Publications by authors named "James Houston"

63 Publications

Functional connectivity abnormalities in Type I Chiari: associations with cognition and pain.

Brain Commun 2021 Jul 14;3(3):fcab137. Epub 2021 Jun 14.

Department of Psychology, The University of Akron, Akron, OH 44325, USA.

There is initial evidence of microstructural abnormalities in the fibre-tract pathways of the cerebellum and cerebrum of individuals diagnosed with Type I Chiari malformation. However, it is unclear whether abnormal white matter architecture and macro-level morphological deviations that have been observed in Chiari translate to differences in functional connectivity. Furthermore, common symptoms of Chiari include pain and cognitive deficits, but the relationship between these symptoms and functional connectivity has not been explored in this population. Eighteen Type I Chiari patients and 18 age-, sex- and education-matched controls underwent resting-state functional MRI to measure functional connectivity. Participants also completed a neuropsychological battery and completed self-report measures of chronic pain. Group differences in functional connectivity were identified. Subsequently, pathways of significant difference were re-analyzed after controlling for the effects of attention performance and self-reported chronic pain. Chiari patients exhibited functional hypoconnectivity between areas of the cerebellum and cerebrum. Controlling for attention eliminated all deficits with the exception of that from the posterior cerebellar pathway. Similarly, controlling for pain also eliminated deficits except for those from the posterior cerebellar pathway and vermis VII. Patterns of Chiari hyperconnectivity were also found between regions of the cerebellum and cerebrum in Chiari patients. Hyperconnectivity in all regions was eliminated after controlling for attention except between left lobule VIII and the left postcentral gyrus and between vermis IX and the precuneus. Similarly, hyperconnectivity was eliminated after controlling for pain except between the default mode network and globus pallidus, left lobule VIII and the left postcentral gyrus, and Vermis IX and the precuneus. Evidence of both hyper- and hypoconnectivity were identified in Chiari, which is posited to support the hypothesis that the effect of increased pain in Chiari draws on neural resources, requiring an upregulation in inhibitory control mechanisms and resulting in cognitive dysfunction. Areas of hypoconnectivity in Chiari patients also suggest disruption in functional pathways, and potential mechanisms are discussed.
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http://dx.doi.org/10.1093/braincomms/fcab137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279071PMC
July 2021

Radiation in orthopaedics (RIO) study: a national survey of UK orthopaedic surgeons.

Br J Radiol 2021 Jul 21:20210736. Epub 2021 Jul 21.

Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.

Objectives: Orthopaedic surgeons have a responsibility to minimise risks of ionising radiation to patients, themselves and staff. This study aims to establish the understanding of radiation practice, legislation and risk by orthopaedic surgeons.

Methods: A nationwide online survey of UK-based orthopaedic surgeons was conducted. Participants answered 18 multiple-choice questions assessing level of radiation safety training, basic principles/knowledge of ionising radiation, relevant legislation and operating practice.

Results: A total of 406 surgeons completed the survey. 92% reported using intraoperative ionising radiation at least once per week. 38% received no formal training on radiation safety. Knowledge of basic principles of radiation and legislation was limited. There was variable knowledge when labelling an image intensifier machine and choosing its safest orientation. Poor uptake of radiation protection equipment was noted. Only 19% agreed they had adequate training in ionising radiation safety and 27% reported receiving adequate training in equipment emitting ionising radiation in the operating theatre.

Conclusion: Many orthopaedic surgeons in the UK do not believe they are adequately trained in radiation safety. There is a deficiency amongst practicing surgeons in basic knowledge, relevant legislation and practicalities of the use of ionising radiation in the operating room. This could potentially put patients and health-care professionals at additional risk. We recommend that a standardised national training programme on the basic principles and safety of ionising radiation is implemented for all practicing orthopaedic surgeons.

Advances In Knowledge: This paper is the first UK national survey amongst orthopaedic surgeons and is one of the largest reported internationally.
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http://dx.doi.org/10.1259/bjr.20210736DOI Listing
July 2021

Is the AO spine thoracolumbar injury classification system reliable and practical? a systematic review.

Acta Orthop Belg 2021 Mar;87(1):181-190

Controversy surrounding the classification of thoracolumbar injuries has given rise to various classification systems over the years, including the most recent AOSpine Thoracolumbar Injury Classification System (ATLICS). This systematic review aims to provide an up-to-date evaluation of the literature, including assessment of a further three studies not analysed in previous reviews. In doing so, this is the first systematic review to include the reliability among non-spine subspecialty professionals and to document the wide variety between reliability across studies, particularly with regard to sub-type classification. Relevant studies were found via a systematic search of PubMed, EBESCO, Cochrane and Web of Science. Data extraction and quality assessment were conducted in line with Cochrane Collaboration guidelines. Twelve articles assessing the reliability of ATLICS were included in this review. The overall inter-observer reliability varied from fair to substantial, but the three additional studies in this review, compared to previous reviews, presented on average only fair reliability. The greatest variation of results was seen in A1 and B3 subtypes. Least reliably classified on average was A4 subtype. This systematic review concludes that ATLICS is reliable for the majority of injuries, but the variability within subtypes suggests the need for further research in assessing the needs of users in order to increase familiarity with ATLICS or perhaps the necessity to include more subtype-specific criteria into the system. Further research is also recommended on the reliability of modifiers, neurological classification and the application of ATLICS in a paediatric context.
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March 2021

Adult Age Differences in Self-Reported Pain and Anterior CSF Space in Chiari Malformation.

Cerebellum 2021 Jun 9. Epub 2021 Jun 9.

Department of Psychology, The University of Akron, Akron, OH, 44325-4301, USA.

Chiari malformation type I (CMI) is a neural disorder with sensory, cognitive, and motor defects, as well as headaches. Radiologically, the cerebellar tonsils extend below the foramen magnum. To date, the relationships among adult age, brain morphometry, surgical status, and symptom severity in CMI are unknown. The objective of this study was to better understand the relationships among these variables using causal modeling techniques. Adult CMI patients (80% female) who either had (n = 150) or had not (n = 151) undergone posterior fossa decompression surgery were assessed using morphometric measures derived from magnetic resonance images (MRI). MRI-based morphometry showed that the area of the CSF pocket anterior to the cervico-medullary junction (anterior CSF space) correlated with age at the time of MRI (r =  - .21). Also, self-reported pain increased with age (r = .11) and decreased with anterior CSF space (r =  - .18). Age differences in self-reported pain were mediated by anterior CSF space in the cervical spine area-and this effect was particularly salient for non-decompressed CMI patients. As CMI patients age, the anterior CSF space decreases, and this is associated with increased pain-especially for non-decompressed CMI patients. It is recommended that further consideration of age-related decreases in anterior CSF space in CMI patients be given in future research.
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http://dx.doi.org/10.1007/s12311-021-01289-wDOI Listing
June 2021

Reproducibility and reliability analysis of the Luk Distal Radius and Ulna Classification for European patients with adolescent idiopathic scoliosis.

J Child Orthop 2021 Apr;15(2):166-170

St Georges University Hospitals NHS Foundation Trust, London, UK.

Purpose: Current clinical and radiological methods of predicting a patient's growth potential are limited in terms of practicality, accuracy and known to differ in different races. This information influences optimal timing of bracing and surgical intervention in adolescent idiopathic scoliosis (AIS). The Luk classification was developed to mitigate limitations of existing tools. Few reliability studies are available and are limited to certain geographical regions with varying results. This study was performed to analyze reproducibility and reliability of the Luk Distal Radius and Ulna Classification in European patients.

Methods: This is a radiological study of 50 randomly selected left hand and wrist radiographs of patients with AIS referred to a tertiary referral centre. They were assessed for bone maturity using the Luk Distal Radius and Ulna Classification. Assessment was performed twice by four examiners at an interval of one month. Statistical analysis was performed using the intraclass correlation (ICC) method to determine the reliabilities within and between the examiners.

Results: In total, 50 radiographs (M:F = 13:37) with a mean age of 13.7 years (10 to 18) were assessed for reliability. The inter-rater ICC value was 0.918 for radius assessment and 0.939 for ulna assessment. The intra-rater ICC values for radius assessment ranged between 0.897 and 0.769 and between 0.948 and 0.786 for ulna assessment. There was near perfect correlation for both assessments.

Conclusion: This study provides independent evidence that the Luk Distal Radius and Ulna Classification is a reliable tool for assessment of skeletal maturity for European patients. Minimal clinical experience is required to reliably utilize it.

Level Of Evidence: IV.
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http://dx.doi.org/10.1302/1863-2548.15.200251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138788PMC
April 2021

The use of ionising radiation in orthopaedic surgery: principles, regulations and managing risk to surgeons and patients.

Eur J Orthop Surg Traumatol 2021 Jul 7;31(5):947-955. Epub 2021 Apr 7.

St George's University Hospitals NHS Foundation Trust, London, UK.

The use of ionising radiation for plain film radiography and computerised tomography is fundamental in both diagnostics and treatment for orthopaedics. However, radiation is not without risk as high exposure can increase the risk of cancer. Little time is spent educating doctors about the relative risks of radiation, both to patients and themselves. In addition, there are common misunderstandings about the best ways to mitigate such risk. We aim to provide an overview of the fundamental principles of the use of ionising radiation and its risks within the context of orthopaedic surgery. While providing a narrative review of the current literature, we discuss the basic physics, standards of good practice and relevant UK and European regulations. We discuss the risks to patients and surgeons and suggest ways that these can be mitigated in the operating theatre. A thorough understanding of the risks, and appropriate procedural rules, with respect to the use of ionising radiation is essential for those in orthopaedic practice.
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http://dx.doi.org/10.1007/s00590-021-02955-9DOI Listing
July 2021

Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation.

Cerebellum 2021 Mar 6. Epub 2021 Mar 6.

Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, MD, USA.

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.
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http://dx.doi.org/10.1007/s12311-021-01251-wDOI Listing
March 2021

A comparison of anterior knee pain, kneeling pain and functional outcomes in suprapatellar versus infrapatellar tibial nailing.

Eur J Orthop Surg Traumatol 2021 Aug 8;31(6):1143-1150. Epub 2021 Jan 8.

Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, Blackshaw road, London, SW17 0QT, UK.

Introduction: Anterior knee pain and kneeling pain are some of the most common complications following intramedullary nailing of tibial shaft fractures. With the increased uptake of suprapatellar nailing at our institution, we undertook a service evaluation to assess anterior knee pain and kneeling pain in patients who underwent the suprapatellar tibial nailing technique compared with the infrapatellar approach.

Methodology: Data from all consecutive intramedullary tibial nailing operations between January 2014 and July 2017 were analysed from a prospectively collected database. All acute diaphyseal fracture nailing procedures were included. All patients were reviewed between six-month and four-year post-operation. Each patient was asked to complete a standardised questionnaire with three main outcome measures: pain on kneeling, presence of anterior knee pain and the severity of pain.

Results: After exclusions, a total of 148 patients were identified. A total of 102 responses were received, 41 in the infrapatellar group (73.2%) and 61 in the suprapatellar group (66.3%). A longer time from surgery to telephone follow-up response was noted in the infrapatellar group: 32.4 months (interquartile range, 16.1) vs. 19.3 months (interquartile range, 17.4), p < 0.001. A trend towards lower reported anterior knee pain was noted in the suprapatellar group (67.9% VS 53.7%). Most patients reported mild or no pain on kneeling, with no significant difference between the two groups. There was also no significant difference in severity of knee pain between the two groups and no significant effect on the Kujala score.

Conclusion: With the comparable pain outcomes between the two groups, our analysis supports the continued use of the suprapatellar tibial nailing technique for tibial shaft fractures at our institution.
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http://dx.doi.org/10.1007/s00590-020-02851-8DOI Listing
August 2021

Defining the Mean Angle of Diaphyseal Long Bone Non-Unions - Does Shear Prevail?

J Orthop Trauma 2020 Dec 28;Publish Ahead of Print. Epub 2020 Dec 28.

Department of Trauma and Orthopaedics, St Georges University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK Institute for Medical and Biomedical Education, St. George's, University of London,London, UK Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, Philadelphia, United States Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States.

Objectives: To define the mean angle of a series of diaphyseal non-unions based on radiographic analysis.

Design: Retrospective cohort study.

Setting: Two level-1 trauma centers.

Patients: One hundred and twenty patients presenting with non-union.

Intervention: A mean non-union angle was calculated from a series of AP and lateral X-rays using a standardised technique. The non-union angle was then estimated in a single plane by considering the greater of the two measured angles. Additional data collected included patient age, sex, non-union site, initial fracture angle and original fracture pattern.

Main Outcome Measurement: Single plane non-union angle.

Results: The mean angles of all non-union in coronal plane was 42 degrees (SD 17 degrees) and 42 degrees in sagittal plane (SD 18 degrees) and 48 degrees (SD 15 degrees) in single plane. The single plane non-union angle in fractures which were originally multiplanar was steeper to those occurring in originally single plane fractures (p 0.002) although both were close to 45 degrees. There was no significant difference in the non-union angles on sub-group analysis of cohort location, sex or anatomic location.

Conclusions: This study demonstrates the mean angle of diaphyseal non-unions from long bones of the lower limb approaches 45 degrees. This is noted in all types of fractures and is irrespective of anatomic location or sex. This confirms the hypothesis that shear is likely to play a role in the development of a non-union. This study provides further evidence that non-unions occur primarily due mechanical instability.

Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000002050DOI Listing
December 2020

An Electrophysiological Study of Aging and Perceptual Letter-Matching.

Exp Aging Res 2021 Jan-Feb;47(1):92-108. Epub 2020 Nov 19.

Department of Psychology, Ashland University , Ashland, USA.

: Previous studies on perceptual letter-matching have found that younger and older adults showed "fast-same" effects for response time and "false-different" effects for errors but the effects were more pronounced for older adults. According to the , internal noise in visual processing distorts "same" trials into appearing different whereas distortion for "different" trials does not affect performance. Older adults have a "noisier" representation of items within perceptual processing which can impact perceptual matching. However, EEG measures may provide a more direct measure of letter-matching decisions. : We measured the P300 event-related potential (ERP) amplitude, an index of familiarity in stimulus categorization, and behavioral measures (response time and accuracy) to assess letter-matching performance. : Individuals responded faster to "same" trials than to "different" trials but were less accurate. Older adults showed similar P300 amplitudes across trial type whereas younger adults produced a larger amplitude for "same" than "different" trials, suggesting that older adults showed less familiarity for "same" trials than did younger adults - a prediction of the . : These ERP results are consistent with the suggesting that an age-related increase in internal noise affected letter-matching performance.
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http://dx.doi.org/10.1080/0361073X.2020.1848329DOI Listing
June 2021

Cannabidiol normalizes resting-state functional connectivity in treatment-resistant epilepsy.

Epilepsy Behav 2020 11 31;112:107297. Epub 2020 Jul 31.

Department of Neurology, the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address:

Objective: Resting-state (rs) network dysfunction is a contributing factor to treatment resistance in epilepsy. In treatment-resistant epilepsy (TRE), pharmacological and nonpharmacological therapies have been shown to improve such dysfunction. In this study, our goal was to prospectively evaluate the effect of highly purified plant-derived cannabidiol (CBD; Epidiolex®) on rs functional magnetic resonance imaging (fMRI) functional connectivity (rs-FC). We hypothesized that CBD would change and potentially normalize the rs-FC in TRE.

Methods: Twenty-two of 27 participants with TRE completed all study procedures including longitudinal pre-/on-CBD rs-fMRI (8M/14F, mean age = 36.2 ± 15.9 years, TRE duration = 18.3 ± 12.6 years); there were no differences in age (p = 0.99) or sex (p = 0.15) between groups. Assessments collected included seizure frequency (SF), Chalfont Seizure Severity Scale (CSSS), Columbia Suicide Severity Rating Scale (C-SSRS), Adverse Events Profile (AEP), and Profile of Mood States (POMS). Twenty-three healthy controls (HCs) received rs-fMRI and POMS once.

Results: Participants with TRE showed average decrease of 71.7% in SF (p < 0.0001) and improved CSSS, AEP, and POMS confusion, depression, and fatigue subscores (all p < 0.05) on-CBD with POMS scores becoming similar to those of HCs. Paired t-tests showed significant pre-/on-CBD changes in rs-FC in cerebellum, frontal areas, temporal areas, hippocampus, and amygdala with some of them correlating with improvement in behavioral measures. Significant differences in rs-FC between pre-CBD and HCs were found in cerebellum, frontal, and occipital regions. After controlling for changes in SF with CBD, these differences were no longer present when comparing on-CBD to HCs.

Significance: This study indicates that highly purified CBD modulates and potentially normalizes rs-FC in the epileptic brain. This effect may underlie its efficacy. This study provides Class III evidence for CBD's normalizing effect on rs-FC in TRE.
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http://dx.doi.org/10.1016/j.yebeh.2020.107297DOI Listing
November 2020

A novel Caldicott-compliant hospital imaging protocol for open fracture photography.

Br J Hosp Med (Lond) 2020 Jun 8;81(6):1-8. Epub 2020 Jun 8.

Department of Trauma and Orthopaedics, St Georges University Hospitals NHS Foundation Trust, London, UK.

Open fractures incur significant morbidity and mortality, and as such have standardised guidelines for their management. Photography of open fractures is an essential component of documentation in the treatment of open fractures as per the British Orthopaedic Association Standards of Trauma and National Institute for Health and Care Excellence guidelines. Smartphones have made photography easily accessible to the clinician, but serious concerns exist regarding data security and the consent process around the use of sensitive clinical images. This project sought to overcome this issue by developing a Caldicott-compliant hospital imaging protocol that allows clinicians to use their smartphone to upload open fracture images into the patient's permanent record. Implementation of the protocol was audited and resulted in the increase of safe and secure open fracture photographic storage to inpatient medical records. This protocol would be transferrable to other hospital trusts and could be adopted across major trauma networks.
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http://dx.doi.org/10.12968/hmed.2020.0139DOI Listing
June 2020

Persistent hypogammaglobulinemia in pediatric solid organ transplant recipients.

Clin Transplant 2020 10 17;34(10):e14021. Epub 2020 Aug 17.

Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.

Introduction: Hypogammaglobulinemia has not been well studied in pediatric solid organ transplant (SOT) recipients. We evaluated plasma immunoglobulin (Ig) and lymphocyte phenotypes among 31 pediatric heart and kidney recipients for two years post-transplant and from 10 non-transplanted children.

Methods: Plasma IgM, IgG, and IgA were quantified by immunoturbidimetric assays, IgG subclasses were quantified by bead-based multiplex immunoassay, and lymphocyte phenotypes were assessed by flow cytometry.

Results: Median age at transplant for SOT recipients was similar to that of the control cohort (15 vs. 12.5 years, respectively; P = .61). Mean plasma IgG and IgM levels for SOT recipients fell significantly below the control cohort means by 1 month post-transplant (P < .001 for both) and remained lower than control levels at 12-18 months post-transplant. Heart recipients had lower frequencies of a CD4 naïve T lymphocytes relative to kidney recipients.

Conclusions: Hypogammaglobulinemia was prevalent and persistent among pediatric SOT recipients and may be secondary to immunosuppressive medications, as well as loss of thymus tissue and CD45RA   CD4 T cells in heart recipients. Limitations of our study include but are not limited to small sample size from a single center, lack of samples for all participants at every time point, and lack of peripheral blood mononuclear cell samples for the non-transplanted cohort.
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http://dx.doi.org/10.1111/ctr.14021DOI Listing
October 2020

Clivus length distinguishes between asymptomatic healthy controls and symptomatic adult women with Chiari malformation type I.

Neuroradiology 2020 Nov 16;62(11):1389-1400. Epub 2020 May 16.

Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA.

Purpose: While the presence of cerebellar tonsillar descent in radiological images has been used as evidence of Chiari malformation type I (CMI), tonsillar ectopia alone is insufficient to identify individuals with symptomatic CMI. This study sought to identify differences in brain morphology between symptomatic CMI and healthy controls in adult females.

Methods: Two hundred and ten adult females with symptomatic CMI and 90 age- and body mass index-matched asymptomatic female controls were compared using seven brain morphometric measures visible on magnetic resonance images. The CMI and control groups were divided into four subgroups based on the tonsillar position (TP) relative to the foramen magnum: group 1 was made up of healthy controls with normal TP (TP < 0 mm); group 2 was comprised of control individuals with low-lying TP (1-5 mm); group 3 was comprised of symptomatic CMI patients with low-lying TP (1-5 mm); group 4 contained symptomatic CMI patients with severe tonsillar descent (6-13 mm).

Results: All morphometrics for symptomatic CMI with severe tonsillar descent were significantly different than those for both control groups. The CMI group with low-lying TP was significantly different for four measures when compared to controls with normal TP. However, only clivus length was statistically different between the CMI and healthy control groups with low-lying TP.

Conclusion: This study demonstrates that clivus length distinguishes adult female healthy individuals with low-lying tonsils from those with symptomatic CMI. Further investigation is required to understand the importance of a shorter clivus length on CMI symptomatology and pathophysiology.
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http://dx.doi.org/10.1007/s00234-020-02453-5DOI Listing
November 2020

Evidence of Neural Microstructure Abnormalities in Type I Chiari Malformation: Associations Among Fiber Tract Integrity, Pain, and Cognitive Dysfunction.

Pain Med 2020 10;21(10):2323-2335

Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA.

Background: Previous case-control investigations of type I Chiari malformation (CMI) have reported cognitive deficits and microstructural white matter abnormalities, as measured by diffusion tensor imaging (DTI). CMI is also typically associated with pain, including occipital headache, but the relationship between pain symptoms and microstructure is not known.

Methods: Eighteen CMI patients and 18 adult age- and education-matched control participants underwent DTI, were tested using digit symbol coding and digit span tasks, and completed a self-report measure of chronic pain. Tissue microstructure indices were used to examine microstructural abnormalities in CMI as compared with healthy controls. Group differences in DTI parameters were then reassessed after controlling for self-reported pain. Finally, DTI parameters were correlated with performance on the digit symbol coding and digit span tasks within each group.

Results: CMI patients exhibited greater fractional anisotropy (FA), lower radial diffusivity, and lower mean diffusivity in multiple brain regions compared with controls in diffuse white matter regions. Group differences no longer existed after controlling for self-reported pain. A significant correlation between FA and the Repeatable Battery for the Assessment of Neuropsychological Status coding performance was observed for controls but not for the CMI group.

Conclusions: Diffuse microstructural abnormalities appear to be a feature of CMI, manifesting predominantly as greater FA and less diffusivity on DTI sequences. These white matter changes are associated with the subjective pain experience of CMI patients and may reflect reactivity to neuroinflammatory responses. However, this hypothesis will require further deliberate testing in future studies.
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http://dx.doi.org/10.1093/pm/pnaa094DOI Listing
October 2020

Robust Classification of High-Dimensional Spectroscopy Data Using Deep Learning and Data Synthesis.

J Chem Inf Model 2020 04 16;60(4):1936-1954. Epub 2020 Mar 16.

School of Computer Science, National University of Ireland, Galway H91 TK33, Ireland.

This paper presents a new approach to classification of high-dimensional spectroscopy data and demonstrates that it outperforms other current state-of-the art approaches. The specific task we consider is identifying whether samples contain chlorinated solvents or not, based on their Raman spectra. We also examine robustness to classification of outlier samples that are not represented in the training set (negative outliers). A novel application of a locally connected neural network (NN) for the binary classification of spectroscopy data is proposed and demonstrated to yield improved accuracy over traditionally popular algorithms. Additionally, we present the ability to further increase the accuracy of the locally connected NN algorithm through the use of synthetic training spectra, and we investigate the use of autoencoder based one-class classifiers and outlier detectors. Finally, a two-step classification process is presented as an alternative to the binary and one-class classification paradigms. This process combines the locally connected NN classifier, the use of synthetic training data, and an autoencoder based outlier detector to produce a model which is shown to both produce high classification accuracy and be robust in the presence of negative outliers.
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http://dx.doi.org/10.1021/acs.jcim.9b01037DOI Listing
April 2020

White Matter Language Pathways and Language Performance in Healthy Adults Across Ages.

Front Neurosci 2019 1;13:1185. Epub 2019 Nov 1.

Department of Neurology, UAB Epilepsy Center, The University of Alabama at Birmingham, Birmingham, AL, United States.

The goal of this study was to determine the relationship between age-related white matter changes, with a specific focus on previously identified language pathways, and language functioning in healthy aging. 228 healthy participants (126 female; 146 right-handed), ages 18 to 76, underwent 3.0 Tesla MR diffusion weighted imaging (DWI) and a battery of language assessments including the Boston Naming Test (BNT), the Peabody Picture Vocabulary Test (PPVT), the Controlled Oral Word Association Test (COWAT), Semantic Fluency Test (SFT), and a subset of the Boston Diagnostic Aphasia Examination (CI-BDAE). Using tract based spatial statistics (TBSS), we investigated measurements of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). TBSS was used to create a white matter skeleton that was then used to analyze white matter changes (indexed by FA, AD, RD, and MD) with age and language performance. Results focused primarily on significant relationships ( < 0.05, cluster-wise FDR corrected for multiple comparisons) in the canonical language white matter pathways. We found a diffuse linear with age in global white matter FA and a significant focal in FA with age within the bilateral superior cerebellar peduncles (SCPs). We observed that increased BNT scores were associated with increased FA within the left SLF, and within the posterior and antero-lateral portions of the right inferior frontal-occipital fasciculus (IFOF). Increased SFT and PPVT scores were associated with increased FA within the posterior portion of the right IFOF and increased FA within the left body of the corpus callosum was associated with lower COWAT scores. We found no association between FA and BDAE. MD, RD, and AD, were found to be inversely proportional to FA within the IFOF, with AD showing a negative correlation with SFT, and RD and MD showing a negative correlation with BNT. There was no association between CI-BDAE and any of the white matter measures. Significant differences between sexes included more pronounced FA decrease with age within the right SLF in males vs. females; there were no differences in language performance scores between sexes. We also found that there was no decline in language testing scores with increasing age in our cohort. Taken together, our findings of varying relationships between DTI metrics and language function within multiple regions of the non-dominant IFOF suggest that more robust language networks with bilateral structural connectivity may contribute to better overall language functioning, regardless of age.
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http://dx.doi.org/10.3389/fnins.2019.01185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838008PMC
November 2019

Evidence for sex differences in morphological abnormalities in type I Chiari malformation.

Neuroradiol J 2019 Dec 18;32(6):458-466. Epub 2019 Jun 18.

Department of Biomedical Engineering, The University of Akron, USA.

Background And Purpose: Relatively little is known about the influence of individual difference variables on the presentation of macro-level brain morphology in type I Chiari malformation (CMI). The goal of the present study is to examine how case-control differences in Chiari are affected by patient sex.

Materials And Methods: Patient-provided magnetic resonance images were acquired through the Chiari 1000 database. Twenty-four morphometric measurements were taken using mid-sagittal images of 104 participants (26 male CMI, 26 female CMI, 26 male controls, and 26 female controls) using internally developed and validated custom software, Morphpro. Case-control comparisons were conducted separately by sex using healthy controls matched by age and body mass index. Probability-based -tests, effect sizes (Cohen's ), and confidence intervals were used to compare case-control differences separately by sex.

Results: Male and female case-control comparisons yielded largely the same trends of CMI-related morphometric abnormalities. Both groups yielded reductions in posterior cranial fossa (PCF) structure heights. However, there was evidence for greater PCF structure height reductions in male CMI patients as measured by Cohen's .

Conclusions: Case-control differences indicated strong consistency in the morphometric abnormalities of CMI malformation in males and females. However, despite the higher prevalence rates of CMI in females, the results from the present study suggest that male morphometric abnormalities may be greater in magnitude. These findings also provide insight into the inconsistent findings from previous morphometric studies of CMI and emphasize the importance of controlling for individual differences when conducting case-control comparisons in CMI.
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http://dx.doi.org/10.1177/1971400919857212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6856994PMC
December 2019

An examination of pain, disability, and the psychological correlates of Chiari Malformation pre- and post-surgical correction.

Disabil Health J 2019 10 21;12(4):649-656. Epub 2019 May 21.

Kent State University, Department of Psychological Sciences, USA; Northeastern Ohio Medical University (NEOMED), Department of Psychiatry, USA. Electronic address:

Background: 50% of patients with Chiari Malformation (CM) report a history of depression; however, rates of other psychological symptoms are unknown. Further, it is unclear whether surgical correction impacts pain, disability, and psychological symptoms.

Objective: /Hypothesis: We examined rates of symptoms in a nationwide sample of CM patients who had (n = 639) and had not (n = 551) undergone surgical correction. We hypothesized lower symptom severity in the latter group.

Methods: Participants completed assessments and submitted pre-surgical MRI scans online (n = 286). Informed by the Fear-Avoidance Model of pain, we controlled for psychological symptoms when assessing pain/disability, and pain/disability when assessing psychological symptoms.

Results: Overall, high rates of depression (44% moderate-severe) and anxiety (60% moderate-severe) were reported. Groups (surgery vs. no-surgery) did not differ in the proportion of patients meeting cutoff scores for current disability; however, the no-surgery group was more likely to meet cutoffs for anxiety (χ2 = 11.26, p < .05), stress (χ2 = 14.63, p < .01) and health anxiety (χ2 = 4.63, p < .05). The surgery group reported lower levels of continuous affective pain F(1, 1065) = 10.28, p < .001), anxiety F(1,1026) = 4.96, p < .05) and stress F(1, 978) = 5.67, p < .05) although effect sizes were small (ηs ranging from 0.010 to 0.006, Cohen's D ranging from 0.17 to 0.25).

Conclusion: CM patients experience high rates of psychological symptomatology regardless of surgical status, suggesting that all CM patients may benefit from evidence-based interventions to address anxiety and depression.
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http://dx.doi.org/10.1016/j.dhjo.2019.05.004DOI Listing
October 2019

fMRI study of cannabidiol-induced changes in attention control in treatment-resistant epilepsy.

Epilepsy Behav 2019 07 24;96:114-121. Epub 2019 May 24.

Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.

Patients with treatment-resistant epilepsy (TRE) frequently exhibit memory and attention deficits that contribute to their poor personal and societal outcomes. We studied the effects of adjunct treatment with pharmaceutical grade cannabidiol (CBD) oral solution (Epidiolex®; Greenwich Biosciences, Inc.) on attention control processes related to stimulus conflict resolution in patients with TRE. Twenty-two patients with TRE underwent 3 T magnetic resonance imaging (MRI) before receiving (PRE) and after achieving a stable dose of CBD (ON). Functional MRI (fMRI) data were collected while patients performed 2 runs of a flanker task (FT). Patients were instructed to indicate via button press the congruent (CON) and incongruent (INC) conditions. We performed t-tests to examine with FT attention control processes at PRE and ON visits and to compare the 2 visits using derived general linear model (GLM) data (INC - CON). We performed generalized psychophysiological interaction (gPPI) analyses to assess changes in condition-based functional connectivity on FT. Median time between fMRI visits was 10 weeks, and median CBD dose at follow-up was 25 mg/kg/d. From PRE to ON, participants experienced improvements in seizure frequency (SF) (p = 0.0009), seizure severity (Chalfont Seizure Severity Scale (CSSS); p < 0.0001), and mood (Total Mood Disturbance (TMD) score from Profile of Mood States (POMS); p = 0.0026). Repeated measures analysis of variance showed nonsignificant improvements in executive function from 34.6 (23.5)% to 41.9 (22.4)% CON accuracy and from 34.2 (25.7)% to 37.6 (24.4)% INC accuracy (p = 0.199). Change in CON accuracy was associated with change in INC accuracy (r = 0.81, p = 0.0005). Participants exhibited CBD-induced increases in fMRI activation in the right superior frontal gyrus (SFG) and right insula/middle frontal gyrus (MFG) and decrease in activation for both regions at ON relative to PRE (corrected p = 0.05). The subset of patients who improved in FT accuracy with CBD showed a negative association between change in right insula/MFG activation and change in accuracy for the INC condition (r = -0.893, p = 0.0068). The gPPI analysis revealed a CBD-induced decrease in condition-based functional connectivity differences for the right SFG seed region (corrected p = 0.05). Whole-brain regression analysis documented a negative association of change in right insula/MFG condition-based connectivity with change in INC accuracy (corrected p = 0.005). Our results suggest that CBD modulates attention control processing in patients with TRE by reducing right SFG and right insula/MFG activation related to stimulus conflict resolution and by dampening differences in condition-based functional connectivity of the right SFG. Our study is the first to provide insight into how CBD affects the neural substrates involved in attention processing and how modulation of the activity and functional connectivity related to attentional control processes in the right insula/MFG may be working to improve cognitive performance in TRE.
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http://dx.doi.org/10.1016/j.yebeh.2019.04.008DOI Listing
July 2019

Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1.

Neuroradiology 2019 Sep 22;61(9):1011-1022. Epub 2019 May 22.

Conquer Chiari Research Center, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA.

Purpose: While 84% of patients surgically treated for Chiari malformation type 1 (CM1) demonstrate improved quality of life after posterior fossa decompression surgery, there are many risks associated with this surgery. Surgical planning to identify candidates likely to improve postoperatively may benefit from an improved understanding of morphological changes after decompression surgery. To evaluate these changes, we quantified 59 morphological parameters on 42 CM1 adult female patients before and after CM1 decompression surgery.

Methods: Fifty-nine morphological parameters in the posterior cranial fossa, cranio-cervical, and intracranial regions in the midsagittal plane were evaluated using 42 T1-weighted magnetic resonance images of female CM1 patients before and after surgery, and 42 healthy female controls. Morphological differences before and after surgery were compared through the development of a technique to establish the opisthion location, a key reference point not present after surgery.

Results: In addition to the expected reduction of the cranio-caudal dimension of the cerebellum, objective analyses showed a significant increase in the area of the cerebrospinal fluid spaces, posterior (6×) and inferior (2.6×) to the cerebellum (+ 112 ± 102 and + 140 ± 127 mm, respectively). This increased area was primarily impacted by an average reduction in the occipital bone length of 24.5 ± 7.3 mm following surgery. Based on multiple angles, results demonstrated a 2°-4° anterior rotation of the cerebellum after surgery.

Conclusion: Our results show that decompression surgery results in significant changes in the cerebellum and cerebrospinal fluid spaces. Further investigation should determine how these morphological changes impact clinical outcomes.
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http://dx.doi.org/10.1007/s00234-019-02206-zDOI Listing
September 2019

Type I Chiari malformation, RBANS performance, and brain morphology: Connecting the dots on cognition and macrolevel brain structure.

Neuropsychology 2019 Jul 16;33(5):725-738. Epub 2019 May 16.

Department of Neurosurgery.

Background: Idiopathic descent of cerebellar tonsils into the cervical spine in Chiari malformation Type I (CMI) is typically associated with occipital headache. Accumulating evidence from experimental studies suggests cognitive effects of CMI. The aim of the current study was to examine the relationship between cognition and CMI using a battery of standardized neuropsychological and symptom inventory instruments.

Method: Eighteen untreated adults with CMI, and 18 gender, age, and education matched healthy controls completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and standardized measures of pain, mood, and disability. Morphometric measurements of key neural and osseous elements were also obtained from structural brain magnetic resonance images, for correlation with symptom outcomes.

Results: CMI patients exhibited deficits in RBANS attention, immediate memory, delayed memory, and total score. After controlling for pain and associated affective disturbance, the significant group effect for RBANS attention remained. CMI patients also presented seven morphometric differences comprising the cerebellum and posterior cranial fossa compartment that differed from healthy controls, some of which were associated with self-reported pain and disability. Notably, group differences in tonsillar position were associated with self-reported pain, disability, and delayed memory.

Conclusion: Adult CMI is associated with domain-specific cognitive change, detectable using a standard clinical instrument. The extent of cognitive impairment is independent of pain or affective symptomatology and may be related to the key pathognomonic feature of the condition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000547DOI Listing
July 2019

Are There Age Differences in Consolidated Episodic Memory?

Exp Aging Res 2019 Mar-Apr;45(2):97-119. Epub 2019 Mar 8.

d Department of Psychological Sciences , Kent State University , Kent , USA.

Background/Study Context: While most aging research on memory uses a retention interval of one hour or less, episodic consolidation takes longer (e.g., 6-24 hours for synaptic consolidation). In three experiments, we examined age differences in recall followed by recognition in which the retention interval was varied in younger and older adults.

Methods: In Experiment 1 (n = 24 for both age groups), zero-, 1- and 24-hour retention intervals were used for recall for all participants, and a 24-hour retention interval was used for recognition. In Experiment 2 (n = 24 for both age groups), just a 24-hour retention interval was used. In Experiment 3 (n = 20 for both age groups), a within-subjects design was used in which participants recalled one word list after one hour and again after 24 hours, and recalled another word list just after 24 hours (with recognition for both conditions after the 24-hour recall).

Results: In Experiment 1, older adults recalled fewer words at both the 1- and 24-hour retention intervals, but the magnitude of the age difference did not differ. In Experiment 2 (just 24-hour retention interval), there were no age differences in recall. In Experiment 3, in the two-recall condition, older adults showed lower recall at both 1-hour and 24-hour retention intervals (but the magnitude of the age difference remained constant across retention interval). In the single-recall just 24-hour retention condition, there were no age differences. There were no age differences in recognition in any of the three experiments.

Conclusion: These results suggest that recall declines for a 24-hour retention interval relative to a zero or one-hour retention interval (Experiments 1 and 3) for both age groups. However, when the first recall attempt occurs after a 24-hour retention interval, there are no age differences. These replicated results suggest that older adults do not benefit as much as younger adults from pre-consolidated rehearsal, but that rehearsal-based age differences do not increase in magnitude from the last rehearsal to memory consolidation. Furthermore, (along with), the present results indicate that there are no age differences in recall when the first recall attempt occurs after a long retention interval - when memory consolidation is likely to have occurred before the first retrieval attempt.
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http://dx.doi.org/10.1080/0361073X.2019.1586104DOI Listing
May 2019

Where are all the males? Gender-specific typologies of childhood adversity based on a large community sample.

Child Abuse Negl 2019 04 16;90:149-159. Epub 2019 Feb 16.

School of Psychology, Ulster University, Northern Ireland, United Kingdom.

Background: Methodological issues have been identified when quantifying exposure to adversity and abuse. To address a single type may obscure covarying effects. To sum multiple exposures gives equal weight to each. Latent class analysis (LCA) addresses this by identifying homogenous subpopulations. Most studies using LCA have pooled gender data in spite of evidence that the nature and frequency of exposure differs by gender. Males report more interpersonal abuse, females report more of other exposures, particularly sexual.

Objective: This study aimed to identify if stratifying data by gender resulted in different profiles of adversity/abuse Participants and setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave II, a large community-based survey, nationally representative of the US population.

Method: This study used 14 indicators of childhood adversity as the basis for LCA.

Results: The number and nature of classes differed by gender. The best solution for females was 4-class: a low risk class; a class at higher risk of sexual abuse; a class at higher risk of physical abuse; a class at higher risk of combined physical and sexual abuse. The best solution for males had only 3-classes; a low risk class, a class at higher risk of sexual abuse; a class at higher risk of physical abuse. The combined dataset resulted in a solution similar to the female solution.

Conclusion: The importance of developing models for males and females separately was evidenced by the male and female classes being differentially associated with mental health variables.
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http://dx.doi.org/10.1016/j.chiabu.2019.02.006DOI Listing
April 2019

Quantification of Cerebellar Crowding in Type I Chiari Malformation.

Ann Biomed Eng 2019 Mar 7;47(3):731-743. Epub 2018 Dec 7.

Department of Mechanical Engineering, The University of Akron, Akron, OH, 44325-3903, USA.

This study was focused on a semi-automated morphometric analysis of the cerebellum in the mid-sagittal plane as an alternative to tonsillar descent alone in the evaluation of Chiari malformation type 1 (CMI) patients. Morphometric analyses of posterior fossa structures were performed on mid-sagittal MRI images of 375 individuals (females, > 18 years, 235 CMI and 140 healthy controls). Twenty-six parameters including linear, angular and area measurements together with non-dimensional ratios were calculated. Eighteen parameters were found to be significantly different between CMI and control subjects. Smaller posterior cranial fossa (PCF) area in CMI subjects was attributed to a smaller PCF area anterior to the brainstem. The cerebellar area was found to be larger in CMI subjects as compared to controls (15.1%), even without inclusion of the tonsillar area below the foramen magnum (FM) (8.4%). The larger cerebellar area in CMI subjects was due to cranial-caudal elongation of the cerebellum, predominately below the fastigium. The cerebrospinal fluid spaces below the FM were smaller in CMI subjects as compared to controls. Overall, greater cerebellar crowding was identified in CMI subjects relative to healthy controls. These observations may improve our understanding of the pathophysiology of CMI in adult female patients.
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http://dx.doi.org/10.1007/s10439-018-02175-zDOI Listing
March 2019

Compromise of Second-Line Antiretroviral Therapy Due to High Rates of Human Immunodeficiency Virus Drug Resistance in Mozambican Treatment-Experienced Children With Virologic Failure.

J Pediatric Infect Dis Soc 2020 Feb;9(1):6-13

Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.

Background: Virologic failure (VF) is highly prevalent in sub-Saharan African children on antiretroviral therapy (ART) and is often associated with human immunodeficiency virus drug resistance (DR). Most children still lack access to routine viral load (VL) monitoring for early identification of treatment failure, with implications for the efficacy of second-line ART.

Methods: Children aged 1 to 14 years on ART for ≥12 months at 6 public facilities in Maputo, Mozambique were consecutively enrolled after informed consent. Chart review and caregiver interviews were conducted. VL testing was performed, and specimens with ≥1000 copies/mL were genotyped.

Results: Of the 715 children included, the mean age was 103 months, 85.8% had no immunosuppression, 73.1% were taking stavudine/lamivudine/nevirapine, and 20.1% had a history prevention of mother-to-child transmission exposure. The mean time on ART was 60.0 months. VF was present in 259 patients (36.3%); 248 (95.8%) specimens were genotyped, and DR mutations were found in 238 (96.0%). Severe immunosuppression and nutritional decline were associated with DR. M184V and Y181C were the most common mutations. In the 238 patients with DR, standard second-line ART would have 0, 1, 2, and 3 effective antiretrovirals in 1 (0.4%), 74 (31.1%), 150 (63.0%), and 13 (5.5%) patients, respectively.

Conclusion: This cohort had high rates of VF and DR with frequent compromise of second-line ART. There is urgent need to scale-up VL monitoring and heat-stable protease inhibitor formulations or integrase inhibitorsfor a more a durable first-line regimen that can feasibly be implemented in developing settings.
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http://dx.doi.org/10.1093/jpids/piy102DOI Listing
February 2020

Emotional arousal deficit or emotional regulation bias? An electrophysiological study of age-related differences in emotion perception.

Exp Aging Res 2018 May-Jun;44(3):187-205. Epub 2018 Mar 26.

d Department of Psychology , University of Akron , Akron , OH , USA.

Background/Study context: Adult age differences in emotion processing have been attributed to age-related decline in earlier emotional perception and age-related bias in later emotional regulation. Yet, the relationship between the processes of early emotion perception and bias in emotional regulation and their influence on behavioral outcomes remains unclear. Event-related potentials (ERPs) have the temporal precision to allow for the online measure of neurophysiological activity and provide potential insight into the complex dynamics of emotion processing and aging.

Methods: ERPs were used as the primary measure to examine the hypotheses that younger adults will differ in emotional arousal and emotional bias as represented by the early P1 waveform and later P3 waveform, respectively. Thirty-two younger and older adults (16 each) performed a facial emotion discrimination task in which they identified standardized angry, happy, or neutral expressions of faces from the NimStim database.

Results: Younger adults showed a greater P1 ERP for angry faces relative to happy faces at parietal channels, while older adults did not exhibit any emotional modulation of the P1. In contrast, both younger and older adults showed a greater late P3 ERP for angry faces compared to happy faces.

Conclusion: The authors' results provide evidence for an age-related deficit in early emotion perception and autonomic arousal. Younger adults, but not older adults, exhibited a pattern of neurophysiological activity believed to reflect preconscious and reflexive identification of threat. Despite these age group differences in early emotion processing, younger and older adults did not exhibit differences in neurophysiological processes believed to reflect emotion regulation.
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http://dx.doi.org/10.1080/0361073X.2018.1449585DOI Listing
January 2019

Paired learning - improving collaboration between clinicians and managers.

J Health Organ Manag 2018 Mar 9;32(1):101-112. Epub 2018 Jan 9.

Centre for Reviews and Dissemination, University of York , York, UK.

Purpose Close collaboration between NHS clinicians and managers is essential in providing effective healthcare, but relationships between the two groups are often poor. Paired learning is a peer-peer buddying tool that can break down barriers, increase knowledge and change attitudes. Paired learning has been used with doctors and managers but not for multi-professional clinicians. The purpose of this paper is to assess whether a paired learning programme (PLP) can improve knowledge and attitudes between multi-professional NHS clinicians and managers. Design/methodology/approach A PLP pairing clinicians and managers over a four-month period to participate in four buddy meetings and three group meetings was delivered. A mixed methods study was completed which collected quantitative and qualitative data in the form of pre- and post-course questionnaires and focus group discussions. Findings Participants reported increased understanding, changed attitudes and better communication between clinicians and managers following the PLP. Self-rated knowledge increased across all domains but was only statistically significant for ability to engage, ability to establish shared goals and knowledge of decision-making processes. Research limitations/implications This paper highlights the value of paired learning in encouraging collaboration between clinicians and managers but is of a small size. The PLP did not provide enough data to examine relationships and interaction between clinicians and managers, this should be considered in any future work. Originality/value To the authors' knowledge, this is the only published paper showing data from a PLP involving multi-disciplinary health professionals.
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http://dx.doi.org/10.1108/JHOM-10-2017-0263DOI Listing
March 2018

A Retrospective 2D Morphometric Analysis of Adult Female Chiari Type I Patients with Commonly Reported and Related Conditions.

Front Neuroanat 2018 19;12. Epub 2018 Jan 19.

Department of Biomedical Engineering, Conquer Chiari Research Center, University of Akron, Akron, OH, United States.

Researchers have sought to better understand Chiari type I malformation (CMI) through morphometric measurements beyond tonsillar position (TP). Soft tissue and bone structures within the brain and craniocervical junction have been shown to be different for CMI patients compared to healthy controls. Yet, several morphological characteristics have not been consistently associated with CMI. CMI is also associated with different prevalent conditions (PCs) such as syringomyelia, pseudotumor, Ehlers-Danlos syndrome (EDS), scoliosis, and craniocervical instability. The goal of this study was two-fold: (1) to identify unique morphological characteristics of PCs, and (2) to better explain inconsistent results from case-control comparisons of CMI. Image, demographic, and PC information was obtained through the , a self-report web-accessed database. Twenty-eight morphometric measurements (MMs) were performed on the cranial MR images of 236 pre-surgery adult female CMI participants and 140 female healthy control participants. Custom software was used to measure 28 structures within the posterior cranial fossa (PCF) compartment, craniocervical junction, oral cavity, and intracranial area on midsagittal MR images for each participant. Morphometric analysis of adult females indicated a smaller McRae line length in CMI participants with syringomyelia compared to those without syringomyelia. TP was reduced in CMI participants with EDS than those without EDS. Basion to posterior axial line was significantly longer in CMI participants with scoliosis compared to those without scoliosis. No additional MMs were found to differ between CMI participants with and without a specific PC. Four morphometric differences were found to be consistently different between CMI participants and healthy controls regardless of PC: larger TP and a smaller clivus length, fastigium, and corpus callosum height in CMI participants. Syringomyelia, EDS, and scoliosis were the only PCs that showed significant morphometric differences between CMI participants. Additionally, four midsagittal MR-based MMs were found to be significantly different between healthy controls and CMI participants regardless of the presence of one or more PCs. This study suggests that the prevalence of comorbid conditions are not strongly related to CMI morphology, and that inconsistent findings in the radiographic literature cannot be explained by varying prevalence of comorbid conditions in CMI study samples.
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http://dx.doi.org/10.3389/fnana.2018.00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785719PMC
January 2018
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