factors such as order of experience when examining the impact of shifting effort-reward associations. Instead of ignoring or reducing order effects, the sequence of experience (e.g. for shifts in ERB) could be manipulated to enhance or reduce value of outcomes or effort itself.

Community-based Skill Building Intervention to Enhance Health Literacy Among Older Rural Adults.

The purpose of this article is to report the outcomes of a skill building intervention to improve general health literacy and health literacy about complementary and alternative therapies (CAM) among older rural adults. The intervention was implemented in eight rural communities. Descriptive statistics and general linear modeling were used for analysis. A total of 127 older adults completed the initial session and Time 1 questionnaire, 67 (51%) completed the intervention sessions and Time 2 questionnaire, and 52 (40.9%) completed the Time 3 questionnaire five months later. CAM health literacy scores and scores on one general health literacy measure were significantly higher at Time 2 compared to Time 1 and 3. The decline in scores over time suggests a need for continuing strategies to support older adults' health literacy. Assisting older adults to make safe health care choices is a critical role for investigators, nurses, and other health care providers.

Special Educators as Coaches to Support Paraprofessional Implementation of Functional Communication Training

The purpose of this study was to examine the effects of special educators’ delivery of training that included an initial training session and follow-up coaching on paraprofessional implementation of an evidence-based practice for students with autism spectrum disorder (ASD). Three special educators each trained a paraprofessional in their classroom to implement functional communication training (FCT) to address the challenging behavior of a student with ASD. The training procedures incorporated the following aspects of behavioral skills training: instruction, modeling, rehearsal, and feedback. Training from special educators resulted in high levels of paraprofessional FCT implementation that maintained over time for two paraprofessionals. Special educators and paraprofessionals found the training to be practical and effective. We present implications for practice and future research directions for paraprofessional training models focused on challenging behavior interventions.

Effect of Peer Mentors in Diabetes Self-management vs Usual Care on Outcomes in US Veterans With Type 2 Diabetes

Diabetes is a substantial public health issue. Peer mentoring is a low-cost intervention for improving glycemic control in patients with diabetes. However, long-term effects of peer mentoring and creation of sustainable models are not well studied. Assess the effects of a peer support intervention for improving glycemic control in patients with diabetes and evaluate a model in which former mentees serve as mentors. A randomized clinical trial was conducted from September 27, 2012, to March 21, 2018, at the Corporal Michael J. Crescenz Medical Center. US veterans with type 2 diabetes aged 30 to 75 years with hemoglobin A1C (HbA1c) greater than 8% received support over 6 months from peers with prior poor glycemic control but who had achieved HbA1c less than or equal to 7.5% (phase 1). Phase 1 mentees were then randomized to become a mentor or not to new randomly assigned participants in phase 2. Outcomes were assessed at 6 and 12 months. Data were analyzed from October 5, 2016, to September 4, 2018. Mentors who received an initial training session and monthly reinforcement training were assigned 1 mentee and given $20 for each month they contacted their mentee at least weekly. Primary outcome was HbA1c change at 6 months. Secondary outcomes included HbA1c change at 12 months and change in low-density lipoprotein, blood pressure, diabetes quality of life, and depression symptoms at 6 and 12 months. The study enrolled 365 participants into phase 1 and 122 participants into phase 2. Most participants were Black (341 [66%]) and male (454 [96%]), with a mean (SD) age of 60 (7.5) years. Mean phase 1 HbA1c change at 6 months for usual care was -0.20% (95% CI, -0.46% to 0.06%) vs -0.52% (95% CI, -0.76% to -0.29%) for mentees (P = .06). Mean phase 2 HbA1c change at 6 months for usual care was -0.46% (95% CI, -1.02% to 0.10%) vs 0.08% (95% CI, -0.42% to 0.57%) for mentees (P = .16). There were no differences in secondary outcomes or HbA1c levels at 12 months. There was no benefit to past mentees who became mentors. In this randomized clinical trial, a peer mentor intervention did not improve 6-month HbA1c levels and did not have sustained benefits. ClinicalTrials.gov Identifier: NCT01651117.

Very Light Daily Smoking in Young Adults: Relationships Between Nicotine Dependence and Lapse.

Very light daily smoking is increasingly common among young adults. Evidence suggests that levels of nicotine dependence vary significantly among young adults who engage in very light daily smoking. However, the links between dependence and clinically relevant outcomes (eg, lapse) in this population remain unclear. The goal of this study was to address this gap by evaluating how well different nicotine dependence scales predict lapse behavior among very light daily smoking young adults. Very light daily smokers (1-5 cigarettes/day) aged 18-25 participated in an initial laboratory session, during which nicotine dependence was assessed using four commonly used measures: the Fagerstrӧm Test for Cigarette Dependence (FTCD), the Hooked On Nicotine Checklist (HONC), the Transdisciplinary Tobacco Use Research Centers (TTURC) Nicotine Dependence Inventory, and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). After a baseline period, eligible participants (n = 40) completed a 10-day abstinence incentive period in which they attempted to refrain from smoking to earn monetary rewards. Cox proportional hazards models were used to test whether dependence predicted days to first lapse. FTCD scores significantly predicted days to lapse, as did scores on the FTCD item assessing time to first cigarette of the day (TTFC). No other dependence measures predicted time to lapse. Both the FTCD and TTFC continued to independently predict time to lapse after controlling for smoking frequency and duration. The FTCD may be a particularly useful tool for capturing clinically meaningful variability in nicotine dependence among young adults who engage in very light daily smoking. This is the first study to directly link self-reported nicotine dependence with the ability to achieve and maintain abstinence among very light daily smoking young adults. The results may aid clinicians in selecting among variable measures of nicotine dependence when assessing and treating this population.

Exploring Counselor‐Client Agreement on Clients’ Work Capacity in Established and Consultative Dyads

Counselor‐client agreement on the work capacity of clients living with serious mental illnesses informs the counseling relationship and facilitates accurate assessments of client eligibility for public programs. In this exploratory mixed‐methods study, we assessed counselor‐client agreement on clients’ work capacity in 61 established therapeutic dyads and compared it with 30 dyads involved in an initial assessment session. Intraclass correlation coefficients and mountain plots were used to examine counselor‐client agreement. Results revealed moderate counselor‐client agreement of work capacity for both dyads. Counselor interviews illuminated sources of discordance. These results have practical implications for assessing the work capacity of clients.

Inside Alcohol Behavioral Couple Therapy (ABCT): In-session speech trajectories and drinking outcomes

The alcohol treatment literature has established in-session client speech as a mechanism of change that therapist behavior can influence and that can predict drinking outcomes. This study aimed to explore temporal patterns of in-session speech in Alcohol Behavioral Couple Therapy (ABCT), including the unique interplay between client and partner speech and the role of speech trajectories in predicting client drinking outcomes. Participants were 165 heterosexual couples receiving ABCT in one of four clinical trials. We coded client speech on an utterance-by-utterance basis using the System for Coding Couples' Interactions in Therapy–Alcohol. We focused on individual-level speech codes of change talk and sustain talk and couple-level variables of positive and negative interactions. We segmented the initial and midtreatment sessions into quartiles to conduct path analyses and latent growth curve models. Path analyses suggested that clients and partners may not have been aligned in terms of treatment goals at the start of the therapy. This misalignment within couples was pronounced during the initial session and decreased by the midtreatment session, reflecting progression toward treatment goals. Of the latent growth curve models, only client sustain talk during the midtreatment session predicted greater client drinking at the end of treatment. Results provide insight into the inner workings of ABCT and suggest recommendations for ABCT therapists. This study also supports a growing consensus that sustain talk may be a stronger mechanism of change than change talk in various alcohol treatment interventions.

A-085 Sports Anxiety Scale − 2: More Sensitive to College Athlete Anxiety

Abstract Objective Concussed student-athletes’ responses on two self-report questionnaires were recorded at two points within the semester in order to evaluate distinguishing changes in psychological symptoms. Methods A sample of (n = 21) collegiate athletes participated in a pre-post study. Student-athletes were recruited from various sports at a private University through the General Psychology course. The participants (age range 18–22, M = 19.38, SD) included 10 females, 11 males.. A pre-post study, mixed-methods experimental design was employed as part of a larger physiological study. The pre-measures included an informed consent, demographic questionnaire, self-report measures (Generalized Anxiety Scale-7 (GAD-7) and the Sports Anxiety Scale-2 (SAS-2)), and 5-time rating scale of performance. All responses were gathered in the neurocognitive lab of the graduate department.. The post-session occurred 5–6 weeks after the initial session, again gathering data on GAD-7 and SAS. Results A within-subject analysis of the data revealed a main effect for time with a moderate effect size (p = .026) in the decrease of SAS-2 total scores. This significant decrease in SAS-2 total scores occurred across groups and across genders in the post-intervention measures. For the GAD-7 measure, there were no significant changes. Conclusion The significant findings for the SAS-2 total scores suggest it is a more sensitive measure of anxiety for healthy college athletes who have a concussion history than the GAD-7. Because of the limited number of participants, further research is necessary to confirm the applicability of the SAS-2.

COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians.

BackgroundThe coronavirus disease (COVID-19) presents unique challenges in health care, including mental health care provision. Telepsychiatry can provide an alternative to face-to-face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working.ObjectiveThe aim of this paper is to produce an open-access, easy-to-consult, and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach.MethodsWe systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre–COVID-19 guidelines and other digital mental health topics where relevant. We summarized the data we extracted as answers to specific clinical questions.ResultsFindings from this study are presented as both a short practical checklist for clinicians and detailed textboxes with a full summary of all the guidelines. The summary textboxes are also available on an open-access webpage, which is regularly updated. These findings reflected the strong evidence base for the use of telepsychiatry and included guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance, and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focused on practical implementation and US guidelines more expansive and detailed. Guidelines on possible combinations with other digital technologies such as apps (eg, from the US Food and Drug Administration, the National Health Service Apps Library, and the National Institute for Health and Care Excellence) are less detailed. Several key areas were not represented. Although some special populations such as child and adolescent, and older adult, and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder, and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, the initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines.ConclusionsWe produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organizations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organizational change in the short- and long-term. Providing easily accessible guidance is a first step but will need cultural change to implement as clinicians start to view telepsychiatry not just as a replacement but as a parallel and complementary form of delivering therapy with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post–COVID-19, and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment.

Outpatient therapy for adult anorexia nervosa: Early weight gain trajectories and outcome.

The purpose of the study was to identify latent classes of trajectory of change in body mass index (BMI) between the initial and thirteenth session of outpatient treatment for adult anorexia nervosa and identify the association with outcome. Participants (n = 120) were randomised to one of three outpatient therapies. Four latent classes were identified; two classes (higher, rapid and higher, moderate) had BMI > 17 kg/m2 at initial assessment, and both gained significantly more weight over the 13 sessions compared to the other two classes. The third and fourth classes (middle, stable and low, stable) had an initial BMI of 16.44 and 15.31, respectively, and neither gained weight over the first 13 sessions. Compared to the other three classes, the higher, rapid class (N = 19, 16%) showed a significantly greater BMI increase over the first 13 sessions of therapy and a significantly higher rate of remission at end of treatment and 12-month follow-up (18-22 months post-randomisation). The group with the greatest early weight gain had significantly higher levels of remission. Higher BMI at baseline without substantial early weight gain was insufficient to produce higher levels of remission than those with lower weight at baseline.

Stereotactic Radiosurgery for Atypical and Anaplastic Meningiomas

Although most meningiomas will be benign, a small proportion will have atypical or anaplastic histologic features and will exhibit more aggressive behavior. The treatment of these tumors has been controversial, especially for patients with recurrence after resection and radiotherapy. We have presented a large series of atypical and anaplastic meningiomas treated with stereotactic radiosurgery (SRS). We performed a retrospective review of a single-institution radiosurgery database and identified 48 patients with 183 lesions who had undergone 99 SRS sessions from 1999 to 2019. The median dose was 15 Gy prescribed to the 50% isodose line. The center of the failures was plotted, and the distance from the treated tumor to the center of the failure was measured. Simulated treatment volumes for external beam radiotherapy were generated according to the target, and failures were characterized as local, marginal, or distant according to the simulated volume. The 5-year disease-free and overall survival rate measured from the initial SRS session was 45.8% and 74.7%, respectively. The 5-year lesional control rate was 68.9%. The most common pattern of first failure was isolated distant failure, followed by isolated local or marginal failure. The incidence of distant failure was significantly greater after treatment of >2 lesions in a single SRS session. Isolated local/marginal failure was associated with grade III tumors and an increasing tumor size. High-risk meningiomas are a heterogeneous group of tumors with a propensity for multiple failures. The most common pattern of relapse after SRS was distant. However, local control remains an issue. Further studies evaluating dose-escalation strategies are warranted.

THE INFLUENCE OF VISUAL FIXATION ON HOP TEST PERFORMANCE

It has been recognized that anterior cruciate ligament (ACL) injuries typically occur when athletes are attending to a secondary task or object, including teammates, opponents, and/or a goal. Commonly applied tests after ACL injury include a series of hop tests to determine functional status, yet do not control for visual fixation. To examine the influence of visual fixation during two functional hop tests in healthy individuals. Repeated measures. Participants performed the crossover triple hop for distance (XHOP) on the left lower limb, and the medial triple hop for distance (MHOP) on the right. For the hop test only conditions, participants were not instructed where to fix their vision while performing the hop test. The visual fixation condition required participants to fix their vision on an alternating plus/minus sign at the center of a display monitor located in front of the participant while performing each hop test, respectively. A retest session occurred 48-72 hours after the initial test session in order to examine reliability. Thirty-four healthy adults (age: 24.0 ± 3.9 years) completed testing procedures, performing the XHOP and MHOP under standard and visual fixation conditions. Of those participants, twelve completed a retest session for reliability analysis. Hop distance was not altered by the addition of visual fixation (p = 0.27), with trivial effect sizes found across conditions (d = 0.02 - 0.07); however, the addition of visual fixation slightly improved within- and between-session intrarater reliability, standard error of measurement, and minimal detectable change of the MHOP. Hop distance during the XHOP and MHOP was not influenced by visual fixation. Measurement of both the XHOP and MHOP was reliable, but lacked precision. Measurement properties for the MHOP including within- and between-session reliability, standard error of measurement, and minimal detectable change improved slightly with the addition of visual fixation compared to normal MHOP procedures. 2b.