Multiple Clinical Populations Research Articles

Clinical gait analysis using video-based pose estimation: Multiple perspectives, clinical populations, and measuring change.

Gait dysfunction is common in many clinical populations and often has a profound and deleterious impact on independence and quality of life. Gait analysis is a foundational component of rehabilitation because it is critical to identify and understand the specific deficits that should be targeted prior to the initiation of treatment. Unfortunately, current state-of-the-art approaches to gait analysis (e.g., marker-based motion capture systems, instrumented gait mats) are largely inaccessible due to prohibitive costs of time, money, and effort required to perform the assessments. Here, we demonstrate the ability to perform quantitative gait analyses in multiple clinical populations using only simple videos recorded using low-cost devices (tablets). We report four primary advances: 1) a novel, versatile workflow that leverages an open-source human pose estimation algorithm (OpenPose) to perform gait analyses using videos recorded from multiple different perspectives (e.g., frontal, sagittal), 2) validation of this workflow in three different populations of participants (adults without gait impairment, persons post-stroke, and persons with Parkinson's disease) via comparison to ground-truth three-dimensional motion capture, 3) demonstration of the ability to capture clinically relevant, condition-specific gait parameters, and 4) tracking of within-participant changes in gait, as is required to measure progress in rehabilitation and recovery. Importantly, our workflow has been made freely available and does not require prior gait analysis expertise. The ability to perform quantitative gait analyses in nearly any setting using only low-cost devices and computer vision offers significant potential for dramatic improvement in the accessibility of clinical gait analysis across different patient populations.

6 A review of neuropsychological measures of executive functioning in the Japanese and Japanese-American population

Objective:There are approximately 1.5 million Japanese and Japanese Americans in the United States, with the Japanese population increasing steadily over the past two decades. Given the growing number of the Japanese population, it is likely that a clinical neuropsychologist may encounter a Japanese patient, particularly for neurocognitive disorder evaluations given the aging population. Literature has reported that cross-cultural bias in neuropsychological testing and cultural factors affect individuals’ test performance. In order to conduct and interpret neuropsychological assessments for this population, it is important to use normative data and consider the impact of various factors such as acculturation, language, and generation in the U.S. Availability of normative cognitive test data for Japanese-Americans is limited. Tests with most extensive use, adaptation, validation, and norming were identified. Many clinically used measures of executive functioning (EF) have been translated into Japanese and studied in multiple clinical populations. We present information on tests in this domain given their appropriateness for use in cross-linguistic and cross-cultural evaluations.Participants and Methods:Available studies of neuropsychological tests measuring EF that have been translated and normed in the Japanese and/or Japanese-American patient population are reported. Review of the literature was conducted by authors of Japanese descent familiar with neuropsychological assessment and Japanese and Japanese-American culture. We prioritized studies published in both English and Japanese and those that included commonly utilized tests in the U.S, allowing for maximum accessibility and utility for Western-based neuropsychologists. Additionally, inclusion priority was given to studies published in English which report the clinical diagnoses, age range, and gender characteristics of the sample population. The Wisconsin card sorting test (WCST) and Trail Making Test (TMT) were reviewed.Results:The WCST and the TMT, with its variant, was the most normed EF cognitive test currently available. The Keio version Japanese-Trail Making Test (J-TMT) and a simplified version of the Trail Making Test (S-TMT) has been utilized in Japan, however norms are still lacking. Of the available studies, the S-TMT and J-TMT were found to be moderately correlated with the TMT. The Keio version WCST (KWCST) (Kao et al., 2012) was correlated to education level (Abe et al., 2004), appropriately differentiating severity of social anxiety disorder (Fujii et al., 2013), patients with schizophrenia (Banno et al., 2012), and cognitive impairment in Parkinson’s disease (Yoshii et al., 2019).Conclusions:Information regarding translated and normed tests are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans. The J-TMT and the S-TMT may be clinically useful as an evaluation of attention for the Japanese population. The KWCST has also been found to be an appropriate tool for this population. However, publicly available norms for these assessments are still sparse, and there is very limited information about administration of these tests by English-speaking neuropsychologists with the use of interpreters. Further work is needed to increase access to and awareness of linguistically and culturally appropriate versions of clinical measures to better serve the Japanese and Japanese-American population.

The influence of age on the frequency of rhythmic masticatory muscle activity during sleep in general population differs from that in clinical research samples.

During sleep, limb and jaw muscle motor activity can be quantified by electromyography (EMG). The frequency of periodic limb activity during sleep increases with age in both the general and clinical research populations. The literature is controversial regarding stability, over age, of the frequency of rhythmic masticatory muscle activity (RMMA), which is one biomarker of sleep bruxism (SB). The purpose of this retrospective sleep laboratory study was to assess if any change in RMMA frequency occurs over age in the general population (GP) and two clinical research (CR) samples. RMMA signals from polysomnography (PSG) recordings of 465 individuals, irrespective of SB awareness, were analysed. The sample comprised 164 individuals from the GP of Sao Paulo, and 301 individuals from Montreal and Osaka CR samples. Data were divided into two subgroups, younger (15-39) and older (40-80) participants. RMMA was classified as low frequency (<2 events/h) or high (≥2 events/h). Pearson correlation (R) and B (slope) analyses were performed with power estimations. In the GP sample, no significant change over age was noted in the RMMA index/year. In the CR samples, a significant reduction was observed in the RMMA index/year (-0.05) with age (R2 =.042; p < .001; 3.5 to 1.5 RMMA/h from 20 to 60 years old). In the GP, the RMMA index remained stable over age. In the CR samples, a significant, reduction was observed. Prospective studies with multiple home sleep recordings, in both general and clinical research populations, are needed before extrapolating from the present findings.

The Diagnostic Value of Ultrasound of the Rectus Femoris for the diagnosis of Sarcopenia in adults: A systematic review

Background & aimSarcopenia is defined as a loss of muscle mass and function, which can be caused by normal ageing or factors such as physical inactivity. Severe health consequences caused by sarcopenia highlight the need for early identification. Computed Tomography (CT) imaging, often mentioned as the gold standard due to its accuracy, is costly and not routinely performed in daily clinical care. Ultrasound of the rectus femoris, however, is low in costs and easily accessible. The aim is to present the current and most recent literature regarding the diagnostic value of ultrasound measurements of the rectus femoris for the diagnosis of sarcopenia in adults. MethodsThe databases PubMed and Web of Science were used to search for studies comparing ultrasound of the rectus femoris with a reference test to diagnose sarcopenia in adults. The quality of the final eligible studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies, version 2, tool (QUADAS-2). ResultsSix studies were included in this systematic review. The muscle thickness and cross-sectional area of the rectus femoris were assessed and compared with the reference tests CT, Dual-Energy X-ray Absorptiometry (DXA), and Bioelectrical Impedance Analysis (BIA). Half of the studies had a low risk of bias on all QUADAS-2 domains. Three studies reported statistical significant outcomes and diagnostic values ranging from 60 to 81% sensitivity and 51 to 94% specificity. ConclusionsUltrasound of the rectus femoris muscle to diagnose sarcopenia has been shown to be a promising method in multiple clinical populations. However, there were some limitations such as a high methodological heterogeneity. Future research should develop standardized protocols and determine clear cut-off values to allow for a better implementation of ultrasound in clinical practice.

Comparison of Azure Kinect and optical retroreflective motion capture for kinematic and spatiotemporal evaluation of the sit-to-stand test

BackgroundThe sit-to-stand test (STS) is commonly used to evaluate functional capabilities within a variety of clinical populations. Traditionally STS is a timed test, limiting the depth of information which can be gained from its evaluation. The Azure Kinect has the potential to add in-depth analysis to STS. Despite these potential benefits, the recently released (2019) Azure Kinect has yet to be evaluated for its ability to accurately assess STS. Research questionsPurposes of this work were to compare data captured during STS using both a 12 camera Vicon motion capture system and the Azure Kinect; and to calculate kinematic and spatiotemporal variables related to the four phases of the STS cycle. MethodsSpatiotemporal and kinematic measures for STS were simultaneously collected by both devices for 15 participants. Cycle waveforms were compared for right and left hip and knee flexion/extension angular displacement, right and left hip and knee flexion/extension angular velocity, and knee-to-ankle separation ratio. Evaluated discrete outcome variables included: phase time points, maximum knee extension velocity from phases 3 to 4, medial-lateral pelvic sway range, and total time to completion. Waveform summary data were compared using R, R2, and RMSE. Discrete variables were analyzed using Spearman’s Rank correlation coefficient. ResultsR and R2 values between the two systems indicated high levels of correlation (all R values > 0.711, all R2 values > 0.660). Although there was an overall high level of agreement between waveform shapes, high RMSE values indicated some minor tracking errors for Kinect within the STS cycle. Spearman’s Rank correlation coefficient indicated high levels of correlation between the systems for discrete variables (all R values > 0.89), with the exception of medial-lateral pelvic sway range. SignificanceThe Azure Kinect provides valuable insight into STS movement strategies allowing for improved precision in clinical decision making across multiple clinical populations.

Computerized Cognitive Training: A Review of Mechanisms, Methodological Considerations, and Application to Research in Depression

Computerized cognitive training (CCT) is receiving attention as a promising and widely accessible intervention that is designed to ameliorate the cognitive symptoms commonly seen across multiple clinical populations as well as mood and activities of daily living. The primary purpose of this review is to elucidate the mechanisms of action and response factors of CCT. The secondary purpose is to review and propose the applicability of CCT to individuals with depression who have been shown to experience several cognitive symptoms that often predate, co-occur, and persist even with the resolution of mood symptoms. Design recommendations for future studies are proposed to determine the suitability of CCT as an adjunctive treatment for depression, including use of both active and waitlist control groups and having shorter yet more frequent training protocols.

Impact of a Yogic Breathing Technique on the Well-Being of Healthcare Professionals During the COVID-19 Pandemic.

BackgroundThe COVID-19 pandemic has created unprecedented challenges for healthcare globally, the brunt of which has been borne by the health care providers (HCPs). These challenges are felt more keenly in India, as they stretch an insufficiently resourced healthcare system. The long hours, cross over of responsibilities, lack of resources to adequately care for patients, and concerns around safety of self and loves ones, have led to a spike in anxiety, depression, insomnia and other stress – related disorders in healthcare providers. Sudarshan Kriya Yoga (SKY) is a mind-body intervention that has been studied in multiple clinical populations. Prior to this study, there has been no exploration of the impact of SKY on healthcare providers, specifically the impact of a mind-body intervention like SKY on HCPs during a pandemic.ObjectiveThis study aims to investigate the impact of SKY on the well-being of HCPs during the COVID-19 pandemic.MethodsWe conducted a pilot feasibility study with a single arm pre-post design. SKY was taught to participants in a 4-day online breath and meditation workshop. We measured outcomes related to depression, anxiety, resilience, life satisfaction, and quality of sleep.ResultsNinety-two subjects completed the study survey before and after the intervention. A significant reduction was observed in the levels of stress, anxiety and depression immediately after the program. In addition, the participants reported sig1nificant improvement in life satisfaction, resilience, and the quality of their sleep.ConclusionThe results indicate that SKY breathing technique had a positive impact on the well-being of healthcare professionals during the pandemic. Participants experienced improved quality of sleep, enhanced satisfaction with life, and increased resilience after SKY. This pilot study provides important data for future multi-site randomized controlled trials to study the impact of yogic techniques on well-being of the HCPs.

Category learning in rodents using touchscreen-based tasks.

Categorization is a fundamental cognitive function that organizes our experiences into meaningful "chunks." This category knowledge can then be generalized to novel stimuli and situations. Multiple clinical populations, including people with Parkinson's disease, amnesia, autism, ADHD and schizophrenia, have impairments in the acquisition and use of categories. Although rodent research is well suited for examining the neural mechanisms underlying cognitive functions, many rodent cognitive tasks have limited translational value. To bridge this gap, we use touchscreens to permit greater flexibility in stimulus presentation and task design, track key dependent measures, and minimize experimenter involvement. Touchscreens offer a valuable tool for creating rodent cognitive tasks that are directly comparable to tasks used with humans. Touchscreen tasks are also readily used with cutting-edge neuroscientific methods that are difficult to do in humans such as optogenetics, chemogenetics, neurophysiology and calcium imaging (using miniscopes). In this review, we show advantages of touchscreen-based tasks for studying category learning in rats. We also address multiple factors for consideration when designing category learning tasks, including the limitations of the rodent visual system, experimental design, and analysis strategies.

Mobile RDoC: Using Smartphones to Understand the Relationship Between Auditory Verbal Hallucinations and Need for Care.

ObjectiveAuditory verbal hallucinations (AVH) are common in multiple clinical populations but also occur in individuals who are otherwise considered healthy. Adopting the National Institute of Mental Health’s Research Domain Criteria (RDoC) framework, the aim of the current study was to integrate a variety of measures to evaluate whether AVH experience varies across clinical and nonclinical individuals. MethodsA total of 384 people with AVH from 41 US states participated in the study; 295 participants (77%) who received inpatient, outpatient, or combination treatments for AVH and 89 participants (23%) who never received care. Participants used a multi-modal smartphone data collection system to report on their AVH experiences and co-occurring psychological states multiple times daily, over 30 days. In parallel, smartphone sensors recorded their physical activity, geolocation, and calling and texting behavior continuously. ResultsThe clinical sample experienced AVH more frequently than the nonclinical group and rated their AVH as significantly louder and more powerful. They experienced more co-occurring negative affect and were more socially withdrawn, spending significantly more time at home and significantly less time near other people. Participants with a history of inpatient care also rated their AVH as infused with significantly more negative content. The groups did not differ in their physical activity or use of their smartphones for digital communication. ConclusionSmartphone-assisted remote data collection revealed real-time/real-place phenomenological, affective, and behavioral differences between clinical and nonclinical samples of people who experience AVH. The study provided strong support for the application of RDoC-informed approaches in psychosis research.

Open-Source Remote Gait Analysis: A Post-Surgery Patient Monitoring Application

Critical to digital medicine is the promise of improved patient monitoring to allow assessment and personalized intervention to occur in real-time. Wearable sensor-enabled observation of physiological data in free-living conditions is integral to this vision. However, few open-source algorithms have been developed for analyzing and interpreting these data which slows development and the realization of digital medicine. There is clear need for open-source tools that analyze free-living wearable sensor data and particularly for gait analysis, which provides important biomarkers in multiple clinical populations. We present an open-source analytical platform for automated free-living gait analysis and use it to investigate a novel, multi-domain (accelerometer and electromyography) asymmetry measure for quantifying rehabilitation progress in patients recovering from surgical reconstruction of the anterior cruciate ligament (ACL). Asymmetry indices extracted from 41,893 strides were more strongly correlated (r = −0.87, p < 0.01) with recovery time than standard step counts (r = 0.25, p = 0.52) and significantly differed between patients 2- and 17-weeks post-op (p < 0.01, effect size: 2.20–2.96), and controls (p < 0.01, effect size: 1.74–4.20). Results point toward future use of this open-source platform for capturing rehabilitation progress and, more broadly, for free-living gait analysis.

The plasma peptidome

BackgroundIt may be possible to discover new diagnostic or therapeutic peptides or proteins from blood plasma using LC–ESI–MS/MS to identify, quantify and compare the statistical distributions of peptides cleaved ex vivo from plasma samples from different clinical populations.MethodsA systematic method for the organic fractionation of plasma peptides was applied to identify and quantify the endogenous tryptic peptides from human plasma from multiple institutions by C18 HPLC followed nano electrospray ionization and tandem mass spectrometry (LC–ESI–MS/MS) with a linear quadrupole ion trap. The endogenous tryptic peptides, or tryptic phospho peptides (i.e. without exogenous digestion), were extracted in a mixture of organic solvent and water, dried and collected by preparative C18. The tryptic peptides from 6 institutions with 12 different disease and normal EDTA plasma populations, alongside ice cold controls for pre-analytical variation, were characterized by mass spectrometry. Each patient plasma was precipitated in 90% acetonitrile and the endogenous tryptic peptides extracted by a stepwise gradient of increasing water and then formic acid resulting in 10 sub-fractions. The fractionated peptides were manually collected over preparative C18 and injected for 1508 LC–ESI–MS/MS experiments analyzed in SQL Server R.ResultsPeptides that were cleaved in human plasma by a tryptic activity ex vivo provided convenient and sensitive access to most human proteins in plasma that show differences in the frequency or intensity of proteins observed across populations that may have clinical significance. Combination of step wise organic extraction of 200 μL of plasma with nano electrospray resulted in the confident identification and quantification ~ 14,000 gene symbols by X!TANDEM that is the largest number of blood proteins identified to date and shows that you can monitor the ex vivo proteolysis of most human proteins, including interleukins, from blood. A total of 15,968,550 MS/MS spectra ≥ E4 intensity counts were correlated by the SEQUEST and X!TANDEM algorithms to a federated library of 157,478 protein sequences that were filtered for best charge state (2+ or 3+) and peptide sequence in SQL Server resulting in 1,916,672 distinct best-fit peptide correlations for analysis with the R statistical system. SEQUEST identified some 140,054 protein accessions, or some ~ 26,000 gene symbols, proteins or loci, with at least 5 independent correlations. The X!TANDEM algorithm made at least 5 best fit correlations to more than 14,000 protein gene symbols with p-values and FDR corrected q-values of ~ 0.001 or less. Log10 peptide intensity values showed a Gaussian distribution from E8 to E4 arbitrary counts by quantile plot, and significant variation in average precursor intensity across the disease and controls treatments by ANOVA with means compared by the Tukey–Kramer test. STRING analysis of the top 2000 gene symbols showed a tight association of cellular proteins that were apparently present in the plasma as protein complexes with related cellular components, molecular functions and biological processes.ConclusionsThe random and independent sampling of pre-fractionated blood peptides by LC-ESI-MS/MS with SQL Server-R analysis revealed the largest plasma proteome to date and was a practical method to quantify and compare the frequency or log10 intensity of individual proteins cleaved ex vivo across populations of plasma samples from multiple clinical locations to discover treatment-specific variation using classical statistics suitable for clinical science. It was possible to identify and quantify nearly all human proteins from EDTA plasma and compare the results of thousands of LC–ESI–MS/MS experiments from multiple clinical populations using standard database methods in SQL Server and classical statistical strategies in the R data analysis system.

Determination of Free 25(OH)D Concentrations and Their Relationships to Total 25(OH)D in Multiple Clinical Populations.

The optimal measure of vitamin D status is unknown. To directly measure circulating free 25-hydroxyvitamin D[25(OH)D] concentrations and relationships to total 25(OH)D in a clinically diverse sample of humans. Cross-sectional analysis. Seven academic sites. A total of 1661 adults: healthy (n = 279), prediabetic (n = 479), outpatients (n = 714), cirrhotic (n = 90), pregnant (n = 20), nursing home resident (n = 79). Merge research data on circulating free 25(OH)D (directly-measured immunoassay), total 25(OH)D (liquid chromatography/tandem mass spectrometry), D-binding protein [DBP; by radial (polyclonal) immunodiffusion assay], albumin, creatinine, intact parathyroid hormone, and DBP haplotype. Distribution of free 25(OH)D (ANOVA with Bonferroni correction for post hoc comparisons) and relationships between free and total 25(OH)D (mixed-effects modeling incorporating clinical condition, DBP haplotype with sex, race, estimated glomerular filtration rate (eGFR), body mass index (BMI), and other covariates). Free 25(OH)D was 4.7 ± 1.8 pg/mL (mean ± SD) in healthy persons and 4.3 ± 1.9 pg/mL in outpatients, with levels of 0.5 to 8.1 pg/mL and 0.9 to 8.1 pg/mL encompassing 95% of healthy persons and outpatients, respectively. Free 25(OH)D was higher in patients with cirrhosis (7.1 ± 3.0 pg/mL; P < 0.0033) and nursing home residents (7.9 ± 2.1 pg/mL; P < 0.0033) than in other groups and differed between whites and blacks (P < 0.0033) and between DBP haplotypes (P < 0.0001). Mixed-effects modeling of relationships between free and total 25(OH)D identified clinical conditions (patients with cirrhosis > nursing home residents > patients with prediabetes > outpatients > pregnant women) and BMI (lesser effect) as covariates affecting relationships but not eGFR, sex, race, or DBP haplotype. Total 25(OH)D, health condition, race, and DBP haplotype affected free 25(OH)D, but only health conditions and BMI affected relationships between total and free 25(OH)D. Clinical importance of free 25(OH)D needs to be established in studies assessing outcomes.

Distress Intolerance Moderation of Attention to Emotion: An Eye-Tracking Study

Distress intolerance (DI) is an important individual difference reflective of the inability to endure aversive affective states and is relevant to multiple clinical populations, but underlying emotional processing mechanisms remain unclear. The current study used eye-tracking to examine biased attention towards emotional stimuli at baseline and in the context of acute stress in a non-clinical sample (N = 165). We hypothesized that DI would incrementally predict greater stressor-elicited increases in sustained/delayed disengagement, but not initial orientation/facilitated engagement negative (i.e., threat, dysphoric) attention biases, and that DI’s association with maladaptive stress regulation would depend on these increases. Partially consistent with predictions, DI was only independently associated with stressor-elicited increases in sustained negative bias and, unexpectedly, decreases in sustained positive bias. Further, DI and change in sustained threat bias marginally interacted to predict cardiovascular but not subjective anxious mood recovery. Theoretical implications are discussed.

Targeted box and blocks test: Normative data and comparison to standard tests.

BackgroundThe Box and Block Test (BBT) is a functional outcome measure that is commonly used across multiple clinical populations due to its benefits of ease and speed of implementation; reliable, objective measurement; and repetition of motion. In this study, we introduce a novel outcome measure called the targeted BBT that allows for the study of initiation, grasping, and transport of objects, and also of object release. These modifications to the existing test may increase the ecological validity of the measure while still retaining the previously stated benefits of the standard BBT.Methods19 able-bodied subjects performed the targeted BBT and two other standard tests. Using an integrated movement analysis framework based on motion capture and ground force data, quantitative information about how subjects completed these tests were captured. Kinematic parameters at the wrist, elbow, shoulder, thorax, and head, as well as measures of postural control, were calculated and statistically compared across the three tests.ResultsIn general, the targeted BBT required significantly higher RoM at the elbow, shoulder, thorax and head when compared to standard tests. Peak angles at these joints were also higher during performance of the targeted BBT. Peak angles and RoM values for the targeted BBT were close to those found in studies of movements of able-bodied individuals performing activities of daily living.ConclusionThe targeted BBT allows analysis of repetitive movements, and may more closely model common real-world object manipulation scenarios in which a user is required to control a movement from pick-up to release.

Adapting Dialectical Behavior Therapy for College Counseling Centers

College counseling centers report increased student presentation with severe psychological issues (Gallagher, ). Although dialectical behavior therapy (DBT) has demonstrated efficacy with multiple clinical populations, standard model DBT is not feasible for many traditional college counseling centers. This article describes the iterative development and evolution of a comprehensive DBT program adapted to fit the scope of a traditional college counseling center. Guidelines for implementing lessons learned over the 3 years of the program are provided.

Inventario de síntomas prefrontales (ISP): validez ecológica y convergencia con medidas neuropsicológicas

The Prefrontal Symptoms Inventory (PSI) is a self-reported questionnaire, created in Spain, which asks about cognitive, emotional and behavioural alterations in activities of daily living and which can be applied in both the general population and in multiple clinical populations. There is a shorter 20-item version (PSI-20) with excellent psychomotor properties for screening. To study the convergent and divergent validity of the PSI and PSI-20, by analysing how their scales reflect the day-to-day consequences of real deficits found in neurological assessment performed by means of performance tests. A sample of 52 persons undergoing treatment for substance addiction (31 males and 21 females) were administered the PSI together with an abbreviated neuropsychological examination battery focused on describing attentional, mnemonic and executive processes. Both versions of the PSI present optimal psychometric properties (0.78 > alpha > 0.94 for the complete 46-item version and 0.7 > alpha > 0.89 for the abbreviated 20-item version). The results confirm the hypotheses regarding their validity: the performance problems scale is related with the capacity to resolve tests that supposedly rate the executive functions of a prefrontal origin (convergent validity), whereas the scales of problems in emotional control and problems with social behaviour are not related with those cognitive capabilities (discriminant validity). The PSI is a test that is clinically useful, psychometrically valid and applicable in multiple clinical populations.

Virtual reality job interview training and 6-month employment outcomes for individuals with schizophrenia seeking employment

BackgroundIndividuals with schizophrenia have low employment rates and the job interview presents a critical barrier for them to obtain employment. Virtual reality training has demonstrated efficacy at improving interview skills and employment outcomes among multiple clinical populations. However, the effects of this training on individuals with schizophrenia are unknown. This study evaluated the efficacy of virtual reality job interview training (VR-JIT) at improving job interview skills and employment outcomes among individuals with schizophrenia in a small randomized controlled trial (n=21 VR-JIT trainees, n=11 waitlist controls). MethodsTrainees completed up to 10h of virtual interviews using VR-JIT, while controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews scored by blinded raters with expertise in human resources and self-reported interviewing self-confidence. Six-month follow-up data on employment outcomes were collected. ResultsTrainees reported that the intervention was easy-to-use, helpful, and prepared them for future interviews. Trainees demonstrated increased role-play scores between pre-test and post-test while controls did not (p=0.001). After accounting for neurocognition and months since prior employment, trainees had greater odds of receiving a job offer by 6month follow-up compared to controls (OR: 8.73, p=0.04) and more training was associated with fewer weeks until receiving a job offer (r=−0.63, p<0.001). ConclusionsResults suggest that VR-JIT is acceptable to trainees and may be efficacious for improving job interview skills in individuals with schizophrenia. Moreover, trainees had greater odds of receiving a job offer by 6-month follow-up. Future studies could evaluate the effectiveness of VR-JIT within community-based services.

The project data sphere initiative: accelerating cancer research by sharing data.

Background. Inthispaper,weprovidebackgroundandcontext regarding the potential for a new data-sharing platform, the ProjectDataSphere(PDS)initiative,fundedbyfinancialandinkind contributions from the CEO Roundtable on Cancer, to transform cancer research and improve patient outcomes. Giventherelativelymodestdeclineincancerdeath ratesover the past several years, a new research paradigm is needed to accelerate therapeutic approaches for oncologic diseases. Phase III clinical trials generate large volumes of potentially usable information, often on hundreds of patients, including patientstreatedwithstandardofcaretherapies(i.e.,controls). Both nationally and internationally, a variety of stakeholders have pursued data-sharing efforts to make individual patientlevel clinical trial data available to the scientific research community.

Application of the Gillette Gait Index, Gait Deviation Index and Gait Profile Score to multiple clinical pediatric populations

Gait indices are now commonly used to assess overall pathology and outcomes from studies with instrumented gait analyses. There are differences in how these indices are calculated and therefore inherent differences in their sensitivities to detect changes or differences between groups. The purpose of the current study was to examine the three most commonly used gait indices, Gillette Gait Index (GGI), Gait Deviation Index (GDI), and Gait Profile Score (GPS), comparing the statistical sensitivity and the ability to make meaningful interpretations of the clinical results. In addition, the GDI*, a log transformed and scaled version of the GPS score which closely matches the GDI was examined. For seven previous or ongoing studies representing varying gait pathologies seen in clinical laboratories, the GGI, GDI, and GPS/GDI* were calculated retrospectively. The GDI and GPS/GDI* proved to be the most sensitive measures in assessing differences pre/post-treatment or from a control population. A power analysis revealed the GDI and GDI* to be the most sensitive statistical measures (lowest sample sizes required). Subjectively, the GDI and GDI* interpretation seemed to be the most intuitive measure for assessing clinical changes. However, the gait variable sub-scores of the GPS determined several statistical differences which were not previously noted and was the only index tool for quantifying the relative contributions of specific joints or planes of motion. The GGI did not offer any advantages over the other two indices.

Neuroimaging of Brain Networks and Function

The human brain consists of multiple interconnected large scale networks. Recent advances in structural and functional neuroimaging techniques have introduced new concepts and approaches to noninvasively assess brain networks, which has attracted enormous research interest. To examine human brain function, traditional neuroimaging research typically focuses on localizing neural responses to varying external stimuli or task demands. However, task-induced phasic neuronal responses account for less than 5% of the brain's energy budget, while the majority of the brain's energy is used for intrinsic spontaneous brain activities. Although the number of human brain imaging studies and the knowledge obtained from these studies are growing exponentially, there are many more unanswered questions regarding the structural organization and the function of brain networks. In this special issue, we have invited a few papers that studied structural and functional brain networks using various neuroimaging methods including resting-state fMRI, diffusion tensor imaging (DTI), arterial spin labeling (ASL) perfusion MRI, functional near-infrared spectroscopy (fNIRS), magnetoencephalogram (MEG), and imaging genetics. These studies involve healthy populations as well as multiple clinical populations, including patients with cirrhosis, mild cognitive impairment (MCI) and Alzheimer's disease (AD), attention deficit hyperactivity disorder (ADHD), and epilepsy. This specific issue includes several studies focusing on clinical populations. In one study by G. Zheng and colleagues, resting-state fMRI was used to examine functional connectivity changes in the progression of minimal hepatic encephalopathy and found continuously impaired intra- and intermodular connectivity in patients with cirrhosis. In another study, Y.-Y. Wai and colleagues used tract-based spatial statistics of DTI to characterize white matter integrity in different subtypes of MCI, including amnestic MCI, dysexecutive MCI, AD, and healthy controls. They found that amnestic MCI and AD patients share significant white matter damage, whereas dysexecutive MCI patients appear to have a distinct pathogenesis. In the third study, A. dos Santos Siqueira and colleagues used graph theory and analyzed a resting-state fMRI data set from healthy children and ADHD patients in the ADHD-200 database. Distinct patterns of network dysfunction were evident for both inattentive and combined ADHD subtypes. However, the authors observed that the classification scores for discriminating between ADHD and healthy subjects were close to chance and that functional connectivity estimations were strongly dependent on the sample characteristics. In the final study, H. Zhu and colleagues used resting-state MEG to identify the epileptogenic and other abnormal regions in patients with left temporal lobe epilepsy (TLE) and provided further evidence supporting the notion that TLE is not a focal focus but a multifocus disease. A few other studies in this specific issue examined brain networks and function in normal population. In one study by H. Lei and colleagues, resting-state fMRI was integrated with genetics to examine the effect of genetic variation of the MAOA gene on resting brain activity in healthy male adolescents. Those with the low-activity MAOA genotype exhibited lower amplitude of low-frequency fluctuation (ALFF) in the pons compared to those with the high-activity MAOA genotype. Moreover, there was a significant genotype by ALFF interaction effect on impulsivity scores. In another study, H. Niu and colleagues examined the effects of learning on resting brain activity using fNIRS and demonstrated that 5 days of visual perceptual learning significantly altered resting oxygenated hemoglobin functional connectivity between visual cortex and frontal/central areas. In the study by C. Xu and colleagues, the regional homogeneity (ReHo) approach was used as an index in the resting-state fMRI to investigate gender differences in spontaneous brain activity among a large sample of young healthy adults. This study found significant ReHo differences in multiple cortical regions and resting-state networks between male and female subjects. This specific issue also includes two studies on neuroimaging methods and one review paper. In one study, X. Li and colleagues compared FAIR and PICORE sequences and systematically optimized ASL imaging parameters for measuring cerebellum grey matter and white matter perfusion. In another study, M. Gorges and colleagues demonstrated a potential framework for multiparametric functional connectivity mapping through combination of resting-state fMRI with DTI. Finally, in the review paper, T. K. Das and colleagues highlighted the structure-function relationship of the brain networks using the Ising model and graph theory. In summary, studies published in this specific issue demonstrate a few examples of continuous efforts to integrate structural and functional neuroimaging methods as well as other research modalities in order to elucidate brain networks and their function in both normal healthy population and clinical patients. Hengyi Rao Danny Jiongjiong Wang Yihong Yang Yong He