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Abstract Leading radiologists and representatives from national radiation protection regulatory authorities and health ministries from 19 countries of the European region worked together with five experts at the workshop on justification and appropriate use of imaging in Zagreb, Croatia, from 26 to 28 October 2017 jointly organised by the IAEA and the European Society of Radiology. The workshop served as a forum to exchange information on challenges and solutions for improving justification and the appropriate use of diagnostic imaging. Common barriers to improving the use of imaging referral guidelines were discussed and the need for increased collaboration identified. Examples of good practices were presented, including use of Clinical Decision Support (CDS) systems to facilitate rapid and good justification decisions. The workshop identified some of the needs of European countries for achieving more appropriate imaging proposing wider use of collaboration, campaigns and champions. Main messages • Drivers for appropriate imaging in Europe are similar to those elsewhere globally. • Implementing imaging referral guidelines is the main barrier to more appropriate imaging. • Clinical Decision Support systems (CDS) facilitates good referral practice and justification decisions. • Collaboration, campaigns and champions may improve awareness, appropriateness and audit.

Nuclear medicine (NM) procedures for diagnosis and treatment of disease are performed routinely in hospitals throughout the world. These involve preparation and administration to patients of pharmaceuticals labelled with radioactive material. The International Atomic Energy Agency (IAEA) and the World Health Organisation highlighted the need for improvement in prevention of medical radiation incidents and accidents in the Bonn Call-for-Action in 2012. An IAEA Technical Meeting was held on prevention of unintended exposures and accidents in NM in 2018 to address the issue. Exposures can take place at any time when radioactive material is being produced and used, and the risk continues after procedures have been completed. Thus there is potential for staff or members of the general public to be exposed, as well as patients. This paper sets out guidelines for incident prevention based on presentations and discussions at the meeting, and review of reports from the literature. It deals with potential incidents in in-house radionuclide production, radiopharmaceutical preparation, administration to patients, and following a procedure, as well as aspects in management of radioactive materials. Special attention has been paid to therapeutic procedures, as these have the potential to cause more harm to patients from erroneous administrations, including tissue reactions from extravasation of radiopharmaceutical, and could lead to significant contamination events. Administration of NM therapy is generally contraindicated in pregnancy. Identification of any patient who may be pregnant is crucial and it might be necessary to verify this with a pregnancy test for patients within the age band considered to be fertile. Inclusion of NM therapy incidents in the IAEA automated reporting system SAFRON is recommended. In summary, the paper aims to highlight errors that could occur during different phases of NM procedures in order to aid prevention of incidents. The value of periodic audit in evaluating systems in place on a regular basis is emphasised. Approaches to incident investigation and follow-up are described, and the need to ensure corrective action is taken to address any deficiencies stressed. [ABSTRACT FROM AUTHOR]

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures, can provide safeguards to reduce the risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional x-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation, and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin, and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than the calculation of numerical values, as these are misleading when applied to individuals. [ABSTRACT FROM AUTHOR]

Background: Radiation-induced injuries to patient skin as a result of fluoroscopy guided interventional procedures are infrequently reported, often misdiagnosed and there is a need to learn lessons from every injury. Methods: This paper describes two cases of radiation induced skin injuries that are, to the best of our knowledge, the first ever reported cases from Bulgaria and possibly from Eastern Europe, and would thus have educational value. Results: The important messages from the skin injuries reported here are: lack of awareness among part of the interventional specialists about the potential for radiation induced skin injury, misdiagnosis after injury happened because of lack of awareness and knowledge among general physicians, dermatologists and surgeons who followed up cases of skin injuries; the lack of system to monitor patients with relatively high exposure; the important role played by the medical physicist in diagnosing the injury and overall in initiating actions; the role of training and informational material displayed in interventional facilities. Conclusions: For avoidance of skin injuries from interventional procedures it is of utmost importance to implement a system that includes (a) regular monitoring of radiation dose parameters of the procedure; (b) established trigger values for reporting; (c) procedure for patient follow-up if a trigger value is exceeded; (d) instructing the patient who has received exposure above the trigger value to self-examine the irradiated area of the skin for any itching/redness and report it back. [ABSTRACT FROM AUTHOR]

Objective: Alcohol consumption patterns during the COVID-19 pandemic have varied notably. Participants: We examined the acute impact of the pandemic on alcohol use disorder (AUD) in a generalizable sample of college students who were surveyed pre-pandemic and re-surveyed in May 2020. Method: Items assessed pre-pandemic included DSM-5 AUD and mental health symptoms. A COVID-19 impacts questionnaire was administered, and alcohol and mental health items re-assessed. Results: AUD symptoms decreased from pre-pandemic to during the pandemic, demonstrating a change in trajectory compared to prior cohorts. Students with persistent AUD reported greater concurrent symptoms of PTSD, depression, and alcohol consumption than those with remitted AUD ( p s ≤ .02), but not increased COVID-19 impact. Persistent AUD status was predicted by higher sensation seeking and alcohol consumption. Conclusions: Students with concurrent mental health problems are at continued risk for persistent AUD. Findings highlight the impact of the college environment and social context for drinking on AUD.

The current study tested a longitudinal mediation model throughout the COVID-19 pandemic focused on whether students' housing instability stress and food/financial instability stress at the beginning of the pandemic in spring 2020 (T1) informed sleep dissatisfaction and duration in fall 2020 (T2) and, in turn, physical and mental health in spring 2021 (T3). Further, we tested whether relations varied based on students' ethnic-racial backgrounds. Participants included 879 Asian, Black, Latine, Multiracial, and White emerging adult college students (Mage = 19.95, SD = 0.33) from a large public university in the mid-Atlantic region of the United States who attended college during the COVID-19 pandemic and completed surveys about their experiences. Findings indicated a significant mediation process, such that T1 housing instability stress predicted greater T2 sleep dissatisfaction and, in turn, less physical health, greater depressive symptoms, and greater anxiety symptoms at T3. Additionally, T1 food/financial instability stress was significantly associated with less T2 sleep duration but was not, in turn, associated with any T3 outcomes. Findings did not vary by students' ethnicity/race. Results highlight that sleep dissatisfaction is an important factor that accounts for relations between COVID-19 stressors predicting mental and physical health outcomes throughout the pandemic., (© 2024 The Authors. Stress and Health published by John Wiley & Sons Ltd.)

Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: • Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. • Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. • An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging., (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Introduction: Recent advances in generative Artificial Intelligence (AI) and Natural Language Processing (NLP) have led to the development of Large Language Models (LLMs) and AI-powered chatbots like ChatGPT, which have numerous practical applications. Notably, these models assist programmers with coding queries, debugging, solution suggestions, and providing guidance on software development tasks. Despite known issues with the accuracy of ChatGPT's responses, its comprehensive and articulate language continues to attract frequent use. This indicates potential for ChatGPT to support educators and serve as a virtual tutor for students., Methods: To explore this potential, we conducted a comprehensive analysis comparing the emotional content in responses from ChatGPT and human answers to 2000 questions sourced from Stack Overflow (SO). The emotional aspects of the answers were examined to understand how the emotional tone of AI responses compares to that of human responses., Results: Our analysis revealed that ChatGPT's answers are generally more positive compared to human responses. In contrast, human answers often exhibit emotions such as anger and disgust. Significant differences were observed in emotional expressions between ChatGPT and human responses, particularly in the emotions of anger, disgust, and joy. Human responses displayed a broader emotional spectrum compared to ChatGPT, suggesting greater emotional variability among humans., Discussion: The findings highlight a distinct emotional divergence between ChatGPT and human responses, with ChatGPT exhibiting a more uniformly positive tone and humans displaying a wider range of emotions. This variance underscores the need for further research into the role of emotional content in AI and human interactions, particularly in educational contexts where emotional nuances can impact learning and communication., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fatahi, Vassileva and Roy.)

Neuroscience has contributed to uncover the mechanisms underpinning substance use disorders (SUD). The next frontier is to leverage these mechanisms as active targets to create more effective interventions for SUD treatment and prevention. Recent large-scale cohort studies from early childhood are generating multiple levels of neuroscience-based information with the potential to inform the development and refinement of future preventive strategies. However, there are still no available well-recognized frameworks to guide the integration of these multi-level datasets into prevention interventions. The Research Domain Criteria (RDoC) provides a neuroscience-based multi-system framework that is well suited to facilitate translation of neurobiological mechanisms into behavioral domains amenable to preventative interventions. We propose a novel RDoC-based framework for prevention science and adapted the framework for the existing preventive interventions. From a systematic review of randomized controlled trials using a person-centered drug/alcohol preventive approach for adolescents, we identified 22 unique preventive interventions. By teasing apart these 22 interventions into the RDoC domains, we proposed distinct neurocognitive trajectories which have been recognized as precursors or risk factors for SUDs, to be targeted, engaged and modified for effective addiction prevention., Competing Interests: Conflict of Interest The authors have reported no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The present study aimed to understand the role of critical action, sociopolitical participation, an essential form of consciousness in the relationship between interpersonal discrimination and the use of tobacco products., Method: The present study was part of a more extensive longitudinal study on students' genetic and environmental experiences. To examine these associations, 164 racially minoritized college students ( M age = 19.86, SD = 0.28) were surveyed for this study., Results: Findings indicated that the relation between interpersonal ethnic-racial discrimination (IERD) and tobacco products was moderated by critical action. Specifically, IERD was associated with greater use of tobacco products when students had low critical consciousness-critical action. The relation between IERD and the use of tobacco products became nonsignificant when students had high critical action., Conclusions: Critical action was protective in mitigating increased tobacco use in the context of discrimination experiences. Research, clinical, and policy implications are discussed in efforts to reduce tobacco-related disparities among racially minoritized college students. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The purpose of this study was to test whether COVID impact interacts with genetic risk (polygenic risk score/PRS) to predict alcohol use disorder (AUD) symptoms. Method: Participants were n  = 455 college students (79.6% female, 51% European Ancestry/EA, 24% African Ancestry/AFR, 25% Americas Ancestry/AMER) from a longitudinal study during the initial stage (March-May 2020) of the pandemic. Path models allowed for the examination of PRS and previously identified COVID-19 impact constructs. Results: There was a main effect of the AUD PRS on AUD symptoms within the EA group (β: .165, p  < .01). Additionally, food/housing insecurity was predictive in the AMER group (β.295, p  < .05), and greater increases in substance use were associated with AUD symptoms for EA (β:.459, p  < .001) and AMER groups (β:.468, p  < .001). Conclusions: Greater food/housing instability and increases in substance use, as well higher scores on PRS are associated with more AUD symptoms for some ancestral groups within this college sample.

This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults., (© 2022. W. Montague Cobb-NMA Health Institute.)

The present study tested whether family home disruptions during the COVID-19 pandemic in the Spring 2020 (Time 1; T1) informed mental health (i.e., posttraumatic stress disorder [PTSD], depressive, and anxiety symptoms) 7 months later in Fall 2020 at T2 and whether family relationship quality moderated relations. Multigroup path analysis models were used to test whether there were significant differences in relations by emerging adults' ethnic-racial backgrounds. Participants were 811 Black, Asian American, Latine, and White emerging adult college students ( M age = 19.95, SD = .33), and the majority (79.6%) who reported their gender identified as cisgender women. Results indicated that across all individuals, T1 family relationship quality moderated relations between T1 family home disruptions and T2 anxiety and depressive symptoms. At lower levels of T1 family relationship quality, family home disruptions predicted greater T2 depressive and anxiety symptoms. At higher levels of T1 family relationship quality, these relations were not significant. Findings highlight that family relationship quality is an important protective factor for diverse emerging adult college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

This study reports results of the first nationwide survey of computed tomography (CT) practice in Ukraine and proposed national diagnostic reference levels (DRLs) for common CT examinations. The collected data included characteristics of CT scanners, frequency of CT exams per anatomical region, dose indices CTDIvol and dose-length product (DLP). National DRLs were proposed at the 75th percentile of median dose indices distributions for four common CT protocols: head without contrast (brain examinations for stroke and trauma), routine chest without contrast, single-phase contrast-enhanced CT of abdomen and pelvis and oncology protocol (chest-abdomen-pelvis). The results showed 4- to 9-fold variations of median dose indices between CT scanners for the same type of examination. The following values of the CTDIvol and DLP were proposed as national DRLs: 59 mGy and 1130 mGy•cm for head, 14 mGy and 492 mGy•cm for chest, 22 mGy and 845 mGy•cm for abdomen/pelvis and 2120 mGy•cm for oncological protocol., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Psychopathy is a collection of personality traits and behaviors that are associated with costly personal, interpersonal, and societal outcomes. The nature of this construct has been widely debated across decades of literature, and such debates have produced a multitude of instruments for the measurement of psychopathy. These measures include self-reports and clinical interviews, yet little work has examined the degree to which measurements of psychopathy may differ across these modalities and whether such potential differences may impact the associations commonly found with psychopathy (e.g., impulsivity). To this end, we applied psychometric network and item response theory analyses to data obtained from the interview-based Psychopathy Checklist: Screening Version and the Levenson Self-Report of Psychopathy in the same sample. Our results revealed similarities and differences across measurement modalities. Regarding the Psychopathy Checklist: Screening Version, Factor 2 items were more important to the psychopathy construct (i.e., the most central and contributed more information than Factor 1 items), whereas Factor 1 items were more important to the Levenson Self-Report of Psychopathy. Factor 1 items were positively linked with Positive Urgency and were either negatively associated or not associated with Negative Urgency. In contrast, Factor 2 items were positively linked with Negative Urgency in both networks. Our analyses also revealed that dishonesty and irresponsibility served as the primary bridges connecting the factors of psychopathy in both networks. We make suggestions for improving the assessment of psychopathy by implementing self-report and interview measures that allow scores to be compared directly. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychopathy comprises antagonistic personality traits and antisocial behaviors that are associated with critical outcomes for the individual and society (e.g., violent behavior). Since its inception, impulsivity has been theorized as a core feature of psychopathy. Research supports this assertion, yet psychopathy and impulsivity are both multifaceted constructs. As such, the associations commonly observed between psychopathy and impulsivity may obscure more nuanced profiles of impulsivity that are only observable at the facet-level. To address this gap in the literature, we collected data from a community sample using a clinical psychopathy interview along with dispositional and neurobehavioral measures of impulsivity. We regressed each of the four facets of psychopathy onto eight impulsivity variables. We followed these analyses with bootstrapped dominance analyses in order to determine which of the impulsivity variables shared the most variance with each psychopathy facet. Our analyses revealed that positive urgency was the most important aspect of impulsivity to all four facets of psychopathy. We further identified distinct profiles of impulsivity linked to each psychopathy facet-the interpersonal facet was typified by sensation seeking and temporal impulsivity. The affective and lifestyle facets were both typified by general trait impulsivity and affective impulsivity. The antisocial facet was typified by affective impulsivity and sensation seeking. Such distinct profiles of impulsivity suggest that specific behaviors linked with each facet (e.g., manipulativeness and the interpersonal facet) may be explained in part by the distinct forms of impulsivity aligned with them., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Georgi Vasilev has ownership interests in the Bulgarian Addictions Institute, where data collection took place. This does not alter our adherence to PLOS ONE policies on sharing data and materials.”, (Copyright: © 2023 West et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The paper presents the results of the activities under the IAEA Technical Cooperation programme in Europe and Central Asia, aiming to improve utilization of diagnostic reference levels (DRLs) in the region through identifying status, problems, and gaps in establishing and utilization of the DRLs, and suggesting potential solutions. Status was identified through a survey with two electronic questionnaires answered by the regulatory bodies for radiation protection of 26 IAEA Member States and 34 representatives of relevant professional bodies of medical physics, radiology, nuclear medicine or radiographers. Problems, good practices and potential solutions were identified as a result of the discussion during a regional workshop with 50 nominated representatives of 21 countries. Results were disseminated through open webinars. Existing gaps are related to the lack of adequate regulations in some countries, inadequate awareness of radiological professionals of DRLs as a tool for optimization, insufficient cooperation among relevant stakeholders, education, and staffing. Strengthening of the cooperation between regulatory and professional bodies could benefit the awareness and consequently the utilization of DRLs in clinical practice. The need of improved education and training of the DRL process was highlighted. Improved inspection procedures and education of inspectors would also support the process. Access to clinically qualified medical physicists was found to be critical for the DRL utilization. Suggestions were placed for continuous IAEA assistance through training, guidance and expert support., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Associazione Italiana di Fisica Medica e Sanitaria. All rights reserved.)

The aim of the current study was to examine the effects of length of abstinence on decision making (impulsive choice) and response inhibition (impulsive action) in former opiate users (OU). Participants included 45 OU in early remission [0−12 months of abstinence], 68 OU in sustained remission [>12 months of abstinence], and 68 control participants. Decision making was assessed with the Iowa Gambling Task (IGT), the Cambridge Gambling Task (CGT), and the Monetary Choice Questionnaire (MCQ). Response inhibition was examined with the Stop Signal Task (SST), and the Go/No-Go Task (GNG). Results revealed group differences in decision making under risk (CGT) and ambiguity (IGT), where control participants displayed better decision making compared to OU in early remission. Both groups of former OU were also characterized by higher discounting of delayed rewards (MCQ). Regression analyses revealed minimal effects of length of abstinence on performance on decision-making tasks and no effects on delay discounting. In addition, both OU groups showed reduced action inhibition (GNG) relative to controls and there were no group differences in action cancellation (SST). Length of abstinence had no effect on response inhibition. Overall, our findings suggest that neurocognitive function may not fully recover even with protracted abstinence, which should be addressed by relapse prevention and cognitive remediation programs for OU.

Purpose: To obtain clinicians' views of the need to account for radiation exposure from previous CT scans and the advisability of a regulatory mechanism to control the number of CT scans for an individual patient., Methods: A convenience survey was conducted by emailing a link to a three-question electronic survey to clinicians in many countries, mostly through radiology and radiation protection contacts., Results: 505 responses were received from 24 countries. 293 respondents (58%) understand that current regulations do not limit the number of CT scans that can be prescribed for a single patient in a year. When asked whether there should be a regulation to limit the number of CT scans that can be prescribed for a single patient in one year, only a small fraction (143, 28%) answered 'No', 182 (36%) answered 'Maybe' and 166 (33%) answered 'Yes'. Most respondents (337; 67%) think that radiation risk should form part of the consideration when deciding whether to request a CT exam. A minority (138; 27%) think the decision should be based only on the medical indication for the CT exam. Comparison among the 4 countries (South Korea, Hungary, USA and Canada) with the largest number of respondents indicated wide variations in responses., Conclusions: A majority of the surveyed clinicians consider radiation risk, in addition to clinical factors, when prescribing CT exams. Most respondents are in favor of, or would consider, regulation to control the number of CT scans that could be performed on a patient annually., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

COVID-19 is a global stressor that has been shown to impact mental health outcomes. Given that COVID-19 is a unique stressor that has been shown to have mental health consequences, identifying protective factors is imperative. The protective influences of resilience are demonstrated through the extant literature, though less is known about resilience and COVID-19 impact. The current study seeks to expand the existing literature on resilience, and on mental health outcomes influenced by COVID-19, by longitudinally investigating relative resilience as a buffer against posttraumatic stress disorder (PTSD) symptoms and alcohol consumption, in the wake of a global pandemic. Participants included 549 undergraduates with a history of lifetime trauma exposure. Using a longitudinal path model, we tested the interaction between relative resilience (i.e., an individual's deviation from distress levels predicted by prior trauma exposure relative to other individuals in the same cohort) and COVID-19 impact domains (i.e., social media use, worry, exposure, change in substance use, and housing/food insecurity) on PTSD symptoms and alcohol consumption. Findings demonstrate a significant interaction between the COVID-19 worry impact domain and baseline resilience on later PTSD symptoms, whereby COVID-19 worry impacts PTSD symptoms at low levels of resilience (β = .26, p < .001), marginally impacts PTSD symptoms at mean levels of resilience (β = .09, p = .05), and does not impact PTSD symptoms at high levels of resilience (β = -.08, p = .16). There were no significant main effects nor interaction effects of resilience on alcohol consumption. This article adds to the literature on resilience and COVID-19 through examining both internalizing (i.e., PTSD) and substance use outcomes, using longitudinal data, and using a quantitative measure of resilience.

Objective: Risky substance use among college students is widespread, and associated with numerous adverse consequences. Current interventions focus primarily on students' current substance use; we hypothesize that shifting focus from current use to underlying risk factors is a complementary approach that may improve effectiveness of prevention/intervention programming. This approach aligns with the personalized medicine movement, which aims to harness knowledge about underlying etiological factors to provide individuals with specific information about their unique risk profiles and personalized recommendations, to motivate and enable individuals to better self-regulate their health. Method: Our group is building and evaluating an online Personalized Feedback Program (PFP) for college students that provides feedback about the individual's underlying genetically influenced externalizing and internalizing risk factors for substance use, along with personalized recommendations/resources. The project capitalizes on work from a university-wide research project (Spit for Science; S4S), in which > 12,000 students (˜70% of 5 years of incoming freshmen) are being followed longitudinally to assess substance use and related factors across the college years. In this article, we describe our foundational work to develop the PFP. Results: From the S4S data, we have identified risk factors across four domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism) that are correlated with college students' substance use. We developed an online self-guided PFP, in collaboration with professionals from student affairs, and using feedback from students, with the ultimate goal of conducting a randomized clinical trial. Conclusion: The provision of personalized risk information represents a novel approach to complement and extend existing college substance use programming. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attentional function in substance use disorder (SUD) is not well understood. To probe attentional function in SUD as a function of primary substance of abuse, we administered the attentional network task (ANT) to 44 individuals with Cocaine Use Disorder (CoUD), 49 individuals with Cannabis Use Disorder (CaUD), 86 individuals with Opioid Use Disorder (OUD), and 107 controls with no SUD, along with the stop-signal task (SST). The ANT quantifies the effects of (temporal) alerting cues and (spatial) orienting cues to reduce reaction time (RT) to targets, as well as probing how conflicting (target-incongruent) stimuli slow RT. The SST quantifies individuals' ability to inhibit already-initiated motor responses. After controlling for sex representation and age, OUD and CaUD participants showed blunted alerting effects compared to controls, whereas CaUD and CoUD participants showed greater stimulus conflict (flanker) effects. Finally, CoUD participants showed a trend toward increased orienting ability. In SST performance, no SUD group showed a prolonged stop-signal reaction compared to controls. However, the OUD group (and CoUD group at trend level) showed prolonged "go" RT to targets and reduced hit rates. These data indicate differences in attentional function in persons with SUD as a function of the primary substance use., (Published by Elsevier B.V.)

Objective: To establish national diagnostic reference levels (NDRLs) for most common paediatric computed tomography (CT) examinations in Egypt., Methods: This was a prospective study that included all dedicated paediatric imaging centers in Egypt. Data from 1680 individual paediatric patients undergoing CT scanning of the head, chest and abdomen-pelvis were collected. Computed tomography dose indices were recorded, data were analysed and compared with the internationally published paediatric DRLs in14 countries., Results: The Egyptian NDRLs of the CTDIvol (mGy) for head, chest and abdomen-pelvis scans among four paediatric age groups were found to be (23, 27, 28, 32, 4, 5, 6, 8, 5, 6, 7, 9) mGy, respectively; and the corresponding NDRLs of the DLP (mGycm) for head, chest and abdomen-pelvis scans were found to be (345, 428, 499, 637, 67, 85, 145, 215, 97, 135, 240, 320) mGycm, respectively. There were variations in the radiation doses between CT centers and identical scanners indicating the need for dose optimization. The NDRLs of the CTDIvol (mGy) and the DLP (mGycm) values were similar to or lower than international DRLs., Conclusion: This study summarizes the results of the first Egyptian Computed Tomography survey that provides national diagnostic reference levels for paediatric patients in Egypt. Despite the reasonable NDRLs values, the study depicted certain pros and cons concerning CT practice, and identified some problems that hinder the process of optimization as well as justification in children., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The purpose of this IAEA-coordinated international study was to understand aspects related to the communication of radiation risk from imaging studies, such as how often imaging department personnel and referring physicians are asked about radiation risks in diagnostic imaging, who asks about these risks, how often professionals are able to provide satisfactory answers using qualitative metrics and how often quantitative risk estimates are needed. A web-based questionnaire with ten questions was completed by 386 healthcare professionals from 63 countries from all four continents, including clinicians/referring physicians (42.5%), radiologists or nuclear medicine physicians (26.7%), medical physicists (23.1%), radiographers/radiological technologists (6.2%) and others (1.6%). The results indicate that radiation risk-related questions are largely asked by patients (73.1%) and parents of child patients (38.6%), and 78% of the professionals believe they are able to answer those questions using qualitative metrics such as very small/minimal, small, medium rather than number of cancers likely occurring. The vast majority, with over three times higher frequency, indicated the purpose of knowing previous radiological exams as 'both clinical information and radiation exposure history' rather than 'only clinical information'. Nearly two-thirds of the clinicians/referring physicians indicated that knowing the radiation exposure history of the patient will affect their decision-making for the next exam, as against only about one-fifth who said 'no, it will not affect their decision-making'. The same question, when addressed to radiologists, resulted in a slightly larger fraction of about three-quarters who said 'yes', as opposed to a smaller fraction of about 12% who said 'no, it will not affect their decision-making'. Mapping the present situation of communication of benefits and risks for patients is important and may be the basis of further analysis, regular monitoring and possibly a target for clinical audits. Further studies focused on specific professional groups might help in obtaining á deeper understanding of the need for practical communication tools., (© 2022 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

Research on sex differences in the association of psychopathy with fluid intelligence is limited, and it remains unknown if fluid intelligence plays a meaningful role in explaining the psychopathy-aggression link for men and women. The present study aimed to test for sex differences in the relation between the four-facet model of psychopathy and intelligence, and to assess whether fluid intelligence moderates the link between psychopathy and aggression. In a community sample of men ( n = 356) and women ( n = 196), we assessed psychopathy using the Psychopathy Checklist: Screening Version (PCL:SV), fluid intelligence using the Raven's Progressive Matrices, and types of aggression using the Aggression Questionnaire (AQ). Hierarchical regressions showed that the psychopathy lifestyle facet was negatively associated with intelligence and there were no sex differences. Our analyses for types of aggression revealed sex differences and similarities. For both men and women, total AQ scores were predicted by higher antisocial facet scores. Lower intelligence moderated the link between higher antisocial facet scores and aggression in men, but not for women. Physical aggression in women was associated with higher interpersonal, affective, and antisocial facet scores, whereas for men, it was only associated with higher antisocial facet scores. Verbal and indirect aggression were associated with higher intelligence in both men and women. For men only, higher antisocial facet scores were associated with verbal and indirect aggression. Higher intelligence moderated the link between the lifestyle facet and indirect aggression for women, whereas for men, it moderated the link between the affective facet and indirect aggression. This study further highlights sex differences in mechanisms of psychopathy-related aggression, which need to be considered in the development of violence interventions and risk assessment.

Background: The COVID-19 pandemic has imposed fundamental challenges on nearly every area of life., Objective: The purpose of the current study was to expand on the literature on the impact of the pandemic on college students by a) examining domains of impact of the pandemic on psychiatric and alcohol outcomes and b) controlling for pre-pandemic outcomes., Method: Participants included 897 college students (78.6% female) from a larger longitudinal study on college student mental health. Structural equation models were fit to examine how COVID-19 impact (exposure, worry, food/housing insecurity, change in social media use, change in substance use) were associated with PTSD, anxiety, depression, suicidal ideation, and alcohol phenotypes. Models were fit to adjust for pre-pandemic symptoms., Results: No effects of COVID-19 exposure remained after adjusting for earlier outcomes. COVID-19 worry predicted PTSD, depression, and anxiety, even after adjusting for earlier levels of outcomes (β's: .091-.180, p 's < .05). Housing/food concerns predicted PTSD, anxiety, and depression symptoms as well as suicidal ideation (β's: .085-.551, p 's < .05) after adjusting for earlier levels of symptoms. Change in media use predicted alcohol consumption (β's: ± .116-.197, p 's < .05). Change in substance use affected all outcomes except suicidality (β's: .112-.591, p 's < .05)., Conclusions: Domains of COVID-19 impact had differential effects on mental health and substance outcomes in college students during the first wave of the coronavirus pandemic. Future studies should examine the trajectory of these factors on college student mental health across waves of the pandemic., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Introduction: Education and training of radiographers is known to be diverse between countries and regions. Under an IAEA project, this work collected data on radiographer education for the Europe and Central Asia region with a particular focus on radiation protection gaps and potential actions., Methods: Following piloting, an electronic questionnaire was distributed to all national counterparts for the IAEA Technial Coopearation (TC) Europe region (n = 33 countries) and nominated national representatives. Contacts were additionally invited to a virtual workshop to discuss and rank common problems in education and training of radiographers and to propose potential solutions., Results: Responses were received from 31 countries, including 14 from the European Union. Just over half of countries reported radiographer education being in higher education with 71% having program durations more than 3 years (range: 1 month-4 years). Programs included a spectrum of both clinical training and radiation protection hours with ten-fold variations noted across the region. Inclusion of core radiation protection topics within curricula varied similarly, as did radiographers' clinical involvement in both justification and optimisation between countries. Workshop participants identified five common training problems, namely education availability, lack of standardisation, radiation protection course quality, teamwork problems and lack of equipment., Conclusion: Radiographer education in the IAEA Europe region is heterogeneous with substantial differences in duration and quality of training programs between countries, which likely impact on quality of patient care delivered. Common problems have been identified and potential solutions proposed to focus quality improvement initiatives., Implications for Practice: Radiographer education and training is diverse throughout the IAEA TC Europe region, with likely impacts on radiation protection practices applied. Clinical involvement of radiographers in justification and optimisation differs, potentially limiting adherence to radiation protection principles., Competing Interests: Conflict of interest The authors have no conflicts of interest to declare., (Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and ongoing competence and qualification in radiation protection for relevant professional groups, considering the available recommendations at international and regional levels. The proposed actions include provisions for train-the-trainer credentialing and facility training accreditation, balance betwee the online and face-to-face training, improved on-the job training, as well as improved inclusion in training programmes of aspects related to application of new technologies, ethical aspects, development of communication skills, and use of software tools for improving justification and optimisation. The need for making the ongoing training practical, applicable, and useful to the trainee was highlighted. The international consultation initiated by the IAEA was appreciated as a good approach to understand and promote coordination and collaboration at all levels, for best results in education and training in radiation protection of health professionals. Implementing such a holistic approach to education and training in radiation protection would contribute towards qualification and competence of health professionals needed to ensure application of high standards for quality and safety in medical uses of ionizing radiation., (© 2022 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

Background: Identifying factors influencing substance use among racial/ethnic minorities (REM) is important given the disproportionate impact of the COVID-19 pandemic on this population., Objectives: We examined factors in four domains and hypothesized that poor mental health, negative coping behaviors, negative environmental aspects, and belonging to more vulnerable social groups would be associated with increased substance use during the pandemic., Methods: Multiple regression was applied to longitudinal data from a college sample assessed prior (fall 2017 to spring 2019) and during (spring 2020) the pandemic ( n = 323; 81.5% cisgender women; 34.5% African-American, 36.1% Asian-American, 15.5% Hispanic/Latinx, 11.8% multi-racial) to identify factors predicting current alcohol, cannabis, and nicotine use frequency (spring 2020) and change in frequency of use between springs 2019 and 2020., Results: While infrequent substance use (monthly or less) decreased during the pandemic, abstinence rates increased (alcohol 39%; cannabis 18%; nicotine 18%) and higher-frequency alcohol use increased (207%-1600% 2-3 times+/week) compared to spring 2019. The strongest protective factor was change in living situation during the pandemic, associated with lower current alcohol and cannabis use. Risk factors included a history of trouble with police and impulsivity since the pandemic, both associated with higher current and increased alcohol and cannabis use. REM did not differ on most factors and the outcomes. However, a higher percentage of Asian-Americans than other REM reported living situation changes., Conclusion: Substance use rates diverged during the pandemic, with both increased abstinence and higher-frequency use, attributed mostly to mental health and environmental domain factors with few REM differences.

Background: Low Quality of Life (QoL) in persons with paraplegia may stem from impulsive behaviors. Impulsivity in persons with paraplegia and persistently low QoL has seldom been probed but could be targeted with cognitive behavioral therapies., Objective: Determine how task-assessed and self-report impulsivity relate to quality of life (QoL) in adults with paraplegia., Methods: In a preliminary study, 33 adults with paraplegia after traumatic SCI were administered verbal interviews on QoL from the PROMIS item bank at baseline and at six-month follow-up, along with several computerized metrics of impulsivity at baseline., Results: A cluster of (n = 10) participants characterized by high levels of negative affect and low levels of resilience and life satisfaction across both baseline and follow-up showed significantly greater negative urgency impulsivity (p = 0.007) as well as significantly lower mindfulness and self-care in some domains (all p < 0.05), compared to the cluster of participants (n = 23) who showed higher life satisfaction and resilience. Behavioral metrics of delay discounting and rapid-response (motoric) impulsivity did not significantly differ (all p > 0.05) between the two clusters of participants., Conclusions: These data suggest that novel interventions that reduce trait impulsivity in other disorders could be applied to potentially reduce risk for reduced self-care and QoL in individuals with paraplegia.

The IAEA contribution to the radiation protection of patients during the global COVID-19 pandemic included a webinar on the use of CT and optimization for COVID-19 pneumonia, a survey with 137 responses from 84 sites across five continents, and a study on the CT utilization, protocols and patient doses with data from 62 healthcare sites from 34 countries. This paper outlines the main results of these efforts, which have been presented in the scientific literature and in several national trainings and international meetings., Competing Interests: Conflicts of interestNo conflict., (© The Author(s) under exclusive licence to International Union for Physical and Engineering Sciences in Medicine (IUPESM) 2022.)

We assessed variations in chest CT usage, radiation dose and image quality in COVID-19 pneumonia. Our study included all chest CT exams performed in 533 patients from 6 healthcare sites from Brazil. We recorded patients' age, gender and body weight and the information number of CT exams per patient, scan parameters and radiation doses (volume CT dose index-CTDIvol and dose length product-DLP). Six radiologists assessed all chest CT exams for the type of pulmonary findings and classified CT appearance of COVID-19 pneumonia as typical, indeterminate, atypical or negative. In addition, each CT was assessed for diagnostic quality (optimal or suboptimal) and presence of artefacts. Artefacts were frequent (367/841), often related to respiratory motion (344/367 chest CT exams with artefacts) and resulted in suboptimal evaluation in mid-to-lower lungs (176/344) or the entire lung (31/344). There were substantial differences in CT usage, patient weight, CTDIvol and DLP across the participating sites., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Symptoms of ADHD are strongly associated with alcohol use disorders, and mental health symptoms attenuate this relationship. There is limited knowledge about how specific symptoms of inattentiveness and hyperactivity/impulsivity can explain this association. We aimed to identify self-reported executive cognitive functioning and mental health and variables that may help identify subjects with an elevated risk of alcohol dependence in the general population. Data included 3917 subjects between 19 and 30 years old in the 4th Trøndelag Health Study. The Adult ADHD Self report Scale-Screener, the Hospital Anxiety and Depression Scale, and demographic variables were used as input variables. The alcohol screening instrument CAGE was used as the response variable for binary alcohol dependence risk. We used logistic regression and automated model selection to arrive at our final model that identified sex, age, inattentiveness, hyperactivity/impulsivity symptoms, and anxiety as predictors of having a CAGE score ≥2, achieving an area under the receiver operating characteristic curve of 0.692. A balanced accuracy approach indicated an optimal cut-off of 0.153 with sensitivity 0.55 and specificity 0.74. Despite attrition in the data, our findings may be important in the assessment of individual risk for alcohol dependency and when developing algorithms for risk triage in public health.

Psychopathy has long been associated with aggression. However, few studies have looked at differences between men and women. Studies that do exist demonstrate that psychopathy differentially relates to aggression in men and women and indicate that environmental factors may play a significant role in influencing these associations. A key environmental factor is a history of lifetime physical abuse (LPA), which has been linked to aggressive behavior in both men and women. The aim of the present study was to test if psychopathy differentially predicted physical, verbal, and indirect aggression in men and women, and if these associations were moderated by LPA. In a large community sample of men ( n = 369) and women ( n = 204), we assessed the 4-facet model of psychopathy (Interpersonal, Affective, Lifestyle, Antisocial) with the Psychopathy Checklist: Screening Version, LPA with the Addiction Severity Index, and self-report aggression with the Aggression Questionnaire. Results revealed sex differences and similarities. Physical aggression was associated with the affective facet of psychopathy in both men and women, though in different directions based on the moderating effects of LPA. Verbal aggression was associated with higher antisocial facet scores and LPA for men and not women. Finally, indirect aggression was associated with the antisocial facet of psychopathy for men, and the interpersonal facet for women, and these associations were not moderated by LPA. In women, low antisocial facet scores and no LPA were found to be protective for indirect aggression. These results show that LPA and psychopathy generally increase the risk of aggression, but the interaction between LPA and psychopathy differentiates the risk of aggression forms for men and women. These sex differences highlight the need for female-responsive interventions to target sex-specific risk factors for aggressive behavior.

Improvements in delivery of radiation dose to target tissues in radiotherapy have increased the need for better image quality and led to a higher frequency of imaging patients. Imaging for treatment planning extends to function and motion assessment and devices are incorporated into medical linear accelerators (linacs) so that regions of tissue can be imaged at time of treatment delivery to ensure dose distributions are delivered as accurately as possible. A survey of imaging in 97 radiotherapy centres in nine countries on six continents has been undertaken with an on-line questionnaire administered through the International Commission on Radiological Protection mentorship programme to provide a snapshot of imaging practices. Responses show that all centres use CT for planning treatments and many utilise additional information from magnetic resonance imaging and positron emission tomography scans. Most centres have kV cone beam CT attached to at least some linacs and use this for the majority of treatment fractions. The imaging options available declined with the human development index (HDI) of the country, and the frequency of imaging during treatment depended more on country than treatment site with countries having lower HDIs imaging less frequently. The country with the lowest HDI had few kV imaging facilities and relied on MV planar imaging intermittently during treatment. Imaging protocols supplied by vendors are used in most centres and under half adapt exposure conditions to individual patients. Recording of patient doses, a knowledge of which is important in optimisation of imaging protocols, was limited primarily to European countries., (Copyright © 2021 Associazione Italiana di Fisica Medica. All rights reserved.)

This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn's disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.

Purpose: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen-pelvis examinations in 18 countries., Materials and Methods: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose-index volume; dose-length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen-pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test., Results: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen-pelvis (10/11 institutions that supplied data for abdomen-pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen-pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen-pelvis CT ( P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen-pelvis CT examinations., Conclusions: Multiphase scan protocols for the routine chest and abdomen-pelvis CT examinations are unnecessary, and their use increases radiation dose.

Background : The novel coronavirus-19 (COVID-19) pandemic is a collective crisis that imposed an abrupt and unprecedented impact on college students, as universities were closed with little warning. Paired with the challenges associated with physical distancing (e.g. economic stress, job loss, food insecurity, housing challenges) and the simultaneous need to balance continued and new academic demands, impact will be wide-ranging. It is critical to determine the structure of the impact of this heterogeneous stressor (e.g. health concerns, pandemic worry, financial concerns) for prevention and intervention planning. Objective : Through an existing recruitment pipeline we were in a unique position to study the wide-ranging reach of this pandemic in a cohort of students for whom their university experiences were like no other cohort in history. Method : Data were collected from students who were in their third year of college during the onset of the pandemic; of the N = 1,899 in the cohort who were invited to participate in this COVID-related survey, 897 (47.2%) completed measures of impact between May and July of 2020. Results : A series of confirmatory and exploratory models were fit to examine the structure of the pandemic-related domains. Following estimation of a single-factor model, a correlated five factors model, as well as two second-order factor structures, the five correlated factors (exposure, worry, housing/food instability, social media, substance use) model was found to represent the data most appropriately, while producing an interpretable solution. Conclusions : These measurement model analyses set the stage for future research to examine how these correlated factors impact psychiatric, substance, and academic outcomes in this vulnerable population., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Psychopathy and substance use disorders (SUDs) are both characterized by neurocognitive impairments reflecting higher levels of impulsivity such as reward-driven decision-making and deficient inhibitory control. Previous studies suggest that psychopathy may exacerbate decision-making deficits, but it may be unrelated to other neurocognitive impairments among substance dependent individuals (SDIs). The aim of the present study was to examine the role of psychopathy and its interpersonal-affective and impulsive-antisocial dimensions in moderating the relationships between dependence on different classes of drugs and neurocognitive domains of impulsivity. Method: We tested 693 participants (112 heroin mono-dependent individuals, 71 heroin polysubstance dependent individuals, 115 amphetamine mono-dependent individuals, 76 amphetamine polysubstance dependent individuals, and 319 non-substance dependent control individuals). Participants were administered the Psychopathy Checklist: Screening Version (PCL:SV) and seven neurocognitive tasks measuring impulsive choice/decision-making (Iowa Gambling Task; Cambridge Gambling Task; Kirby Delay Discounting Task; Balloon Analog Risk Task), and impulsive action/response inhibition (Go/No-Go Task, Immediate Memory Task, and Stop Signal Task). Results: A series of hierarchical multiple regressions revealed that the interpersonal-affective dimension of psychopathy moderated the association between decision-making, response inhibition and both amphetamine and heroin dependence, albeit differently. For amphetamine users, low levels of interpersonal-affective traits predicted poor decision-making on the Iowa Gambling Task and better response inhibition on the Stop Signal task. In contrast, in heroin users high interpersonal-affective psychopathy traits predicted lower risk taking on the Cambridge Gambling Task and better response inhibition on the Go/No-Go task. The impulsive-antisocial dimension of psychopathy predicted poor response inhibition in both amphetamine and heroin users. Conclusions: Our findings reveal that psychopathy and its dimensions had both common and unique effects on neurocognitive function in heroin and amphetamine dependent individuals. Our results suggest that the specific interactions between psychopathy dimensions and dependence on different classes of drugs may lead to either deficient or superior decision-making and response inhibition performance in SDIs, suggesting that psychopathy may paradoxically play a protective role for some neurocognitive functions in specific subtypes of substance users., Competing Interests: GV has ownership interests in the Bulgarian Addictions Institute, where data collection took place. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Psederska, Thomson, Bozgunov, Nedelchev, Vasilev and Vassileva.)

The Balloon Analogue Risk Task (BART) is a popular task used to measure risk-taking behavior. To identify cognitive processes associated with choice behavior on the BART, a few computational models have been proposed. However, the extant models either fail to capture choice patterns on the BART or show poor parameter recovery performance. Here, we propose a novel computational model, the exponential-weight mean-variance (EWMV) model, which addresses the limitations of existing models. By using multiple model comparison methods, including post hoc model fits criterion and parameter recovery, we showed that the EWMV model outperforms the existing models. In addition, we applied the EWMV model to BART data from healthy controls and substance-using populations (patients with past opiate and stimulant dependence). The results suggest that (1) the EWMV model addresses the limitations of existing models and (2) heroin-dependent individuals show reduced risk preference than other groups, which may have significant clinical implications., Competing Interests: Conflict of Interest: The authors declare no competing financial interest.

On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic. The expert organisations recommend more cautious use of thoracic computed tomography (CT), opting for low-dose protocols. We aimed at determining a threshold value of automatic tube current modulation noise index below which there is a chance to miss an onset of ground-glass opacities (GGO) in COVID-19. A team of radiologists and medical physicists performed 25 phantom CT studies using different automatic tube current modulation settings ( SURE Exposure3D technology). We then conducted a retrospective evaluation of the chest CT images from 22 patients with COVID-19 and calculated the density difference between the GGO and unaffected tissue. Finally, the results were matched to the phantom study results to determine the minimum noise index threshold value. The minimum density difference at the onset of COVID-19 was 252 HU (p < 0.001). This was found to correspond to the SURE Exposure 3D noise index of 36. We established the noise index threshold of 36 for the Canon scanner without iterative reconstructions, allowing for a decrease in the dose-length product by 80%. The proposed protocol needs to be validated in a prospective study.

Positive social connections are crucial for recovery from Substance Use Disorder (SUD). Of interest is understanding potential social information processing (SIP) mediators of this effect. To explore whether persons with different SUD show idiosyncratic biases toward social signals, we administered an emotional go-nogo task (EGNG) to 31 individuals with Cocaine Use Disorder (CoUD), 31 with Cannabis Use Disorder (CaUD), 79 with Opioid Use Disorder (OUD), and 58 controls. Participants were instructed to respond to emotional faces (Fear/Happy) but withhold responses to expressionless faces in two task blocks, with the reverse instruction in the other two blocks. Emotional faces as non-targets elicited more "false alarm" (FA) commission errors as a main effect. Groups did not differ in overall rates of hits (correct responses to target faces), but participants with CaUD and CoUD showed reduced rates of hits (relative to controls) when expressionless faces were targets. OUD participants had worse hit rates [and slower reaction times (RT)] when fearful faces (but not happy faces) were targets. CaUD participants were most affected by instruction effects (respond/"go" vs withhold response/"no-go" to emotional face) on discriminability statistic A. Participants were faster to respond to happy face targets than to expressionless faces. However, this pattern was reversed in fearful face blocks in OUD and CoUD participants. This experiment replicated previous findings of the greater salience of expressive face images, and extends this finding to SUD, where persons with CaUD may show even greater bias toward emotional faces. Conversely, OUD participants showed idiosyncratic behavior in response to fearful faces suggestive of increased attentional disruption by fear. These data suggest a mechanism by which positive social signals may contribute to recovery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bjork, Keyser-Marcus, Vassileva, Ramey, Houghton and Moeller.)

Background: In the collaborative business environment, blockchain coupled with smart contract removes the reliance on a central system and offers data integrity which is crucial when the transacting parties rely on the shared data. The acceptance of such blockchain-based systems is necessary for the continued use of the services. Despite many extensive studies evaluating the performance of blockchain-based systems, few have focused on users' acceptance of real-life applications., Objective: The main objective of this research is to evaluate the user acceptance of a real-life blockchain-based system (BBS) by observing various latent variables affecting the development of users' attitudes and intention to use the system. It also aims to uncover the dimensions and role of trust, security and privacy alongside the primary Technology Acceptance Model (TAM)-based predictors and their causal relationship with the users' behavior to adopt such BBS., Methods: We tested the augmented TAM with Trust Model on a BBS that comprises two subsystems: a Shopping Cart System (SCS), a system oriented towards end-users and a Data Sharing System (DSS), a system oriented towards system administrators. We set research questions and hypotheses, and conducted online surveys by requesting each participant to respond to the questionnaire after using the respective system. The main study comprises two separate sub-studies: the first study was performed on SCS and the second on DSS. Furthermore, each study data comprises initial pre-test and post-test data scores. We analyzed the research model with partial least square structural equation modelling., Results: The empirical study validates our research model and supports most of the research hypotheses. Based on our findings, we deduce that TAM-based predictors and trust constructs cannot be applied uniformly to BBS. Depending on the specifics of the BBS, the relationships between perceived trust antecedents and attitudes towards the system might change. For SCS, trust is the strongest determinant of attitudes towards system, while DSS has perceived privacy as the strongest determinant of attitudes towards system. Quality of system shows the strongest total effect on intention to use SCS, while perceived usefulness has the strongest total effect on intention to use DSS. Trust has a positive significant effect on users' attitudes towards both BSS, while security does not have any significant effect on users' attitudes toward BBS. In SCS, privacy positively affects trust, but security has no significant effect on trust, whereas, in DSS, both privacy and security have significant effects on trust. In both BBS, trust has a moderating effect on privacy that correlates with attitudes towards BBS, whereas security does not have any mediating role between privacy and attitudes towards BBS. Hence, we recommend that while developing BBS, particular attention should be paid to increasing user trust and perceived privacy., Competing Interests: Ajay Kumar Shrestha is a Ph.D. candidate at the University of Saskatchewan. Ajay Kumar Shrestha has received the UofS CGPS Dean’s Scholarship, Teacher-Scholar Doctoral Fellowship, NSERC (Discovery grant of Dr. Vassileva). Ajay Kumar Shrestha is a member of the Services Society. Julita Vassileva is an Academic Editor for PeerJ., (© 2021 Shrestha et al.)

Introduction: Fluoroscopy-guided endourology procedures require proper radiation protection to minimize radiation risk. This multicenter study aimed at investigating radiation protection practice and related radiation exposure of operating team members. Materials and Methods: Six endourology centers from the South-Eastern European Group for Urolithiasis Research answered questionnaires and collected data of 315 procedures performed within a 3-months period, with simultaneous measurement of dose to staff and dose area product (DAP) to patient. A pair of calibrated personal dosimeters, one for body and one for eye-lens dose, was worn by all key staff members. Dosimeters were centrally calibrated, measured, and analyzed. Results: The annual workload ranged from 173 to 865 procedures per center. Practice of personal dose monitoring and use of radiation protection shielding was found to be inconsistent. Lead aprons and thyroid collars were used by all, whereas protective eyewear was used in only half of centers. Due to the regular use of protective aprons, the whole-body dose of all 44 monitored staff members was safely below the regulatory dose limits. Eye-lens dose of 17 (14 urologists and 3 assisting staff) was above the dosimeter detection level, and dose per procedure varied from <10 to 63 μSv. The highest annual eye-lens dose of 13.5 mSv was found for the surgeon in the busiest department by using an over-the-couch X-ray tube without a ceiling suspended screen. Working closer to patient body with no protection resulted in a six-time higher eye-lens dose per DAP for a surgeon compared with others in the same center. Lower eye-dose per procedure was associated with lower DAP to patient and with the use of an under-the-couch tube, lower fluoroscopy pulse rate, collimation, fluoroscopy time, and acquired images. Conclusion s: The study results call for the need to establish standard protocols about use of fluoroscopy during endourology procedures and to increase radiation protection knowledge and awareness of surgical staff.

Purpose: Optimization of CT scan practices can help achieve and maintain optimal radiation protection. The aim was to assess centering, scan length, and positioning of patients undergoing chest CT for suspected or known COVID-19 pneumonia and to investigate their effect on associated radiation doses., Methods: With respective approvals from institutional review boards, we compiled CT imaging and radiation dose data from four hospitals belonging to four countries (Brazil, Iran, Italy, and USA) on 400 adult patients who underwent chest CT for suspected or known COVID-19 pneumonia between April 2020 and August 2020. We recorded patient demographics and volume CT dose index (CTDI vol ) and dose length product (DLP). From thin-section CT images of each patient, we estimated the scan length and recorded the first and last vertebral bodies at the scan start and end locations. Patient mis-centering and arm position were recorded. Data were analyzed with analysis of variance (ANOVA)., Results: The extent and frequency of patient mis-centering did not differ across the four CT facilities (>0.09). The frequency of patients scanned with arms by their side (11-40% relative to those with arms up) had greater mis-centering and higher CTDI vol and DLP at 2/4 facilities (p = 0.027-0.05). Despite lack of variations in effective diameters (p = 0.14), there were significantly variations in scan lengths, CTDI vol and DLP across the four facilities (p < 0.001)., Conclusions: Mis-centering, over-scanning, and arms by the side are frequent issues with use of chest CT in COVID-19 pneumonia and are associated with higher radiation doses., (Published by Elsevier Ltd.)