Search for Relativistic Magnetic Monopoles with Eight Years of IceCube Data

We present an all-sky 90% confidence level upper limit on the cosmic flux of relativistic magnetic monopoles using 2886 days of IceCube data. The analysis was optimized for monopole speeds between 0.750c and 0.995c, without any explicit restriction on the monopole mass. We constrain the flux of relativistic cosmic magnetic monopoles to a level below 2.0×10^{-19}  cm^{-2} s^{-1} sr^{-1} over the majority of the targeted speed range. This result constitutes the most strict upper limit to date for magnetic monopoles with β≳0.8 and up to β∼0.995 and fills the gap between existing limits on the cosmic flux of nonrelativistic and ultrarelativistic magnetic monopoles.

Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model

OBJECTIVES

The current study was aimed to identify the factors and mechanisms that promote nonsuicidal self-injury and suicidal ideation (SI) as precursors of suicidal behaviors in a sample of 553 Israeli active-duty soldiers.

METHODS

A mediation model was used to examine the contribution of posttraumatic stress disorder (PTSD) symptoms, emotion-regulation difficulties, habituation, and risk-taking behaviors to soldiers' self-injury and SI.

RESULTS

Results indicated direct effects between PTSD symptoms and self-injury and SI, as well as between emotion regulation difficulties and self-injury. Indirect effects were found between PTSD symptoms and nonsuicidal self-injury (NSSI) through the mechanisms of habituation and risk-taking behavior and between difficulties in emotion regulation and NSSI through the mechanism of risk-taking behaviors.

CONCLUSION

To tackle soldiers' suicidal behaviors, clinicians might assess soldiers' PTSD symptoms and difficulties in emotion regulation and intervene by lessening their access to thrill-seeking situations and situations that increase habituation to pain and death.

Switching from originator recombinant growth hormone (Genotropin™) to biosimilar (CRISCY™): Results from a 6-month, multicentric, non-inferiority, extension trial

OBJECTIVE

A previous 12-month comparative trial with Criscy™ (r-hGH Cristália), a biosimilar recombinant growth hormone, demonstrated equivalent efficacy and safety to Genotropin™. This extension trial evaluated the effects of switching patients treated with Genotropin™ to the biosimilar Criscy™ over an additional 6-month treatment period, comparing efficacy, safety, and immunogenicity parameters with patients remaining in the Criscy™ arm.

DESIGN

This extension study included 11 research centers and 81 patients who participated in the CERES study (Czepielewski et al., 2019 [1]). Participants from the Genotropin™ arm (n = 39) had the drug replaced by Criscy™ and the remaining participants were kept in the Criscy™ arm (n = 42) for an additional 6-month period to evaluate immunogenicity, efficacy (growth rate, height SDS), and safety (laboratory tests, and adverse events).

RESULTS

Before the switch, both Criscy™ and Genotropin groups were similar concerning demographics, and auxological measures: age, sex, height, height SDS, weight, and BMI. Height velocity (HV) after 18 months of treatment was 8.7 ± 1.56 cm/year for Criscy™ group and 8.9 ± 1.36 cm/year for Genotropin™ group in the ITT population (p = 0.43). The auxological parameters and IGF-1 and IGFBP-3 SDS were comparable between both groups of patients. No participants were excluded from the study due to adverse events. There were no clinical or statistical relevant differences between the treatment groups concerning frequency, distribution, intensity, and AEs outcome. Similarly, no new anti-r-hGH (ADA) cases among patients that switched from Genotropin™ to Criscy™ were reported. No neutralizing antibody (nAb) was detected in either group.

CONCLUSIONS

This trial showed that switching from originator recombinant human growth hormone to Criscy™ had no impact on efficacy, safety, nor immunogenicity as compared to continued treatment with Criscy™. Growth rates and ADA incidence remained the same as seen before the switch.

Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement

This manuscript reports the Brazilian Diabetes Society Position Statement for insulin adjustments based on trend arrows observed in continuous glucose monitoring systems. The Brazilian Diabetes Society supports the utilization of trend arrows for insulin dose adjustments in patients with diabetes on basal-bolus insulin therapy, both with multiple daily insulin doses or insulin pumps without closed-loop features. For those on insulin pumps with predictive low-glucose suspend feature, we suggest that only upward trend arrows should be used for adjustments. In this paper, tables for insulin adjustment based on sensitivity factors are provided and strategies to optimize the use of trend arrows in clinical practice are discussed.

eV-Scale Sterile Neutrino Search Using Eight Years of Atmospheric Muon Neutrino Data from the IceCube Neutrino Observatory

The results of a 3+1 sterile neutrino search using eight years of data from the IceCube Neutrino Observatory are presented. A total of 305 735 muon neutrino events are analyzed in reconstructed energy-zenith space to test for signatures of a matter-enhanced oscillation that would occur given a sterile neutrino state with a mass-squared differences between 0.01 and 100  eV^{2}. The best-fit point is found to be at sin^{2}(2θ_{24})=0.10 and Δm_{41}^{2}=4.5  eV^{2}, which is consistent with the no sterile neutrino hypothesis with a p value of 8.0%.

Adolescents' Sexual Encounters With Either Romantic or Casual Partners and the Quality of Their Romantic Relationships Four Years Later

Adolescent sexual behavior was examined within a health perspective. Assuming a developmental perspective, the current study investigated the associations between sexual behavior in either stable relationships or in casual encounters, and the quality of romantic relationships and affect 4 years later. Data were collected from 144 Israeli adolescents aged 16-18 years (mean age 16.57 years). Participants completed diary data over a period of 10 days and reported on the quality of their romantic encounters and their emotions, and on their sexual behavior in stable relationships or casual encounters. Four years later, they were asked to complete diary data again for 10 consecutive days and report on the quality of their romantic relationships and their positive and negative affect. Findings indicate that involvement in sexual behavior in stable romantic relationships was associated only with future romantic partner support. In contrast, earlier involvement in casual sexual behavior was associated with a number of future indices: lower partner support, greater negative affect as well as greater relationship tension, and dyadic hurtful behavior 4 years later. The differential role of sexuality within a stable relationship or casual encounters among adolescents for their future romantic development is discussed within a developmental framework.

Efficacy and safety of a biosimilar recombinant human growth hormone (r-hGH Cristalia) compared with reference r-hGH in children with growth hormone deficiency (CERES study): A randomized, multicentric, investigator-blind, phase 3 trial

OBJECTIVE

The CERES study was a randomized, multicenter, investigator-blind trial aimed to evaluate the efficacy and safety of a recombinant human growth hormone (r-hGH) developed by Cristalia, as a biosimilar product, with analytical, functional and pharmacokinetics similarities comparable to Genotropin™, in children with growth hormone deficiency (GHD).

DESIGN

A total of 135 naïve prepubertal children with GHD were recruited, of whom 97 were randomized in 14 Brazilian sites to received either r-hGH Cristalia (n = 49) or Genotropin™ (n = 48). Efficacy was evaluated considering the height standard deviation score (SDS) and growth velocity as auxological parameters, IGF-1 and IGFBP-3 were measured as pharmacodynamic parameters during 12 months treatment time. Safety was assessed by monitoring adverse events, immunogenicity, blood count with platelets, biochemical profile and hormonal levels particularly fasting glucose, insulin and HbA1C.

RESULTS

The auxological parameters and IGF-1 and IGFBP-3 levels were comparable between both groups of patients. At end of study or the 12th month treatment, the means growth velocity was 9.7 cm/year and 9.5 cm/year, for r-hGH Cristalia and Genotropin™, respectively. The ANCOVA mean difference between the groups was 0.16 cm/year to Cristalia group (CI 95% = -0.72 to 1.03 cm/year). There was no difference in adherence among the treatment groups. The safety profile was comparable between groups.

CONCLUSIONS

The clinical similarity between r-hGH and Genotropin™ was demonstrated within 12 month of treatment. On the basis of comparability of quality, safety, and efficacy to the reference product, r-hGH from Cristalia can be considered a cost-effective therapeutic option for patients with growth disorders.

Personality maturation among emerging adults and future career success

Purpose

The purpose of this paper is to examine the role of maturation processes – personality change and reflectivity as characterized by greater awareness to self and others – during emerging adulthood in predicting career success.

Design/methodology/approach

A sample of 205 of Israeli emerging adults was followed over a 12-year period. Participants completed measures of self-criticism at age 23 and 29, reflectivity at the age of 29 and subjective and objective career outcomes such as satisfaction with work and level of income at the age of 35. Hierarchical regressions determined the extent that decreases in self-criticism as well as greater reflectivity that predicted future career success.

Findings

The findings of this paper indicated that greater decreases in self-criticism were longitudinally associated with less frequent negative experiences at work and lesser tendency to have doubts about one’s career. Greater reflective capacity was longitudinally associated with a future higher income, greater career satisfaction and a stronger perception of one’s career as a means to implement inner interests.

Research limitations/implications

The results of this paper suggest that decreasing negative self-perception and enhancing awareness about self and others might facilitate a future career success.

Originality/value

This is among the first studies that demonstrate the role of personality maturation during emerging adulthood for future career success.

Abstract P4-13-05: Evolving treatment patterns in hormone receptor-positive, HER2-negative metastatic breast cancer

Background: The last several years have seen the approval of multiple targeted agents for use alone or combined with standard endocrine therapies (ET) in the 1st, 2nd, and 3rd line hormone receptor positive (HR+), HER2 negative (HER2-) metastatic breast cancer (MBC) settings. Due to these new approvals, standards of care for treatment are evolving.

Methods: Prescribing preferences (PPrefs) of 592 U.S.-based medical oncologists were studied using a validated, proprietary, case-based market research tool (Challenging Cases®). Data were acquired using blinded, audience-response iPad technology at 8 live and virtual events during 2016-2018.

Two core hypothetical cases were presented: 1st line MBC and recurrent (REC) MBC. For each core case the following variables were introduced: time from completion of adjuvant (adj) therapy (Tx) to REC disease, site of metastases [visceral (VIS) vs non-visceral (N-VIS)], and age for the 1st line case, and type of metastases and line of Tx for the recurrent case. Rx choices for which there are published phase 3 data were offered, as well as a category for “other.”

Results:

Table 1.Preferred Rx for recurrent disease during or after 5 yrs of adjuvant non-steroidal aromatase inhibitor (NSAI)*ScenarioExemestane (EXE) + Everolimus (EVE)NSAI + CDK inhibitor (CDKi)Fulvestrant (FUL) + CDKiChemotherapy (CT)Endocrine therapy (ET)OtherREC 18 months (mos) into adj AI Tx, VIS) and N-VIS mets, Age 635%25%63%3%4%0%REC post 5 yrs adj AI and 2 yr treatment free interval (TFI), N-VIS mets, Age 674%49%34%1%12%1%REC post 5 yrs adj AI and 2 yr TFI, N-VIS mets, Age 853%34%19%0%42%1%* May not equal 100% due to rounding.

Table 2.Preferred Rx for 2nd or 3rd recurrence*ScenarioEXE + EVENSAI + CDKiFUL + CDKiCTETAbemaciclibOtherREC post 5 yrs adj AI and 2 yr TFI, N-VIS mets, age 67 --> 12 mos 1st line Tx --> N-VIS mets31%12%38%6%12%1%1%REC post 5 yrs adj AI and 2 yr TFI, N-VIS mets, age 67 --> 12 mos 1st line NSAI + palbociclib Tx --> N-VIS mets38%1%33%9%15%0%3%REC 12 mos into adj AI, age 61,N-VIS mets -->12 mos Tx 1st line -->N-VIS mets21%9%53%9%6%0%1%REC post 5 yrs adj AI and 2 yr TFI, N-VIS mets, age 67 -->12 mos 1st line Tx, N-VIS mets --> 6 mos 2nd line Tx --> VIS and N-VIS mets23%1%9%59%5%2%1%* May not equal 100% due to rounding.

In the setting of a patient (pt), age 63 with early REC on an adj AI, the most preferred strategy was FUL + a CDKi. In a pt, age 67, who completed 5 years of an adj AI with a TFI of 2 years, the most common preference was NSAI + a CDKi. In an older pt (age 85) who completed 5 years of an adj AI and TFI of 2 years, the most common choice of TX was single agent ET. For a pt with N-VIS mets treated in the 2nd line setting, FUL + a CDKi was the most preferred strategy. In a 2nd line pt with REC at 12 mos on adj Tx and after 12 mos of 1st line Tx, FUL + a CDKi and EXE + EVE were the most preferred therapies. In a 3rd line pt, with VIS mets CT was the preferred choice.

Conclusion: Treatment patterns in HR+ HER2- MBC are evolving with the approval of several new agents and emerging data. Age, time to relapse, line of Tx, and type of mets may be some of the key factors that determine PPrefs in HR+, HER2- MBC.

Citation Format: Lankford ML, Britton SL, Buettner AD, Scharf M, Tiscione B, Willey JP, Mahtani RL. Evolving treatment patterns in hormone receptor-positive, HER2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-13-05.

Romantic outcomes in young adulthood: The role of dependency, parental support, and reflective functioning

In recent years, an increasing number of young adults have difficulties making a smooth transition to adulthood in becoming romantically committed and balancing romantic commitments and other aspects of life. The present study was conducted on a sample of 100 Israeli emerging adults (54 males) who were followed from age 23 to 34 years. The study examined the role of personality attributes (dependency, self-criticism), parental support, and reflectivity concerning own family of origin in making a smoother transition to mature romantic engagement. Greater achievement of romantic goals and greater mastery in balancing family and work demands were predicted by low dependency or low self-criticism (assessed at age 23) and a high level of reflectivity (assessed at age 29). The distinctive role of reflectivity with regard to own family script and personality attributes for a smoother romantic transition in adulthood is discussed. In addition, the possible implications of the findings for intervention are also discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The role of change in self-criticism across young adulthood in explaining developmental outcomes and psychological wellbeing

OBJECTIVE

Past research has confirmed the role of self-criticism in numerous forms of psychopathology and negative interpersonal outcomes. However, the majority of these studies were cross-sectional and have not addressed the role of possible changes in self-criticism across time for future outcomes. The current study investigated the degree to which changes in self-criticism during young adulthood precede better psychological outcomes beyond the contribution of their baseline levels.

METHOD

A total of 168 Israeli emerging adults were followed for 12 years. Participants completed assessments of self-criticism at age 23, 24, 26.5, and 29, and of developmental tasks and psychological adaptation at age 35. Analyses assessed the extent to which the intercept and linear slope of self-criticism were associated with assessments of coping with age-related tasks and psychological well-being at age 35.

RESULTS

Findings indicated that decreases in self-criticism between the ages of 23 and 29 were associated with better coping with age-related task outcomes and psychological health at age 35.

CONCLUSIONS

These findings are among the first to show that decreases in self-criticism serve as important precursors of coping with age-related tasks and psychological outcomes and point to the positive contributions of changes in personality attributes for future development.

Adolescent psychopathology in Times of Change: The need for integrating a developmental psychopathology perspective

In addition to the major physical, sexual and cognitive changes, as well as changes in relationships with parents and peers, in recent years adolescents also have to cope with many technological changes and increasing societal instabilities. Most of the existing research has examined the extent to which increasing uncertainties might impact expression of psychopathology and its magnitude. Emerging from a developmental psychopathology perspective, we are looking first for a better understanding of the meaning that adolescents give to these changes, which in turn is likely to affect their behavior. We are also looking for better understanding the importance of the role parents, and other societal systems/institutions (such as peers) play in ameliorating or enhancing the likelihood of maladaptive adolescent behavior under these circumstances.

Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC

OBJECTIVE

Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state.

PROGRAM DESCRIPTION

CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs.

METHODS

The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program.

RESULTS

CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence.

CONCLUSIONS

CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.

Sense of Coherence and Parenting Representation among Parents of Adolescents with Type 1 Diabetes

INTRODUCTION

This study examines the association between parental sense of coherence (SOC) and maternal and paternal representations of parents of adolescents diagnosed with type 1 diabetes (IDDM).

METHOD

Seventy five mothers and fathers of adolescents (age 13-18) diagnosed with IDDM, were recruited. Data were gathered from a demographic and SOC questionnaires, and the Parenting Representations Interview (PRI-A).

RESULTS

A significant association was found between mothers' and fathers' SOC and a more balanced description of parenting, and positive correlations between mothers' and fathers' SOC and their representations of the self as parent, representations of the adolescent, and relationships representations. Furthermore, a negative correlation was found between parents' SOC and less differentiated relationships.

CONCLUSIONS

SOC may promote well-being in spite of exposure to challenging circumstances as parenting an adolescent with IDDM. It appears that fathers and mothers need to and can be addressed as significant caregivers in any treatment or clinical intervention, as they have a relative involvement in taking care of children and therefore sharing the caregiving responsibilities and functioning as co-primary caregivers.

Identification of the flotillin-1/2 heterocomplex as a target of autoantibodies in bona fide multiple sclerosis

BACKGROUND

Autoantibodies, in particular those against aquaporin-4 and myelin-oligodendrocyte glycoprotein (MOG), aid as biomarkers in the differential diagnosis of demyelination. Here, we report on discovery of autoantibodies against flotillin in patients with multiple sclerosis (MS).

METHODS

The target antigen was identified by histo-immunoprecipitation using the patients' sera and cryosections of rat or pig cerebellum combined with mass spectrometrical analysis. Correct identification was ascertained by indirect immunofluorescence and neutralization tests using the target antigens recombinantly expressed in HEK293 cells.

RESULTS

Serum and CSF of the index patient produced a fine-granular IgG indirect immunofluorescence staining of the hippocampal and cerebellar molecular layers. Flotillin-1 and flotillin-2 were identified as target autoantigens. They also reacted with recombinant human flotillin-1/2 co-expressed in HEK293 cells, but not with the individual flotillins in fixed- and live-cell assays. Moreover, neutralization using flotillin-1/2, but not the single flotillins, abolished the tissue reactivity of patient serum. Screening of 521 patients, for whom anti-aquaporin-4 testing was requested and negative, revealed 8 additional patients with anti-flotillin-1/2 autoantibodies. All eight were negative for anti-MOG. Six patients ex post fulfilled the revised McDonald criteria for MS. Vice versa, screening of 538 MS sera revealed anti-flotillin-1/2 autoantibodies in eight patients. The autoantibodies were not found in a cohort of 67 patients with other neural autoantibody-associated syndromes and in 444 healthy blood donors.

CONCLUSIONS

Autoantibodies against the flotillin-1/2 heterocomplex, a peripheral membrane protein that is involved in axon outgrowth and regeneration of the optic nerve, are present in 1-2% of patients with bona fide MS.

When somatization is not the only thing you suffer from: Examining comorbid syndromes using latent profile analysis, parenting practices and adolescent functioning

Understanding somatization presents a challenge to clinicians because it is often associated with other syndromes. We addressed somatization's comorbidity with other internalizing syndromes (anxiety, depression, withdrawal) using latent profile analysis. A representative sample of 3496 Israeli middle and high-school youths reported their internalizing symptoms, perceived parenting practices, psychosocial functioning, and health behaviors. Four profiles, similar across age and gender, were identified: overall-low (65.4%), moderately-high anxiety/depression/withdrawal (24.4%), high somatization (4.8%), and overall-high (5.4%). MANOVAs and follow-up ANOVAs revealed that for the most part the overall-high profile evinced the worst parenting, psychosocial functioning, and health behaviors (smoking and drinking), while the overall-low group evinced the best. For most variables the high somatization and moderately high profiles displayed midway results. However, the moderately-high profile reported higher levels of harsh parenting than the high somatization profile. The high somatization profile reported similar or higher levels of smoking, risk taking, vandalism, and rule violation than the overall-high group. High somatization, either alone or alongside anxiety, depression, and withdrawal, was associated with disruptive and risk-taking behaviors. This link might reflect problems in emotion and anger regulation and become stronger in adolescence because of dysregulation processes characterizing this period. Implications for practice are discussed.

The diversity of romantic pathways during emerging adulthood and their developmental antecedents

The present study examined patterns of romantic pathways in 100 Israeli emerging adults (54 males) who were followed from age 22 to 29 years. Analyses of interviews at age 29 yielded four distinctive romantic pathways differing in stability and ability to learn from romantic experiences: Sporadic, Lengthy Relationships but Absence of Experiential Learning, Moving from Casual to Steady Involvements, and Steady Relationships. Low efficacy, immature dependency, and level of maternal support measured 7 years earlier, predicted less optimal romantic pathways; Sporadic, and Lengthy relationships but absence of experiential learning. Distinctive gender pathways suggested that men are more likely to embark on a sporadic romantic pathway, while women tend more to prefer a stable romantic pathway. Findings of the study suggest that gender, intrapersonal capabilities, and maternal support can predict the pattern of the romantic pathway on which young people embark during their twenties.

Sibling Relationships in Emerging Adulthood and in Adolescence

In this study, 116 emerging adults and adolescents completed questionnaires and were interviewed about their relationship with a sibling. Respondents’ siblings and their mothers also rated the quality of the sibling relationship. Emerging adults were found to spend less time and to be less involved in joint activities with their siblings than adolescents, but they reported being more involved in emotional exchanges with and feeling more warmth toward their siblings. Conflict and rivalry were also reported by emerging adults to be less intense than by adolescents. Narrative analyses showed that emerging adults had a more mature perception of their relationship with their siblings. Unlike in adolescence, the quality of emerging adults’ relationships with their siblings was less related to their relationship with their parents. The results are discussed in the framework of changes in close relationships from adolescence to emerging adulthood.

Ecological Constraints for Intergenerational Transmission of Attachment

To determine whether the transmission of attachment across generations is free from contextual constraints, adult attachment representations were assessed in two kibbutz settings, home-based and communal sleeping. It was hypothesised that under extreme child-rearing circumstances, such as the communal sleeping arrangement, the transmission of attachment is not evident, whereas in the more regular home-based environment the expected transmission of attachment will be found. The participants were 45 mothers and 45 infants, about equal numbers of boys and girls, from 20 kibbutz infant houses with communal sleeping arrangements, and from 25 kibbutz infant houses with home-based sleeping arrangements. Mothers were administered the Adult Attachment Interview (AAI), and infants were assessed through the Ainsworth Strange Situation. Among the home-based pairs, a correspondence of 76% was found between AAI and Strange Situation classifications, whereas the correspondence was only 40% in the communal sleeping group. It is argued that living in a communal sleeping arrangement reduces the expected transmission of attachment.

Mother-child attachment and social anxiety: Associations with friendship skills and peer competence of Arab children

The goal of the study was to examine the joint and distinct contribution of attachment security and social anxiety to Arab children’s peer competence in middle childhood. We focused on Arab children as very little research has examined close relationships for this group. A sample of 404 third-, fourth- and fifth-grade Arabic students (203 boys and 201 girls), mostly from lower middle-class neighborhoods in northern Israel, participated in the study. In a cross-sectional design, bivariate correlations and regression analyses were performed, and findings revealed that attachment security was negatively related to distancing strategies in help-seeking and help-giving contexts, whereas social anxiety was positively related to these strategies. Secure attachment was also associated with providing reassurance to friends, and with peer competence as perceived by teachers. The possible implications of the socio-cultural context, suggestions for future studies, and implications for school intervention are discussed.

[High versus moderate intense running exercise - effects on cardiometabolic risk-factors in untrained males]

Introduction | The philosophy on how to improve cardiometabolic risk factors most efficiently by endurance exercise is still controversial. To determine the effect of high-intensity (interval) training (HI[I]T) vs. moderate-intensity continuous exercise (MICE) training on cardiometabolic risk factors we conducted a 16-week crossover randomized controlled trial. Methods | 81 healthy untrained middle aged men were randomly assigned to a HI(I)T-group and a control-group that started the MICE running program after their control status. HI(I)T consisted of running exercise around or above the individual anaerobic threshold (≈ 80- 100 % HRmax); MICE focused on continuous running exercise at ≈ 65-77.5 % HRmax. Both protocols were comparable with respect to energy consumption. Study endpoints were cardiorespiratory fitness (VO2max), left ventricular mass index (LVMI), metabolic syndrome Z-score (MetS-Z-score), intima-media-thickness (IMT) and body composition. Results | VO2max-changes in this overweighed male cohort significantly (p=0.002) differ between HIIT (14.7 ± 9.3 %, p=0.001) and MICE (7.9 ± 7.4 %,p=0.001). LVMI, as determined via magnetic resonance imaging, significantly increased in both exercise groups (HIIT: 8.5 ± 5.4 %, p=0.001 vs. MICE: 5.3 ± 4.0 %, p=0.001), however the change was significantly more pronounced (p=0.005) in the HIIT-group. MetS-Z-score (HIIT: -2.06 ± 1.31, p=0.001 vs. MICE: -1.60 ± 1.77, p=0.001) and IMT (4.6 ± 5.9 % p=0.011 vs. 4.4 ± 8.1 %, p=0.019) did not show significant group-differences. Reductions of fat mass (-4.9 ± 9.0 %, p=0.010 vs. -9.5 ± 9.4, p=0.001) were significantly higher among the MICE-participants (p=0.034), however, the same was true (p=0.008) for lean body mass (0.5 ± 2.3 %, p=0.381 vs. -1.3 ± 2.0 %, p=0.003). Conclusion | In summary high-intensity interval training tends to impact cardiometabolic health more favorable compared with a moderate-intensity continuous endurance exercise protocol.

Tissue characteristics in tendon-to-bone healing change after rotator cuff repair using botulinumneurotoxin A for temporary paralysis of the supraspinatus muscle in rats

We hypothesized that botulinumneurotoxin A (BoNtA) positively influences tissue characteristics at the re-insertion site when used as an adjuvant prior to rotator cuff repair. One hundred and sixty Sprague-Dawley rats were randomly assigned to either a BoNtA or saline-injected control group. BoNtA or saline solution was injected into the supraspinatus muscle one week prior to repair of an artificially created supraspinatus tendon defect. Post-operatively, one subgroup was immobilized using a cast on the operated shoulder while the other had immediate mobilization. Histologically, the fibrocartilage transition zone was more prominent and better organized in the BoNtA groups when compared to the saline control group. In the immediately mobilized BoNtA groups significantly more collagen 2 at the insertion was detected than in the control groups (p<0.05). Fiber orientation of all BoNtA groups was better organized and more perpendicular to the epiphysis compared with control groups. Tendon stiffness differed significantly (p<0.05) between casted BoNtA and casted saline groups. Tendon viscoelasticity was significantly higher (p<0.05) in the immobilized saline groups no matter if repaired with increased or normal repair load. The results of this study suggest that reduction of load at the healing tendon-to-bone interface leads to improved repair tissue properties.

Adolescents' ADHD symptoms and adjustment: The role of attachment and rejection sensitivity

The associations between attachment style, ADHD symptoms, and social adjustments were examined in a community sample of adolescents. Five hundred and eight junior high school students completed questionnaires pertaining to attachment style, ADHD symptoms (inattention and hyperactivity), and rejection sensitivity, and were rated by homeroom teachers on social adjustment. Analyses supported a 3-profile pattern of attachment styles: secure, dismissing, and preoccupied. The 3 attachment profiles showed differential risk on adolescents' social adjustment, as well as on ADHD symptoms. The secure profile showed the most adaptive outcomes on all of the examined adjustment outcomes, compared with the other 2 profiles. In contrast, the preoccupied attachment profile showed the highest levels of ADHD problems, angry and anxious expectations, while displaying a similar level of maladjustment to the dismissing profile. In addition, structural equation modeling was used and supported a model that tested an indirect link between attachment security and adolescent adjustment via an ADHD latent factor. Findings suggest that clinicians and educators should pay attention to relational patterns (attachment styles) in adolescence, as these may serve as a developmental precursor for ADHD and a range of adjustment problems in school.

Patterns of romantic involvement among emerging adults

The present study examined patterns of romantic involvement in 100 Israeli emerging adults (54 males) who were followed from age 22 to 29 years. Analyses of interviews at age 29 yielded four distinctive relational patterns that are associated with different levels of concurrent wellbeing: Intimately committed, Intimate, Non- intimately committed, and Non-stable. Low efficacy, immature dependency and low parental support, measured 7 years earlier, predicted less optimal romantic relational patterns—non-stable or non-intimately committed. Continued pursuit of studies predicted a delay in entering a committed relationship, despite the capability for such a relationship. Findings of the study suggest that personality and family attributes explain the type and quality of relationships in which young people will be involved, while contextual factors only explain postponement of commitment.

Children’s social competence within close friendship: The role of self-perception and attachment orientations

The associations between self-perception and attachment orientations and three aspects of children’s competence within friendships were examined: Managing conflict, seeking support, and giving support. Questionnaires were completed by 260 4th- and 5th-grade students. Homeroom teachers reported on the children’s social adjustment. Secure attachment orientation and positive self-perception were positively associated with prosocial friendship competencies, and negatively associated with disengaging strategies. By contrast, ambivalent attachment was related to accommodation strategy and to disengaging strategies in the context of seeking and giving support. Girls and boys showed different levels of competencies within friendships; the results also demonstrate that engaging and disengaging strategies might function differently for boys and girls, and reveal the moderating role of attachment. The role of culture in children’s competencies and the implications for intervention for children with friendship difficulties are discussed.

Dynamic contrast-enhanced ultrasound (DCE-US) for easy and rapid evaluation of hepatocellular carcinoma compared to dynamic contrast-enhanced computed tomography (DCE-CT)--a pilot study

PURPOSE

To check the feasibility of the easy quantification of tumor vascularization derived from dynamic contrast-enhanced ultrasound (DCE-US) in comparison to dynamic contrast-enhanced computed tomography (DCE-CT) in patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

19 patients with cirrhosis and histologically proven HCC prospectively underwent CEUS (SonoVue) and CT (Imeron400). Following CEUS, the software ImageJ was used for the easy quantification of the echogenicity in HCC lesions and tumor-free liver parenchyma. For DCE-CT we used the software Hepacare and created arterial enhancement fraction color maps of the whole liver and HCC lesions.

RESULTS

Unifocal/multifocal HCCs were detected in 12/7 (US) and 10/9 patients (CT) and biopsied nodules were defined as a reference lesion with a median of 40 mm (US) and 42 mm (CT). CEUS showed HCC-typical hyper-/hypoenhancement in the arterial/late phase in 16/19 reference lesions, while all reference lesions showed an HCC-typical vascular pattern in CT. With DCE-US, quantitative assessment could not be performed in 3/19 patients due to respiratory motion or insufficient image quality. 13/16 reference lesions showed an HCC-typical vascular pattern. Quantitative assessment was possible with DCE-CT in all patients and all reference nodules showed HCC-typical values of the arterial enhancement fraction. There was no statistical difference between CEUS, DCE-US and DCE-CT in the quantitative assessment of contrast enhancement.

CONCLUSION

The quantitative evaluation of DCE-US was feasible in HCC without a statistical difference with respect to DCE-CT. Further studies with a larger study population including small nodules ≤ 2 cm are needed to assess whether this technique is helpful in routine ultrasound.

Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care: performance of MR imaging in a multi-reader environment

PURPOSE

False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy.

MATERIALS AND METHODS

115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years.

RESULTS

For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI.

CONCLUSION

MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging.

Disorganizing experiences in second- and third-generation holocaust survivors

Second-generation Holocaust survivors might not show direct symptoms of posttraumatic stress disorder or attachment disorganization, but are at risk for developing high levels of psychological distress. We present themes of difficult experiences of second-generation Holocaust survivors, arguing that some of these aversive experiences might have disorganizing qualities even though they do not qualify as traumatic. Based on in-depth interviews with 196 second-generation parents and their adolescent children, three themes of disorganizing experiences carried across generations were identified: focus on survival issues, lack of emotional resources, and coercion to please the parents and satisfy their needs. These themes reflect the frustration of three basic needs: competence, relatedness, and autonomy, and this frustration becomes disorganizing when it involves stability, potency, incomprehensibility, and helplessness. The findings shed light on the effect of trauma over the generations and, as such, equip therapists with a greater understanding of the mechanisms involved.

Buds of Parenting in Emerging Adult Males: What We Learned From Our Parents

The authors examine the precursors of parenting buds (representations regarding parenting before actual parenting) by following 60 men from adolescence to emerging adulthood. Quality of relationships with parents, and attachment representations (state of mind with respect to attachment and attachment styles) assessed in adolescence, contribute to the development of parenting buds in emerging adulthood (desire to have children, perceived parenting capacity, satisfaction with future parenting, self-as-a-parent and future-child perceptions). Quality of relations with parents in emerging adulthood is also associated with parenting buds. Qualitative analyses reveal distinct profiles of parenting buds among participants with different attachment representations. The findings highlight the importance of studying parenting buds as part of the attempt to understand the development of the caregiving behavioral system.

HLA-B*9553: a novel HLA allele shown in three generations of a family

Human leukocyte antigen (HLA)-B*9553, a novel HLA-B allele, was identified in a volunteer hematopoietic stem cell donor. HLA-B*9553 differs from the closely related allele HLA-B*1518 in one single nucleotide substitution resulting in an amino acid substitution.

Too close for comfort: inadequate boundaries with parents and individuation in late adolescent girls

This longitudinal study examined the ramifications of psychological control-guilt induction, parentification, triangulation, and blurring in parent-adolescent relationships for girls' individuation and adjustment. The study followed 120 girls in their transition from high school to military service. Results from the variable-centered and person-centered analyses merged in underscoring the somewhat different developmental path of two groups of inadequate boundary constellations. The group with high guilt induction and psychological control, which involves rejection and invalidation of the child's autonomous self, evinced the worst coping and adjustment to the transition and the lowest level of individuation with a combination of angry entanglement and strivings for overindependence. The blurred-parentified group resembled the adequate boundaries group regarding some indicators (e.g., low levels of engulfment anxiety and high conflictual independence), but further revealed overdependence and immaturity (e.g., high nurturance seeking, low emotional independence, and the lowest functional independence). Implications for preventive work with adolescents and their families are suggested.