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Background: Treatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoanalytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP + TAU. Methods: We conducted a within-trial economic evaluation using a Bayesian framework. Results: Quality-adjusted life years (QALYs) were 0.16 higher in the LTPP + TAU group compared with TAU. The direct cost of LTPP was £5500, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP + TAU group were £5000 more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was ≈£33,000/QALY; the probability that LTPP + TAU was cost-effective at a willingness to pay of £20,000/QALY was 18 %. Limitations: The sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50 % at all time points. The study was conducted at a single site, potentially reducing generalizability. Conclusions: Although LTPP + TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation.

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients between 18 and 70 years of age presenting with kidney stone or musculoskeletal back pain. Participants were randomly assigned to 1 of 3 risk communication strategies: (1) a personalized probabilistic risk visual aid, (2) a visual aid and a video narrative, or 3) general risk information. The primary outcomes were accuracy of risk recall, reported opioid use, and treatment preference at time of discharge. Results. A total of 1301 participants were enrolled between June 2017 and August 2019. There was no difference in risk recall at 14 days between the narrative and probabilistic groups (43.7% vs 38.8%; absolute risk reduction = 4.9%; 95% confidence interval [CI] = −2.98, 12.75). The narrative group had lower rates of preference for opioids at discharge than the general risk information group (25.9% vs 33.0%; difference = 7.1%; 95% CI = 0.64, 0.97). There were no differences in reported opioid use at 14 days between the narrative, probabilistic, and general risk groups (10.5%, 10.3%, and 13.3%, respectively; P = .44). Conclusions. An emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall. Trial Registration. Clinical Trials.gov identifier: NCT03134092. (Am J Public Health. 2022;112(S1):S45–S55. https://doi.org/10.2105/AJPH.2021.306511 )

To develop and validate a prostate cancer (PCa) risk calculator (RC) incorporating multiparametric magnetic resonance imaging (mpMRI) and to compare its performance with that of the Prostate Biopsy Collaborative Group (PBCG) RC.Men without a PCa diagnosis receiving mpMRI before biopsy in the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (2015-2020) were included. Data from a separate institution were used for external validation. The primary outcome was diagnosis of no cancer, grade group (GG)1 PCa, and clinically significant (cs)PCa (≥GG2). Binary logistic regression was used to explore standard clinical and mpMRI variables (prostate volume, Prostate Imaging-Reporting Data System [PI-RADS] version 2.0 lesions) with the final PLUM RC, based on a multinomial logistic regression model. Receiver-operating characteristic curve, calibration curves, and decision-curve analysis were evaluated in the training and validation cohorts.A total of 1010 patients were included for development (N = 674 training [47.8% PCa, 30.9% csPCa], N = 336 internal validation) and 371 for external validation. The PLUM RC outperformed the PBCG RC in the training (area under the curve [AUC] 85.9% vs 66.0%; P 0.001), internal validation (AUC 88.2% vs 67.8%; P 0.001) and external validation (AUC 83.9% vs 69.4%; P 0.001) cohorts for csPCa detection. The PBCG RC was prone to overprediction while the PLUM RC was well calibrated. At a threshold probability of 15%, the PLUM RC vs the PBCG RC could avoid 13.8 vs 2.7 biopsies per 100 patients without missing any csPCa. At a cost level of missing 7.5% of csPCa, the PLUM RC could have avoided 41.0% (566/1381) of biopsies compared to 19.1% (264/1381) for the PBCG RC. The PLUM RC compared favourably with the Stanford Prostate Cancer Calculator (SPCC; AUC 84.1% vs 81.1%; P = 0.002) and the MRI-European Randomized Study of Screening for Prostate Cancer (ERSPC) RC (AUC 84.5% vs 82.6%; P = 0.05).The mpMRI-based PLUM RC significantly outperformed the PBCG RC and compared favourably with other mpMRI-based RCs. A large proportion of biopsies could be avoided using the PLUM RC in shared decision making while maintaining optimal detection of csPCa.

As the emerging field of equity in STEM education continues to grow, debates surrounding how to best serve populations with historically restricted access and successful outcomes within the STEM fields is growing as well. In this article, a group of doctoral students who took a course titled Equity in STEM Education and discusses their takeaways regarding the literature discussed in the course. The topics covered in this article will center around Gutiérrez’s (2007) equity framework of power, identity, access, and achievement. Through the lens of the equity framework, the dimension of power will be used to present discourse on the sociopolitical turn in STEM education. Identity will be used to explore debates on race, poverty, gender, and sexuality within STEM equity and education. Access will be used to examine discussions on students’ ability to achieve STEM equity in rural settings and within specific domains such as computer science. Finally, achievement will be used to explore arguments on both sides of the achievement gap research. To conclude, we urge researchers, educators, and policymakers to listen and act upon the work of contemporary scholars in order to achieve an equitable STEM education system.

L’apparition de lésions blanches pré- carieuses de l’émail (LPCE) est un des facteurs de risque de traitement d’orthodontie. Elles compromettent l’aspect esthétique du résultat final du traitement orthodontique. La littérature foisonne à ce sujet qui concerne tous les praticiens pratiquant la science dentaire. La connaissance précise de la structure de l’émail permet de mieux cerner le processus de diffusion de la lésion ainsi que définir les possibilités thérapeutiques. Les approches thérapeutiques à l’aide de bains de bouche, d’applications topiques, d’infiltrations par des résines de basse viscosité sont destinées à arrêter l’évolution des lésions amélaires pré-carieuses. En gagnant en profondeur, les lésions pré-carieuses de l’émail deviennent des lésions carieuses initiales. Elles ont fait l’objet de suivi clinique et de thérapeutiques spontanées non-invasives visant à la re-minéralisation des lésions carieuses. Malgré de nombreuses stratégies préventives ces lésions initiales sont encore très fréquentes. Le rôle du pédodontiste est d’inciter à avoir les bons gestes dès le plus jeune âge et d’établir une maintenance avec des fluorations régulières durant le traitement orthodontique tandis

The high levels of biodiversity supported by mountains suggest a possible link between geologic processes and biological evolution. Freshwater biodiversity is high not only in tectonically active settings but also in tectonically quiescent montane regions such as the Appalachian Mountains. We show that erosion through different rock types drove allopatric divergence between lineages of the Greenfin Darter ( Nothonotus chlorobranchius ), a fish species endemic to rivers draining metamorphic rocks in the Tennessee River basin in the United States. In the past, metamorphic rock preferred by N. chlorobranchius was more widespread, but as erosion exposed other rock types, lineages of this species were progressively isolated in tributaries farther upstream, where metamorphic rock remained. Our results suggest a geologic mechanism for initiating allopatric diversification in mountains long after tectonic activity ceases.

Children with congenital heart disease (CHD) can face neurodevelopmental, psychological, and behavioural difficulties beginning in infancy and continuing through adulthood. Despite overall improvements in medical care and a growing focus on neurodevelopmental screening and evaluation in recent years, neurodevelopmental disabilities, delays, and deficits remain a concern. The Cardiac Neurodevelopmental Outcome Collaborative was founded in 2016 with the goal of improving neurodevelopmental outcomes for individuals with CHD and pediatric heart disease. This paper describes the establishment of a centralised clinical data registry to standardize data collection across member institutions of the Cardiac Neurodevelopmental Outcome Collaborative. The goal of this registry is to foster collaboration for large, multi-centre research and quality improvement initiatives that will benefit individuals and families with CHD and improve their quality of life. We describe the components of the registry, initial research projects proposed using data from the registry, and lessons learned in the development of the registry.

As sequence and structural databases grow along with powerful analysis tools, the prevalence and diversity of pseudoenzymes have become increasingly evident. Pseudoenzymes are present across the tree of life in a large number of enzyme families. Pseudoenzymes are defined as proteins that lack conserved catalytic motifs based on sequence analysis. However, some pseudoenzymes may have migrated amino acids necessary for catalysis, allowing them to catalyze enzymatic reactions. Furthermore, pseudoenzymes retain several non-enzymatic functions such as allosteric regulation, signal integration, scaffolding, and competitive inhibition. In this review, we provide examples of each mode of action using the pseudokinase, pseudophosphatase, and pseudo ADP-ribosyltransferase families. We highlight the methodologies that facilitate the biochemical and functional characterization of pseudoenzymes to encourage further investigation in this burgeoning field.

Background Intimate partner violence (IPV) alters women's neurobiological stress response systems. We propose that individual differences early in the attentional processing of threats are associated with these neurobiological mechanisms and contribute to mental illness in this population. Methods We assessed attentional bias in relation to threat (AB) in women survivors of IPV (n = 69) and controls (n = 36), and examined overall cortisol secretion using hair cortisol (HC), and stress responsiveness measuring salivary cortisol and α-amylase (sAA) before (T0), and after (T1, T2) an acute psychosocial stress task (Trier Social Stress Test). We used repeated-measures ANCOVAs to explore the associations between Group (IPV, control) and AB with acute stress response, and regression models to examine the associations with mental health symptoms. Results There were no between-group differences in HC levels. An interaction between Group and AB was found regarding cortisol reactivity (p < 0.05). IPV women with threat avoidance AB showed a blunted cortisol response compared to controls and to IPV participants with threat vigilance AB. The association between sAA reactivity and the interaction between Group, AB, and time approached significance (p = 0.07), with a trend to lower sAA levels particularly in IPV women with threat avoidance AB. Group and cortisol reactivity were associated with symptoms of depression, generalized anxiety, and post-traumatic stress disorder (8–20% explained variance). Conclusions Threat avoidance AB is associated with blunted acute cortisol response among women exposed to chronic stress (IPV). Experiencing IPV and acute cortisol response appear to be clearly implicated in long-term mental health problems.

Introdução: os profissionais da saúde são providos de técnicas e de conhecimento científico durante sua formação e percebidos como pessoas preparadas para atuar em qualquer situação relacionada à saúde. Em sua maioria fadados ao sentimento de culpa e impotência pelo fracasso, ao enfrentarem o processo de morte-morrer de seus pacientes. As evidências apontam para a necessidade de preparar os futuros profissionais durante a graduação pois estes serão expostos ao sofrimento dos pacientes que se encontram neste processo como uma intervenção capaz de mitigar estes sentimentos. Objetivo: identificar e tipificar a presença da temática morte e morrer/tanatologia nos cursos de enfermagem brasileiros reconhecidos pelo mec. Método: estudo transversal de natureza quantitativa que investigou a presença do ensino sobre a morte e o morrer nas instituições públicas e privadas brasileiras que oferecem cursos de graduação em enfermagem com notas 5, 4 e 3, no enade. Resultados: participaram do estudo 7272 instituições de ensino, destas, 37 concordaram em participar, 5 foram excluídas por enviarem o instrumento em duplicidade, 7 excluídas por responderem somente a primeira pergunta de forma afirmativa, 1 deixou o formulário em branco, 1 instituição não concordou com os termos de consentimento do estudo, restaram 23 registros válidos. Das 23 instituições participantes, apenas 4 (1.87%) são privadas, as outras 19 (87,3%) são públicas. Conclusão: As Instituições de Ensino Superior (IES) apresentam uma deficiência no ensino desta temática, pois capacitar os alunos não trata apenas de passar conhecimento teórico-prático, mas fornecer-lhes ferramentas para lidar com os entraves psicológicos que terão de vivenciar na sua vida profissional, com relação a morte dos pacientes.

BackgroundEpithelial remodeling is a histopathologic feature of chronic inflammatory airway diseases including chronic rhinosinusitis (CRS). Cell type shifts and their relationship to CRS endotypes and severity are incompletely described.ObjectiveThe purpose of this study was to understand the relationship of epithelial cell remodeling to inflammatory endotypes and disease outcomes in CRS.MethodsUsing cell type transcriptional signatures derived from epithelial single cell sequencing, we analyzed bulk RNA sequencing data from sinus epithelial brushes obtained from patients with CRS with and without nasal polyps in comparison to healthy controls.ResultsThe airway epithelium in nasal polyposis displayed increased tuft cell transcripts and decreased ciliated cell transcripts along with an IL-13 activation signature. In contrast, chronic rhinosinusitis without polyps showed an IL-17 activation signature. IL-13 activation scores were associated with increased tuft cell, goblet cell and mast cell scores and decreased ciliated cell scores. Furthermore, the IL-13 score was strongly associated with a previously reported activated (“polyp”) tuft cell score and a prostaglandin E2 (PGE2) activation signature. The Lund-McKay score, a computed tomographic metric of sinus opacification, correlated positively with activated tuft cell, mast cell, PGE2, and IL-13 and negatively with ciliated cell transcriptional signatures.ConclusionsThese results demonstrate that cell type alterations and PGE2 stimulation are key components of IL-13 induced epithelial remodeling in nasal polyposis, while IL-17 signaling is more prominent in CRS without polyps, and that clinical severity correlates with the degree of IL-13 induced epithelial remodeling.Key MessagesCell type signatures from single cell RNA sequencing, applied to bulk sequenced RNA sinus brushes, suggest increased tuft cells and mast cells and decreased ciliated cells in nasal polyp epithelium.IL-17 signaling rather than IL-13 signaling is observed in epithelium from CRSsNP.IL-13-drives epithelial remodeling and prostaglandin E2 signatures correlated with clinical measures of sinus opacification in CRS.Capsule SummaryMeasures of epithelial remodeling, including both IL-13 and PGE2 induced epithelial activation and cell type specific transcript alterations, correlate with a radiographic metric of disease severity in CRSwNP.

To examine the association between prescription opioid use and the risk of dementia in old-age, since existing studies of the association are few, and the evidence is inconsistent.Prospective national cohort study (N = 91,307, aged 60 years and over), without a dementia diagnosis for ten years, followed-up for incident dementia from January 2013 to October 2017.Opioid exposure was based on opioid purchases classified from Anatomical Therapeutic Chemical Classification system codes (N02A), and classified as exposed if the purchase period covered at least 60 days within a 120-day interval; otherwise, unexposed.Healthcare maintenance organization in Israel.During follow-up, 2,849 (3.1%) persons were opioid exposed (mean age 73.94 ± 6.71 years), and 5,298 (5.8 %) persons developed dementia (mean age 78.07 ± 6.54 years). Cox regression models were fitted to quantify the risk of incident dementia with Hazard Ratios (HR) and their associated 95% Confidence Intervals (CI). The opioid exposed group aged 75+ to 80 years were at an increased risk of incident dementia (Adjusted HR = 1.39, 95% CI = 1.01, 1.92, Z-statistic = 2.02, p0.05) compared to the unexposed. The point-precision estimates were generally similar to the primary analysis across fourteen sensitivity analyses.Policymakers, caregivers, patients, and clinicians may wish to consider that opioid exposure aged 75-80 is linked with an increased dementia risk to balance the potential benefits and adverse side effects of opioid use in old age.

To provide global coverage for the hyperspectral infrared (IR) and microwave (MW) sounders, the low-Earth-orbiting (LEO) satellite constellation is in operation in three temporally well-spaced sun-synchronous orbits. However, the satellite program can be altered as a result of aging satellites needing to deorbit and/or termination of the legacy program, resulting in less spatiotemporal coverage. In this study, to stress the contribution of IR and MW sounder observations from the LEO satellite constellation on numerical weather prediction (NWP) system performance, the change of the analysis impact is assessed under two assumptions: 1) the loss of the IR and MW sounder observations in each of three sun-synchronous orbits and 2) the loss of the secondary LEO satellite in two orbits, using a 2017 version of the National Centers for Environmental Prediction Global Forecast System (GFS). In the analysis verification, it is found that the analysis field is degraded due to the loss of the IR and MW sounders in each of the three primary orbits. In particular, the satellites in the afternoon orbit significantly contribute to improving the analysis as compared with the satellites in the other two orbits. In addition, the loss of the secondary satellite results in significant degradation of the analysis, resulting from reduced spatial coverage by the IR and MW sounders. These results suggest that the LEO satellite constellation, consisting of the LEO satellites in three primary sun-synchronous orbits, should be maintained in terms of the contribution to the NWP. Significance Statement Hyperspectral infrared (IR) and microwave (MW) sounders from low-Earth-orbiting (LEO) satellites significantly contribute to improving numerical weather forecasting. Nevertheless, the resiliency of the LEO satellite programs, operating in three sun-synchronous orbits, can be compromised by aging satellites needing to deorbit and/or termination of legacy satellite systems. Thus, to highlight the importance of the IR and MW sounder observations from LEO satellites in terms of numerical weather forecasting, we assessed the analysis impact of these observations with diverse satellite data availability scenarios. In the trial experiments, it is demonstrated that analysis performance is significantly degraded if the IR and MW sounders are lost, suggesting that the satellite programs carrying the IR and MW sounders should be maintained seamlessly in the future.

Background. Pituitary apoplexy (PA) is a clinical syndrome of pituitary hemorrhage or infarction and can result in hypopituitarism as well as compression of adjacent brain structures. Visual loss occurs frequently, as a result of tumor expansion and compression of the optic chiasm and optic nerves. Additionally, with pituitary tumor invasion into the fixed space of the cavernous sinus, compression of multiple cranial nerves can result in cavernous sinus syndrome (CSS). We describe a case of an undiagnosed pituitary tumor manifesting as abrupt PA with CSS during hemodialysis (HD). Clinical Case. A 77-year-old male with end-stage renal disease (ESRD) presented with acute onset of severe headache, decreased vision, ophthalmoplegia of the left eye, and hypotension during HD. MRI of the brain revealed a 2.5 cm pituitary adenoma with acute hemorrhage, compression of the left prechiasmatic optic nerve, and invasion into the left cavernous sinus (CS). The hormonal profile was consistent with multiple pituitary hormone deficiencies. The patient was treated with glucocorticoids and underwent transsphenoidal resection of the tumor. He had an uneventful postoperative hospital course, and his left visual acuity stabilized, although there was no immediate improvement in his other ocular symptoms. Conclusion. Our case highlights a rare constellation of a pituitary adenoma with CS invasion complicated by PA and CSS during HD. The pathophysiology of PA is not well understood, and there are very limited data regarding PA in patients with end-stage renal disease (ESRD) on HD. Prompt recognition of PA in a patient presenting with CSS, particularly in the HD setting, is essential to ensure appropriate care is provided for this medical emergency.

On October 15, 2021, the FDA approved atezolizumab as adjuvant therapy in patients with stage II to IIIA non–small cell lung cancer (NSCLC) whose tumors have programmed cell death ligand 1 (PD-L1) expression on ≥1% of tumor cells (TC), as detected by an FDA-approved test. The approval was based on results from the IMpower010 trial, in which 1,005 patients with NSCLC who had completed tumor resection and cisplatin-based adjuvant chemotherapy were randomly assigned 1:1 to receive atezolizumab for 16 cycles or best supportive care. The primary endpoint of disease-free survival (DFS) as assessed by investigator was tested hierarchically in the following analysis populations: stage II–IIIA NSCLC with PD-L1 expression on ≥1% of TCs (PD-L1 ≥ 1% TC); all randomly assigned patients with stage II–IIIA NSCLC; and the intent-to-treat population comprising all randomly assigned patients. At the prespecified interim DFS analysis, IMpower010 demonstrated a statistically significant and clinically meaningful improvement in DFS in the stage II–IIIA PD-L1 ≥ 1% TC analysis population, with an HR of 0.66 (95% confidence interval, 0.50–0.88; P = 0.004) favoring the atezolizumab arm. The safety profile of atezolizumab was generally consistent with known toxicities of anti–PD-(L) antibodies. The VENTANA PD-L1 (SP263) Assay (Ventana Medical Systems, Inc.) was contemporaneously approved as a companion diagnostic device to select patients with NSCLC who are PD-L1 ≥ 1% TC for adjuvant treatment with atezolizumab. Atezolizumab is the first immune checkpoint inhibitor approved by FDA for the adjuvant treatment of NSCLC.

The FDA Oncology Center of Excellence recently launched a crowdsourcing pilot to request ideas from the scientific community for research questions that FDA could address with pooled analyses of clinical trial data submitted to the agency for regulatory purposes. This effort builds on FDA's track record of publishing pooled analyses to explore scientific questions that cannot be addressed in a single trial due to limited sample size. The research crowdsourcing pilot tested a new approach for obtaining external input on regulatory science activities, because FDA is generally unable to share patient-level data outside of the agency due to federal disclosure laws and regulations protecting different types of data submitted in regulatory applications. We received 29 submissions over the 28-day crowdsourcing campaign, including one research idea that we are exploring for possible follow-up. Based on our experience with this pilot, we learned that crowdsourcing is a promising new approach to gather external input and feedback. We identified opportunities to build understanding in the external oncology community about the types of data typically included in regulatory applications and expand the dissemination of published FDA pooled analyses to help inform future drug development and clinical practice.

Background: The COVID-19 pandemic brought unparalleled strain to the United States’ already overburdened health care workforce, and research is just beginning to shed light on its effects. This study sought to document health care pro-vider stressors during the pandemic to inform prevention and intervention strategies to better support their well-being. Methods: A one-time online survey was completed in July and August 2021 by Ohio health care professionals employed during the COVID-19 pandemic. We assessed for work and employment status changes and measured the severity of various work and home stressors among respondents who worked during the COVID-19 pandemic (N = 12 807). Results: Over a quarter of respondents had a change in work setting, and 59% had an increase in their workload; 20% of respondents were furloughed, laid off, or unemployed at some point during the COVID-19 pandemic. Over 37% reported a negative financial impact. The work stressors causing the greatest concern were spreading the virus and insuf-ficient communication from leadership. The primary home stressors were a lack of quality time with family and friends, being too tired when home from work to cook, do chores, etc, and being a supportive, present parent. At least half of the sample scored each of these as moderate, significant, or extreme stressors. Conclusion: The COVID-19 pandemic caused unrelenting stress affecting Ohio health care professionals at work and at home. Prevention and early intervention programs and public policies are required to prevent burnout and better support health care worker well-being.

The 6 February 2023 Mw 7.8 Pazarcık and subsequent Mw 7.5 Elbistan earthquakes generated strong ground shaking that resulted in catastrophic human and economic loss across south-central Türkiye and northwest Syria. The rapid characterization of the earthquakes, including their location, size, fault geometries, and slip kinematics, is critical to estimate the impact of significant seismic events. The U.S. Geological Survey National Earthquake Information Center (NEIC) provides real-time monitoring of earthquakes globally, including rapid source characterization and impact estimates. Here, we describe the seismic characterization products generated and made available by the NEIC over the two weeks following the start of the earthquake sequence in southeast Türkiye, their evolution, and how they inform our understanding of regional seismotectonics and hazards. The kinematics of rupture for the two earthquakes was complex, involving multiple fault segments. Therefore, incorporating observations from rupture mapping was critical for characterizing these events. Dense local datasets facilitated robust source characterization and impact assessment once these observations were obtained and converted to NEIC product input formats. We discuss how we may improve the timeliness of NEIC products for rapid assessment of future seismic hazards, particularly in the case of complex ruptures.

Background: Transcranial direct-current stimulation (tDCS) is a promising adjunct to therapy for chronic aphasia. Methods: This single-center, randomized, double-blind, sham-controlled efficacy trial tested the hypothesis that anodal tDCS augments language therapy in subacute aphasia. Secondarily, we compared the effect of tDCS on discourse measures and quality of life and compared the effects on naming to previous findings in chronic stroke. Right-handed English speakers with aphasia Results: Baseline characteristics were similar between the tDCS (N=30) and sham (N=28) groups: patients were 65 years old, 53% male, and 2 months from stroke onset on average. In intent-to-treat analysis, the adjusted mean change from baseline to 1-week posttreatment in picture naming was 22.3 (95% CI, 13.5–31.2) for tDCS and 18.5 (9.6–27.4) for sham and was not significantly different. Content and efficiency of picture description improved more with tDCS than sham. Groups did not differ in quality of life improvement. No patients were withdrawn due to adverse events. Conclusions: tDCS did not improve recovery of picture naming but did improve recovery of discourse. Discourse skills are critical to participation. Future research should examine tDCS in a larger sample with richer functional outcomes. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02674490.