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OBJECTIVES: To characterize the beliefs and opinions of nursing home (NH) and emergency medicine providers about communication between NH and emergency departments (ED) during transitions of care of NH residents. DESIGN: A cross-sectional study using a mailed and Internet survey. PARTICIPANTS AND SETTING: Physicians, nurse practitioners, physicians assistants, and nurses who practice in ED settings and NH settings, affiliated with hospitals of an academic medical center in Rochester, New York. MEASUREMENTS: Opinions on communication; beliefs about frequency of information transmission; opinions on how often verbal communication should occur. RESULTS: A total of 155 nurses and medical providers participated in the survey for a response rate of 32.2% (155/481). Of the survey participants, 63.0% and 56.8% had been more than 5 years in their position and facility, respectively. Most respondents felt that important information was lost during patient transfers between NH and ED settings. Providers from ED and NH settings had different opinions on the likelihood that key information would be readily identifiable at patient transfer and that care would include requested tests and follow-up. Providers from both sites of care supported verbal communication at their position when NH residents are transferred to the other setting. CONCLUSION: Nurses and medical providers from both emergency and NH settings agree that transitional communication is poor between NHs and EDs and support a role for verbal communication during the ED transitions of care of NH residents. [ABSTRACT FROM AUTHOR]

Emotion recognition is central in prosocial interaction, enabling the inference of mental and affective states. Individuals who have committed sexual offenses are known to exhibit socio-affective deficits, one of the four dynamic risk assessment dimensions found in the literature. Few research focused on emotion recognition. The available literature, exclusively on individuals in prison who have committed sexual offenses, showed contrasting results. Some found a global (across all emotions) or specific (e.g., anger, fear) deficit in emotion recognition. In contrast, others found no difference between individuals in prison who have committed sexual offenses and those who have committed non-sexual offenses. In addition, no such study has been undertaken among forensic inpatients who exhibit socio-affective deficits. This study aims to investigate the recognition of dynamic facial expressions of emotion in 112 male participants divided into three groups: forensic inpatients who have committed sexual offenses ( n = 37), forensic inpatients who have committed non-sexual offenses ( n = 25), and community members ( n = 50), using the Signal Detection Theory indices: sensitivity ( d ') and response bias ( c ). In addition, measures related to reaction time, emotion labeling reflection time, task easiness, and easiness reflection time were also collected. Non-parametric analyses (Kruskall-Wallis' H , followed by Mann-Whitney's U with Dunn-Bonferroni correction) highlighted that the two forensic inpatient groups exhibited emotion recognition deficits when compared to community members. Forensic inpatients who have committed sexual offenses were more conservative in selecting the surprise label than community members. They also took significantly more time to react to stimuli and to select an emotional label. Despite emotion recognition deficits, the two forensic inpatient groups reported more stimuli easiness than community members., 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 Tiberi, Gillespie, Saloppé, Vicenzutto and Pham.)

Background and Objectives: Psychopathic traits - and especially callous affective features - have been linked to altered processing of others' emotional expressions, and to reduced attention to the eyes. Despite the importance of gaze cueing (i.e., the tendency to orient attention toward where someone else is looking) for social functioning, few studies have investigated relationships between psychopathic traits and gaze cueing, and whether facial emotional expression influence these relationships, obtaining mixed results. To address this gap, the present study aimed to evaluate associations between psychopathic traits and gaze cueing for emotional and neutral expressions., Methods: 65 non-clinical male participants (M age  = 27.3 years) completed two self-report measures of psychopathy and performed laboratory tasks to assess gaze-cueing for emotional vs. neutral faces and an arrow-cueing task as a comparison., Results: Linear mixed models showed no significant associations of emotional (versus neutral) expressions, or psychopathy trait dimensions, with either gaze cueing or arrow cueing., Limitations: Reliance on a convenience sample of non-clinical men, assessed with self-reports measures of psychopathy, and using static emotional stimuli limit the generalizability of our findings., Conclusions: Findings suggest that psychopathic traits are not associated with individual differences in following others' gaze to direct attention, and that there was no advantage for affective relative to neutral expressions., Competing Interests: Declaration of competing interest The authors are not aware of any competing interests that are relevant to the content of this article. The authors received no financial support for the research, authorship, and/or publication of this article., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The prevalence of research conducted online in the addiction field has increased rapidly over the past decade. However, little focus has been given to careless responding in these online studies, despite the issues it may cause for statistical inference and generalizability. Our aim was to examine whether alcohol use is associated with careless responses., Method: Raw data were requested from online studies examining alcohol use and related problems which also addressed careless responding. We obtained 13 data sets of 12,237 participants ( M age = 42.16, SD = 15.65, 50.5% female). The sample had an average Alcohol Use Disorders Identification Test (AUDIT) score of 10.88 ( SD = 7.77). Predictors included demographic information (age, gender) and AUDIT total scores. The primary outcome was whether an individual was classed as a careless responder, for example, by failing an explicit attention check question., Results: AUDIT total scores were associated with careless responding ( OR = 1.07, 95% CI [1.06, 1.08], p < .001). Hazardous drinking or worse was associated with 2.21 greater odds ( OR = 2.21, 95% CI [1.81, 2.71] of careless responding, whereas harmful drinking or worse was associated with 3.43 greater odds ( OR = 3.43, 95% CI [2.83, 4.17]) and probable dependence was associated with 3.63 greater odds ( OR = 3.63, 95% CI [2.95, 4.48])., Conclusions: Alcohol use and related problems are positively associated with careless responding in online research. Removal of individuals identified as careless responders may lead to issues of generalizability, and more care should be taken to identify and handle careless responder data. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: One size does not fit all in assessment and intervention for people with convictions for sexual offences. Crime scene indicators and risk-related variables have been used to identify distinct clusters of people with convictions for sexual offences, but there is a need for more robust typologies that identify clusters based on psychologically meaningful risk factors that can be targeted in treatment., Aims: To use robust modelling techniques to identify latent profiles of people with convictions for sexual offences based on indicators of dynamic risk., Method: Adult male participants, who had been convicted for sexual offences and assessed for eligibility for the prison-based Core Sex Offender Treatment Programme delivered by His Majesty's Prison and Probation Service (UK), were randomly allocated to a test ( n = 1577: 70.2%) or validation ( n = 668: 29.8%) data-set. Exploratory factor analysis (EFA) was used to select measures of dynamic risk from psychological test data. EFA indicated four factors, from which six measures were selected for inclusion in latent profile analysis., Results: Five latent profiles were identified in the test and validation data-sets. These were labelled low psychological impairment, impulsive, distorted thinker, rape preoccupied and child fantasist. Profiles varied in individual characteristics, offence histories, victim preferences and level of risk., Conclusions: Our findings should be used to guide assessment and intervention practices that are tailored to distinct psychological profiles consistent with principles of risk, need and responsivity.

The role of the nervous system in the regulation of cancer is increasingly appreciated. In gliomas, neuronal activity drives tumour progression through paracrine signalling factors such as neuroligin-3 and brain-derived neurotrophic factor 1-3 (BDNF), and also through electrophysiologically functional neuron-to-glioma synapses mediated by AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptors 4,5 . The consequent glioma cell membrane depolarization drives tumour proliferation 4,6 . In the healthy brain, activity-regulated secretion of BDNF promotes adaptive plasticity of synaptic connectivity 7,8 and strength 9-15 . Here we show that malignant synapses exhibit similar plasticity regulated by BDNF. Signalling through the receptor tropomyosin-related kinase B 16 (TrkB) to CAMKII, BDNF promotes AMPA receptor trafficking to the glioma cell membrane, resulting in increased amplitude of glutamate-evoked currents in the malignant cells. Linking plasticity of glioma synaptic strength to tumour growth, graded optogenetic control of glioma membrane potential demonstrates that greater depolarizing current amplitude promotes increased glioma proliferation. This potentiation of malignant synaptic strength shares mechanistic features with synaptic plasticity 17-22 that contributes to memory and learning in the healthy brain 23-26 . BDNF-TrkB signalling also regulates the number of neuron-to-glioma synapses. Abrogation of activity-regulated BDNF secretion from the brain microenvironment or loss of glioma TrkB expression robustly inhibits tumour progression. Blocking TrkB genetically or pharmacologically abrogates these effects of BDNF on glioma synapses and substantially prolongs survival in xenograft models of paediatric glioblastoma and diffuse intrinsic pontine glioma. Together, these findings indicate that BDNF-TrkB signalling promotes malignant synaptic plasticity and augments tumour progression., (© 2023. The Author(s).)

This meta-analysis aims to examine the relationship between psychopathic traits and theory of mind (ToM), which is classically and broadly defined as competency in representing and attributing mental states such as emotions, intentions, and beliefs to others. Our search strategy gathered 142 effect sizes from 42 studies, with a total sample size of 7463 participants. Random effects models were used to analyze the data. Our findings suggested that psychopathic traits are associated with impaired ToM task performance. This relationship was not moderated by factors such as age, population, psychopathy measurement (self-report versus clinical checklist) or conceptualization, or ToM task type (cognitive versus affective). The effect also remained significant after excluding tasks that did not require the participant to 1) mentalize or 2) differentiate between self and other perspectives. However, interpersonal/affective traits were associated with a more pronounced impairment in ToM task performance compared to lifestyle/antisocial traits. Future research should investigate the effects of distinct psychopathy facets that will allow for a more precise understanding of the social-cognitive bases of relevant clinical presentations in psychopathy., Competing Interests: Declaration of interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Psychopathy has traditionally been linked with heightened criminality, but the relationship of psychopathy with increased risk for dangerousness is contested. To address this debated issue, we conducted an umbrella review (PROSPERO CRD42020214761) of all available meta-analyses of psychopathy and indices of 'dangerousness' (e.g., violent or sexual recidivism, self-reported aggression). We searched PsycINFO, Web of Science, PubMed, and Scopus from inception to August 19, 2022, to identify systematic reviews and meta-analyses on psychopathy and dangerousness. Our review included 33 studies, with the quantitative synthesis including 17 effect sizes extracted from 10 studies (N = ∼77,000 participants). Overall, we observed a pooled correlation coefficient r = 0.284 [95% CI = 0.233, 0.336] for the association of psychopathy with dangerousness (equivalent to Cohen's d = 0.592). Despite considerable heterogeneity (I 2  = 89.9%), leave-one-out analyses had minimal impact. The effect was robust to examination of potential moderators such as study quality and sample ages. However, the relationship was stronger when psychopathy was assessed using self-report compared to clinical rating scales. The association should be interpreted as meaningful in both the short-term and the long-term and suggests that psychopathy is one of the strongest predictors of dangerousness in the realm of psychopathology., Competing Interests: Declaration of Competing Interest The authors have no known conflicts of interest to disclose., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic elevated telehealth as a prevalent care delivery modality for older adults. However, guidelines and best practices for the provision of healthcare via telehealth are lacking. Principles and guidelines are needed to ensure that telehealth is safe, effective, and equitable for older adults. The Collaborative for Telehealth and Aging (C4TA) composed of providers, experts in geriatrics, telehealth, and advocacy, developed principles and guidelines for delivering telehealth to older adults. Using a modified Delphi process, C4TA members identified three principles and 18 guidelines. First, care should be person-centered; telehealth programs should be designed to meet the needs and preferences of older adults by considering their goals, family and caregivers, linguistic characteristics, and readiness and ability to use technology. Second, care should be equitable and accessible; telehealth programs should address individual and systemic barriers to care for older adults by considering issues of equity and access. Third, care should be integrated and coordinated across systems and people; telehealth should limit fragmentation, improve data sharing, increase communication across stakeholders, and address both workforce and financial sustainability. C4TA members have diverse perspectives and expertise but a shared commitment to improving older adults' lives. C4TA's recommendations highlight older adults' needs and create a roadmap for providers and health systems to take actionable steps to reach them. The next steps include developing implementation strategies, documenting current telehealth practices with older adults, and creating a community to support the dissemination, implementation, and evaluation of the recommendations., (© 2022 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Traditional and more modern conceptualizations of psychopathy cite problems with impulse control. However, the extent to which these problems represent a cardinal feature of the disorder has been debated. In this study, we conducted a preregistered systematic review and meta-analysis, searching Embase, Medline, PsycINFO, and PubMed, for studies from inception to January 6th, 2022. We included 21 studies, published between 2009 and 2021, that reported on the relationship of psychopathy with performance on the go/no-go or stop signal task. A multilevel random-effects meta-analysis, including 43 effect sizes from 17 studies (total N = 1394), showed a significant pooled association between psychopathy and response inhibition r = -0.143 (95 % CI: -0.250 to -0.034). The relatively small effect size, although statistically significant, calls in to question the extent to which difficulties in response inhibition should be considered a cardinal feature of psychopathic personality. The strength of the relationship did not significantly differ between non-criminal and criminal samples, gender, task type, tasks with or without an affective component, or by psychopathy trait dimension., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Functional impairment is a core feature of both autism and schizophrenia spectrum disorders. While diagnostically independent, they can co-occur in the same individual at both the trait and diagnostic levels. The effect of such co-occurrence is hypothesized to worsen functional impairment. The diametric model, however, suggests that the disorders are etiologically and phenotypically diametrical, representing the extreme of a unidimensional continuum of cognition and behavior. A central prediction of this model is that functional impairment would be attenuated in individuals with mixed symptom expressions or genetic liability to both disorders. We tested this hypothesis in two clinical populations and one healthy population. In individuals with chronic schizophrenia and in individuals with first episode psychosis we evaluated the combined effect of autistic traits and positive psychotic symptoms on psychosocial functioning. In healthy carriers of alleles of copy number variants (CNVs) that confer risk for both autism and schizophrenia, we also evaluated whether variation in psychosocial functioning depended on the combined risk conferred by each CNV. Relative to individuals with biased symptom/CNV risk profiles, results show that functional impairments are attenuated in individuals with relatively equal levels of positive symptoms and autistic traits-and specifically stereotypic behaviors-, and in carriers of CNVs with relatively equal risks for either disorder. However, the pattern of effects along the "balance axis" varied across the groups, with this attenuation being generally less pronounced in individuals with high-high symptom/risk profile in the schizophrenia and CNV groups, and relatively similar for low-low and high-high individuals in the first episode psychosis group. Lower levels of functional impairments in individuals with "balanced" symptom profile or genetic risks would suggest compensation across mechanisms associated with autism and schizophrenia. CNVs that confer equal risks for both disorders may provide an entry point for investigations into such compensatory mechanisms. The co-assessment of autism and schizophrenia may contribute to personalized prognosis and stratification strategies., (© 2022. The Author(s).)

Objectives: Describe how Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) team members discussed the COVID-19 vaccine with Veteran patients and their caregivers; describe HBPC team members' experiences providing care during the pandemic; identify facilitators and barriers to vaccinating HBPC Veterans during the COVID-19 pandemic., Design: Online survey that included 3 open-ended COVID-19 vaccine-related questions., Setting and Participants: HBPC Program Directors from 145 VA Medical Centers were invited to participate and share the survey invitation with team members. The survey was open from March to May 2021. We collected N = 573 surveys from 73 sites., Methods: We analyzed demographic data using descriptive frequencies and open-ended questions using thematic analysis., Results: Respondents from all HBPC roles were included in the study: Registered Nurses, Psychologists, Advanced Registered Nurse Practitioners, Social Workers, Dieticians, Occupational Therapists, Pharmacists, Physical Therapists, HBPC Program Directors, HBPC Medical Directors, MDs, Physician Assistants, Other. Qualitative thematic analysis revealed 3 themes describing VA HBPC team members' experiences discussing and administering the COVID-19 vaccine: communication and education, advocating for prioritization of HBPC Veterans to receive the vaccine, and logistics of delivering and administering the vaccine., Conclusions and Implications: Our study findings highlight the multifaceted experiences of VA HBPC team members discussing and administering initial doses of the COVID-19 vaccine to primarily homebound Veterans. Although the VA's HBPC program offers an example of a singular health care system, insights from more than 70 sites from across the United States reveal key lessons around the internal and external structures required to successfully support programs and their staff in providing these key activities. These lessons include proactively addressing the needs of homebound populations in national vaccine rollouts and developing vaccine education and training programs for HBPC team members specifically aligned to HBPC program needs. These lessons can extend to non-VA organizations who care for similar homebound populations., (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Peoples' sexual behaviors have changed during the period of enforced COVID-19 social distancing, in some cases, to cope with negative feelings during lockdown. Research on coping using sex is relatively restricted to samples of men with a history of sexual offending, and it is unknown whether coping using sex is associated with health-related behaviors and mental health in the general population., Aim: We examined if coping using sex before and during lockdown was associated with adverse outcomes (i.e., self-perceived reduction in health-related behaviors and mental health) in a community sample., Hypotheses: We hypothesized that participants who reported greater use of sex to cope in the weeks preceding lockdown would show a greater decline in health-related behaviors and mental health during lockdown. Furthermore, that changes in coping using sex resulting from lockdown would account for further variance in the worsening of health-related behaviors and mental health., Methods: Participants were UK residents, aged 18-60 years, and fluent in English. 789 participants completed an online survey, providing demographic information, self-reported social distancing, loneliness, and coping using sex over a 14-day period during lockdown, and retrospectively preceding lockdown., Outcomes: Participants reported perceived changes in health-related behaviors and mental health symptomatology during lockdown compared to before the pandemic. They also self-reported levels of stress, anxiety and depression during lockdown., Results: Greater coping using sex prior to lockdown predicted positive change in health-related behaviors, for example, higher scores were associated with participants reporting having exercised and slept more. It was also associated with higher trait levels of anxiety, stress and depression during lockdown. Changes in coping using sex from before to during lockdown did not predict perceived changes in health related behaviors or mental health symptomatology., Conclusions: Overall, greater coping using sex prior to lockdown was associated with worse mental health symptomatology during lockdown (anxiety, depression and stress), however, it was also associated with perceived positive change in health-related behaviors compared with before lockdown. This suggests that coping using sex may be associated with negative emotional reactions during lockdown, but may also be linked with positive change in health-promoting behaviors., 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 © 2022 Daly, Jones, Garofalo, Uzieblo, Robinson and Gillespie.)

Dynamics of the autonomic nervous system (ANS) are hypothesized to play a role in the emergence of interpersonal violence. In the present study, we examined continuous activities of the inhibitory parasympathetic pathway of the ANS through the root mean square of successive differences between normal heartbeats (RMSSD) in 22 male offenders who committed interpersonal violence and 24 matched controls from the general population across three successive phases: resting baseline, while performing an emotional Go/No-Go task, and post-task recovery. Results showed that across the three phases, the offender group presented lower RMSSD at baseline (p FDR  = .003; Cohen's d =  - 1.11), but similar levels during the task, attributed to a significant increase in their RMSSD level (p FDR  = .027, Cohen's d =  - 1.26). During recovery, while no distinction between the two groups was found, both groups showed signs of recovering toward baseline values. These findings suggest that violent incarcerated offenders can flexibly engage parasympathetic resources to meet environmental challenges. This underscores the necessity of considering parasympathetic dynamics and its respective mobilization/flexibility to better understand ANS profiles underlying interpersonal violence as well as its potential utility in designing more tailored interventions., (© 2022. The Author(s).)

Technologies for detecting cell-cell contacts are powerful tools for studying a wide range of biological processes, from neuronal signaling to cancer-immune interactions within the tumor microenvironment. Here, we report TRACC (Transcriptional Readout Activated by Cell-cell Contacts), a GPCR-based transcriptional recorder of cellular contacts, which converts contact events into stable transgene expression. TRACC is derived from our previous protein-protein interaction recorders, SPARK (Kim et al., 2017) and SPARK2 (Kim et al., 2019), reported in this journal. TRACC incorporates light gating via the light-oxygen-voltage-sensing (LOV) domain, which provides user-defined temporal control of tool activation and reduces background. We show that TRACC detects cell-cell contacts with high specificity and sensitivity in mammalian cell culture and that it can be used to interrogate interactions between neurons and glioma, a form of brain cancer., Competing Interests: KC, SG, NK, MQ, MJ, MM, AT No competing interests declared, (© 2022, Cho et al.)

Diffuse intrinsic pontine glioma (DIPG) and other H3K27M-mutated diffuse midline gliomas (DMGs) are universally lethal paediatric tumours of the central nervous system 1 . We have previously shown that the disialoganglioside GD2 is highly expressed on H3K27M-mutated glioma cells and have demonstrated promising preclinical efficacy of GD2-directed chimeric antigen receptor (CAR) T cells 2 , providing the rationale for a first-in-human phase I clinical trial (NCT04196413). Because CAR T cell-induced brainstem inflammation can result in obstructive hydrocephalus, increased intracranial pressure and dangerous tissue shifts, neurocritical care precautions were incorporated. Here we present the clinical experience from the first four patients with H3K27M-mutated DIPG or spinal cord DMG treated with GD2-CAR T cells at dose level 1 (1 × 10 6 GD2-CAR T cells per kg administered intravenously). Patients who exhibited clinical benefit were eligible for subsequent GD2-CAR T cell infusions administered intracerebroventricularly 3 . Toxicity was largely related to the location of the tumour and was reversible with intensive supportive care. On-target, off-tumour toxicity was not observed. Three of four patients exhibited clinical and radiographic improvement. Pro-inflammatory cytokine levels were increased in the plasma and cerebrospinal fluid. Transcriptomic analyses of 65,598 single cells from CAR T cell products and cerebrospinal fluid elucidate heterogeneity in response between participants and administration routes. These early results underscore the promise of this therapeutic approach for patients with H3K27M-mutated DIPG or spinal cord DMG., (© 2022. The Author(s).)

Decades of concerns about the quality of care provided by nursing homes have led state and federal agencies to create layers of regulations and penalties. As such, regulatory efforts to improve nursing home care have largely focused on the identification of deficiencies and assignment of sanctions. The current regulatory strategy often places nursing home teams and government agencies at odds, hindering their ability to build a culture of safety in nursing homes that is foundational to health care quality. Imbuing safety culture into nursing homes will require nursing homes and regulatory agencies to acknowledge the high-risk nature of post-acute and long-term care settings, embrace just culture, and engage nursing home staff and stakeholders in actions that are supported by evidence-based best practices. The response to the COVID-19 pandemic prompted some of these actions, leading to changes in nursing survey and certification processes as well as deployment of strike teams to support nursing homes in crisis. These actions, coupled with investments in public health that include funds earmarked for nursing homes, could become the initial phases of an intentional renovation of the existing regulatory oversight from one that is largely punitive to one that is rooted in safety culture and proactively designed to achieve meaningful and sustained improvements in the quality of care and life for nursing home residents., (Published by Elsevier Inc.)

People with high levels of psychopathic traits are often described as fearless and lacking in emotional depth, particularly when evaluating threats in their environments. Skin conductance responsivity (SCR) to negative emotional stimuli represents a robust autonomic correlate of conduct problem behavior in children (Fanti et al., in  Neuroscience and Biobehavioral Reviews , 100, 98-107, 2019). However, studies that have examined threat-related processing in youth with conduct problems have tended to use a variety of negative stimuli that might induce various and unspecific negative emotions. Few studies have taken in to account the moderating effects of anxiety on the relationship of distinct psychopathic traits (e.g., narcissism, callousness, impulsivity) with SCR to a fear inducing stimulus. In this study, we examined SCR to a virtual reality rollercoaster drop - that is, a discrete fear inducing event - in a sample of 75 youths (61 males; M  = 14 years, SD  = 1.4) enrolled in a non-mainstream school. The rollercoaster drop was used to more clearly examine an event-related response to a discrete threat, rather than examining SCR throughout the rollercoaster ride. We used the teacher-reported Antisocial Process Screening Device (Frick & Hare, in  Antisocial process screening device: APSD . Toronto: Multi-Health Systems, 2001) to examine the relations of distinct psychopathic traits with SCR and self-reported anxiety. Lower anxiety was associated with higher callousness, but only in youths with low SCR to discrete threat. These findings suggest that fear and anxiety show complex and interactive relations with distinct psychopathic traits., Competing Interests: Conflict of InterestLuna C.M. Centifanti, Steven M. Gillespie and Nicholas D. Thomson declare that they have no conflict of interest., (© The Author(s) 2021.)

Social functioning is defined as how a person operates in their unique social environment (ie, engagement in activities, connectedness with others, and contributions to social roles). Healthy social functioning is important for nursing home residents as they are at increased risk for loneliness and isolation. Social functioning has long been an underacknowledged aspect of nursing home residents' health, but now, with the COVID-19 pandemic, residents' risk for decreased social functioning is increased. Several reliable and well-validated tools are available to supplement routine care planning and delivery and track and improve changes in social functioning over time. The overarching aim of this article is to provide resources and recommendations for interdisciplinary team assessment related to social functioning for nursing home residents. We describe 2 domains of social functioning measures, care-planning measures and outcome measures, and provide recommendations for how to integrate said measures into practice. Healthy social functioning is needed to maintain nursing home residents' well-being and quality of life. Measures and recommendations outlined in this article can be used by nursing home staff to understand residents' social preferences and address social functioning during COVID-19 and beyond., (Published by Elsevier Inc.)

Clinical prognostic tools are used to objectively predict outcomes in many fields of medicine. Whilst over 400 have been developed for use in chronic obstructive pulmonary disease (COPD), only a minority have undergone full external validation and just one, the DECAF score, has undergone an implementation study supporting use in clinical practice. Little is known about how such tools are used in the UK. We distributed surveys at two time points, in 2017 and 2019, to hospitals included in the Royal College of Physicians of London national COPD secondary care audit program. The survey assessed the use of prognostic tools in routine care of hospitalized COPD patients. Hospital response rates were 71/196 in 2017 and 72/196 in 2019. The use of the DECAF and PEARL scores more than doubled in decisions about unsupported discharge (7%-15.3%), admission avoidance (8.1%-17%) and readmission avoidance (4.8%-13.1%); it more than tripled (8.8%-27.8%) in decisions around hospital-at-home or early supported discharge schemes. In other areas, routine use of clinical prognostic tools was uncommon. In palliative care decisions, the use of the Gold Standards Framework Prognostic Indicator Guidance fell (5.6%-1.4%). In 2017, 43.7% of hospitals used at least one clinical prognostic tool in routine COPD care, increasing to 52.1% in 2019. Such tools can help challenge prognostic pessimism and improve care. To integrate these further into routine clinical care, future research should explore current barriers to their use and focus on implementation studies.Supplemental data for this article is available online at https://dx.doi.org/10.1080/15412555.2021.1959540.

Socio-affective dysfunction is a risk-factor for sexual offense recidivism. However, it remains unknown whether men who have sexually offended with and without child victims show differences in eye scan paths and autonomic responsivity while viewing facial expressions of emotion. We examined differences in accuracy of emotion recognition, eye movements, and pupil dilation responses between sex offenders with child victims, sex offenders without child victims, and a group of non-offenders living in the community. Sex offenders without child victims looked for longer at the eyes than sex offenders with child victims and non-offenders. Men without child victims also scored higher for psychopathy linked disinhibition, and these traits were associated with looking longer at the eyes of afraid faces. We found no evidence for group differences in accuracy, visual attention to the mouth, or pupil dilation responses. Our findings have implications for understanding the nature of socio-affective dysfunction in sexual offenders., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Psychopathic tendencies are associated with difficulties in affective theory of mind (ToM), that is, in recognizing others affective mental states. In clinical and non-clinical adult samples, it has been shown that where psychopathic tendencies co-occur with schizophrenia spectrum disorders, the impairing effects of psychopathic tendencies on ToM are attenuated. These effects are yet to be examined in adolescents. We examined if the impairing effect of psychopathic tendencies on affective ToM was attenuated with increasing severity of schizotypal personality disorder (PD) in a sample of 80 incarcerated adolescent boys. We showed that the impairing effect of psychopathic tendencies on the recognition of neutral mental states, but not positive or negative mental states, was evident when the relative severity of schizotypal PD was low. However, with higher scores on both measures, we observed better performance in judging neutral mental states. The preservation of affective ToM in adolescents who show elevations in psychopathic tendencies and schizotypal PD may enable them to manipulate and extort their victims for personal gain. Our results emphasize the need to consider comorbidity in clinical case formulation when working with adolescents with conduct problems and psychopathic tendencies. More broadly, our results also suggest that the pattern of social cognitive abilities associated with co-occurring psychopathology does not always conform to an often-theorized double-dose of deficit hypothesis.

Objectives: This study examined the extent to which program site-based and Veteran characteristics were associated with potentially avoidable hospitalizations or other hospitalization of Veterans enrolled in the Veterans Affairs (VA) Home-Based Primary Care (HBPC)., Design: Retrospective claims-based study., Setting and Participants: HBPC programs that responded to a national survey of HBPC programs (n = 189) in fiscal year (FY) 2016 were studied. Veterans in the analysis cohort were identified as having been enrolled in VA-HBPC in FY2016 who had not received care by VA-HBPC within 1 year prior to their first HBPC enrollment in FY2016 (N = 8497)., Methods: Multinomial logistic regression analysis with 5 outcome categories within the 6 months following the first HBPC enrollment date: (1) any potentially avoidable hospitalizations for ambulatory care-sensitive conditions (ACSC) as identified by AHRQ Prevention Quality Indicator (PQI), (2) any other hospitalizations for non-ACSC conditions, (3) died during study period, (4) discharged from HBPC, or (5) remained at home with HBPC. Average marginal effects (AME) of veteran-level and VA-HBPC-level covariates are reported for each of the outcome categories., Results: More frail Veterans and Veterans 85 years old or older were more likely to have potentially preventable ACSC hospitalizations (AME = 5.4%, 1.8%, respectively). Veterans who were younger than 75 years, functionally impaired, bed-bound, or frail were more likely to have non-ACSC hospitalization (AME = 3.0%, 2.2%, 3.5%, and 9.0%, respectively). Veterans with low frailty index scores were less likely to have non-ACSC hospitalizations (AME = -17.1%). Six-month hospitalization patterns were not associated with reported HBPC site characteristics., Conclusions and Implications: Within the framework of the national VA HBPC program, variations in the structural model used at HBPC sites are not significantly associated with hospitalizations. Tailoring of HBPC care, based on individual patient factors and clinical judgment rather than standard protocols, may be central to the success of HBPC in reducing ACSC hospitalizations., (Published by Elsevier Inc.)

Intimate partner violence is predominantly viewed as a social problem of men's violence against women. However, a growing evidence base suggests an equal prevalence rate for male and female perpetrated intimate partner physical aggression. Moreover, female perpetrated intimate partner violence is often assumed to be reactive, yet there is limited evidence to support this notion. In this article, we describe the results of two studies that investigated the prevalence of female perpetrated intimate partner physical aggression, and its correlates in heterosexual female university students. The relationships of personality traits, resting heart rate, and heart rate variability (a correlate of vagal activity) were compared between females who did and did not report having engaged in intimate partner physical aggression. In Study 1, we found that 30.9% of participants reported enacting intimate partner physical aggression during the preceding 12 months. This finding suggests that a considerable number of undergraduate females aggress against their intimate partners. Perpetrators, relative to nonperpetrators, scored higher on secondary psychopathic traits. In Study 2, female intimate partner violence was shown to be associated with low resting heart rate and high heart rate variability. Perpetrators, relative to nonperpetrators, scored higher on psychopathic traits that index emotional resilience and unempathic tendencies, and reported increased proactive and reactive aggression. This raises the possibility that some incidences of female intimate partner physical aggression represent proactive aggressive acts. These findings also support the frequently found association between low resting heart rate and aggression, but raise the prospect that the reported aggressive acts reflect high heart rate variability and strong parasympathetic nervous system activity.

Objective: This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning., Design: A qualitative study design was used in addition to administration of standardized depression and mental status screens., Setting and Participants: Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York., Methods: Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge., Results: Thematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23)., Conclusions and Implications: This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals., (Published by Elsevier Inc.)

Background: The use of sex to cope with negative affective states during the coronavirus disease 2019 (COVID-19) pandemic may be influenced by various sociodemographic and psychological characteristics., Aim: We aimed to examine the effects of social distancing, loneliness, difficulties in emotion regulation, and self-regulation on participants self-reported coping using sex during lockdown in the United Kingdom., Methods: Participants had to be residents of the United Kingdom, aged between 18-60 years, fluent in English, and had to have an Internet connection. They were instructed not to participate if they had consumed alcohol in the previous 24 hours. A total of 789 participants aged 18-59 years completed an online survey. Participants provided self-report measures of social distancing, loneliness, and difficulties in emotion regulation. A Go/No-Go task was used to assess self-regulation., Outcomes: Participants self-reported their use of sex to cope over a 14-day period during lockdown, as well as retrospectively for a 14-day period immediately preceding lockdown. Coping using sex items included consensual and non-consensual themes., Results: Overall, there was no increase in coping using sex during lockdown compared with before lockdown. Findings showed that 30% of participants reported increased coping using sex during lockdown compared with before, 29% reported decreased coping using sex, and 41% reported no change. All regression models included age, gender, ethnicity, diagnosis of psychiatric condition, level of education, being at high-risk for difficulties relating to COVID-19, living alone, and diagnosed or suspected COVID-19 as covariates. Being younger, being male, and greater emotion dysregulation were associated with higher coping using sex total and consent subscale scores during lockdown. Being younger, being male, not living alone, and less adherence to social distancing advice were associated with coping using sex with a theme of rape/violence during lockdown., Clinical Translation: A proportion of participants used sex to cope more often during lockdown compared with before. Less adherence to social distancing advice and emotion dysregulation were associated with using sex to cope during lockdown., Strengths & Limitations: Strengths of this study were the large sample size and inclusion of key sociodemographic characteristics as covariates. The main limitations were the cross-sectional design and a sample that was mostly white, educated, and female., Conclusion: Participants who had difficulty regulating emotions were more likely to use sex to cope. It is important that support is available for people who have problems regulating their emotions during the pandemic and that they have access to appropriate help and advice. Gillespie SM, Jones A, Uzieblo K, et al. Coping Using Sex During the Coronavirus Disease 2019 (COVID-19) Outbreak in the United Kingdom. J Sex Med 2021;18:50-62., (Copyright © 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the rate and clinical factors associated with postoperative nausea and vomiting (PONV) and severe pain after robotic-assisted mitral valve repair., Design: Retrospective chart review., Setting: Major quaternary academic medical center., Participants: Adult patients undergoing robotic-assisted mitral valve repair from May 5, 2018 through September 13, 2019., Interventions: Participant electronic medical records were abstracted for clinical characteristics, PONV within the first 72 postoperative hours, episodes of severe pain (defined as pain score ≥7 using an 11-point numerical pain rating scale), and opioid use within the first 24 postoperative hours. Multivariate analyses were performed., Measurements and Main Results: Of 124 participants, PONV was noted in 83 (67%; 95% confidence interval [CI] 58%-75%) patients and severe pain in 96 (77%, 95% CI 69%-84%) patients. The median (interquartile range) time to PONV was 6.1 (3.7-14.7) hours. After adjusting for age, sex, and duration of surgery, pre-incisional use of methadone was associated with reduced risk for severe pain (odds ratio 0.40 [95% CI 0.16-0.99]; p = 0.048) and a lower 24-postoperative hour opioid requirement (estimate -29.0 mg intravenous morphine equivalents [95% CI -46.7 to -11.3]; p = 0.006). However, methadone was not associated with a reduction of the cumulative opioid dose (intraoperative and 24-hour postoperative opioid dose; p = 0.248). Both severe pain and PONV were associated with longer hospital stay., Conclusion: PONV and severe pain are common after robotic-assisted mitral valve repair. Peri-incisional methadone is associated with a modest decrease in the severe pain rate but without a reduction in opioid dose or hospital stay., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to examine site of death and hospice use, identifying potential disparities among veterans dying in Department of Veterans Affairs (VA) Home Based Primary Care (VA-HBPC)., Methods: Administrative data (2008, 2012, and 2016) were compiled using the VA Residential-History-File which tracks health care service location, daily. Outcomes were site of death [home, nursing home (NH), hospital, inpatient hospice]; and hospice use on the day of death. We compared VA-HBPC rates to rates of 2 decedent benchmarks: VA patients and 5% Traditional Medicare non-veteran males. Potential age, race, urban/rural residence and living alone status disparities in rates among veterans dying in VA-HBPC in 2016 were examined by multinomial logistic regression., Results: In 2016, 7796 veterans died in VA-HBPC of whom 62.1% died at home, 11.8% in NHs, 14.7% in hospitals and 11.4% in inpatient hospice. Hospice was provided to 60.9% of veterans dying at home and 63.9% of veterans dying in NH. Over the 2008-2012-2016 period, rates of VA-HBPC veterans who died at home and rates of home death with hospice increased and were higher than both benchmarks. Among VA-HBPC decedents, younger/older veterans were more/less likely to die at home and less/more likely to die with hospice. Race/ethnicity and urban/rural residence were unrelated to death at home but veterans living alone were less likely to die at home., Conclusions: Results reflect VA-HBPC's primary goal of supporting its veterans at home, including at the end-of-life, surpassing other population benchmarks with some potential disparities remaining.

There has been a longstanding debate about the link between callous-unemotional traits and fearlessness. However, biological evidence for a relationship in adolescents is lacking. Using two adolescent samples, we measured emotional reactivity and cardiac measures of sympathetic (pre-ejection period) and parasympathetic (respiratory sinus arrhythmia) reactivity during 3D TV and virtual reality fear induction. Study 1 included 62 community adolescents from a stratified sample. Study 2 included 60 adolescents from Emotional and Behavioral Difficulties schools. Results were consistent across both studies. Adolescents with high callous-unemotional traits showed coactivation of the sympathetic and parasympathetic nervous system. Consistent with these results, youths with callous-unemotional traits self-reported that they felt more in control after the fear induction. Thus, in both samples, youth with callous-unemotional traits displayed a physiological and emotional profile suggesting they maintained control during fear induction. Therefore, it is proposed here that a shift in thinking of youth with callous-unemotional traits as fearless to youth with callous-unemotional traits are better able to manage fearful situations, may be more appropriate.

The COVID19 crisis has magnified the issues plaguing academic science, but it has also provided the scientific establishment with an unprecedented opportunity to reset. Shoring up the foundation of academic science will require a concerted effort between funding agencies, universities, and the public to rethink how we support scientists, with a special emphasis on early career researchers., Competing Interests: Declaration of Interests Dr. Roberts serves as Editor-in-Chief of books for the American Psychiatric Association Publishing Division and as Editor-in-Chief of the journal Academic Medicine. Unrelated to this publication, Dr. Roberts serves as an advisor for the Bucksbaum Institute of the University of Chicago Pritzker School of Medicine and owns the small business Terra Nova Learning Systems., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and Objectives: Previous studies have shown that staff perception of team effectiveness is related to better health outcomes in various care settings. This study focused on the Veterans Health Administration's Home-Based Primary Care (HBPC) program. We examined variations in HBPC interdisciplinary teamwork (IDT) and identified modifiable team and program characteristics that may influence staff perceptions of team effectiveness., Research Design: We used a broadly validated survey instrument to measure perceived team effectiveness, workplace conditions/resources, group culture, and respondents' characteristics. Surveys were initiated in January and completed in July, 2016., Methods: Team membership rosters (n = 249) included 2,852 IDT members. The final analytical data set included 1,403 surveys (49%) from 221 (89%) teams. A generalized estimating equation model with logit link function, weighted by survey response rates, was used to examine factors associated with perceived team effectiveness., Results: Respondents who served as primary care providers (PCPs) were 8% more likely (p = .0044) to view team's performance as highly effective compared to other team members. Teams with nurse practitioners serving as team leader reported 6% higher likelihood of high-perceived team effectiveness (p = .0234). High team effectiveness was 13% more likely in sites where the predominant culture was characterized as group/developmental, and 7%-8% more likely in sites with lower environmental stress and better resources and staffing, respectively., Conclusions and Implications: Team effectiveness is an important indirect measure of HBPC teams' function. HBPC teams should examine their predominant culture, workplace stress, resources and staffing, and PCP leadership model as part of their quality improvement efforts., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Recent years have witnessed an increase of research on socio-affective factors that can explain individual differences in aggressive tendencies across community and offender populations. Specifically, mindfulness and emotion regulation have emerged as important factors, which could also constitute important prevention and treatment targets. Yet, recent studies have advanced the possibility that mindfulness may also have a "dark" side, being associated with increased levels of aggression-related variables, especially when accounting for the variance associated with emotion regulation. The present study sought to elucidate relationships among mindfulness, emotion regulation, and aggression dimensions (i.e., verbal and physical aggression, anger, and hostility) across violent offender (N = 397) and community (N = 324) samples. Results revealed expected associations between both mindfulness and emotion regulation and aggression dimensions, such that greater impairments in mindfulness and emotion regulation were related to increased levels of aggression across samples. Further, analyses of indirect effects revealed that a latent emotion dysregulation factor accounted for (i.e., mediated) relationships between mindfulness facets and aggression dimensions in both samples. Previously reported positive associations between the residual variance in mindfulness scales (i.e., controlling for emotion regulation) and aggression-related variables were not replicated in the current samples. Taken together, findings suggest that mindfulness and emotion regulation have unequivocal relations with lower levels of aggression, and should therefore be considered as relevant targets for prevention and treatment programs aimed at reducing aggressive tendencies., (© 2019 The Authors. Aggressive Behavior published by Wiley Periodicals, Inc.)

Development of effective targeted cancer therapies is fundamentally limited by our molecular understanding of disease pathogenesis. Diffuse intrinsic pontine glioma (DIPG) is a fatal malignancy of the childhood pons characterized by a unique substitution to methionine in histone H3 at lysine 27 (H3K27M) that results in globally altered epigenetic marks and oncogenic transcription. Through primary DIPG tumor characterization and isogenic oncohistone expression, we show that the same H3K27M mutation displays distinct modes of oncogenic reprogramming and establishes distinct enhancer architecture depending upon both the variant of histone H3 and the cell context in which the mutation occurs. Compared with non-malignant pediatric pontine tissue, we identify and functionally validate both shared and variant-specific pathophysiology. Altogether, we provide a powerful resource of epigenomic data in 25 primary DIPG samples and 5 rare normal pediatric pontine tissue samples, revealing clinically relevant functional distinctions previously unidentified in DIPG., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background/objectives: The US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) Program provides interdisciplinary, long-term primary care for frail, disabled, or chronically ill veterans. This research identifies strategies used by HBPC teams to support veterans in their homes, rather than in institutionalized care., Design: Focus groups and semistructured interviews were conducted with HBPC interdisciplinary team (IDT) members, including program directors, medical directors, and key staff, from September 2017 to March 2018. Field observations were gathered during visits to veterans' homes and IDT meetings., Setting: In-person site visits were conducted at eight HBPC Programs across the United States. Sites varied in location, setting, and primary care model., Participants: A total of 105 HBPC professionals., Measurement: Qualitative thematic content analysis., Results: Four main strategies drive and support the shared mission of IDTs to support veterans at home: fostering frequent communication among IDT members, veterans, caregivers, and outside agencies; development of longitudinal, trusting, reliable relationships within IDTs and with veterans and caregivers; ongoing, consistent education for IDT members and veterans and caregivers; and collaboration within and outside IDTs. Adhering to this mission meant providing timely and efficient care that kept veterans in their homes and minimized the need for acute hospitalizations and nursing home placement., Conclusion: HBPC IDTs studied worked together across disciplines to effectively create a dedicated culture of caring for veterans, caregivers, and themselves, leading to keeping veterans at home. Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes when caring for medically complex, homebound patients within and outside the VA. J Am Geriatr Soc 67:2511-2518, 2019., (© 2019 The American Geriatrics Society.)

Diffuse midline gliomas (DMGs) are universally lethal malignancies occurring chiefly during childhood and involving midline structures of the central nervous system, including thalamus, pons, and spinal cord. These molecularly related cancers are characterized by high prevalence of the histone H3K27M mutation. In search of effective therapeutic options, we examined multiple DMG cultures in sequential quantitative high-throughput screens (HTS) of 2706 approved and investigational drugs. This effort generated 19,936 single-agent dose responses that inspired a series of HTS-enabled drug combination assessments encompassing 9195 drug-drug examinations. Top combinations were validated across patient-derived cell cultures representing the major DMG genotypes. In vivo testing in patient-derived xenograft models validated the combination of the multi-histone deacetylase (HDAC) inhibitor panobinostat and the proteasome inhibitor marizomib as a promising therapeutic approach. Transcriptional and metabolomic surveys revealed substantial alterations to key metabolic processes and the cellular unfolded protein response after treatment with panobinostat and marizomib. Mitigation of drug-induced cytotoxicity and basal mitochondrial respiration with exogenous application of nicotinamide mononucleotide (NMN) or exacerbation of these phenotypes when blocking nicotinamide adenine dinucleotide (NAD + ) production via nicotinamide phosphoribosyltransferase (NAMPT) inhibition demonstrated that metabolic catastrophe drives the combination-induced cytotoxicity. This study provides a comprehensive single-agent and combinatorial drug screen for DMG and identifies concomitant HDAC and proteasome inhibition as a promising therapeutic strategy that underscores underrecognized metabolic vulnerabilities in DMG., (Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

H3K27M mutations resulting in epigenetic dysfunction are frequently observed in diffuse intrinsic pontine glioma (DIPGs), an incurable pediatric cancer. We conduct a CRISPR screen revealing that knockout of KDM1A encoding lysine-specific demethylase 1 (LSD1) sensitizes DIPG cells to histone deacetylase (HDAC) inhibitors. Consistently, Corin, a bifunctional inhibitor of HDACs and LSD1, potently inhibits DIPG growth in vitro and in xenografts. Mechanistically, Corin increases H3K27me3 levels suppressed by H3K27M histones, and simultaneously increases HDAC-targeted H3K27ac and LSD1-targeted H3K4me1 at differentiation-associated genes. Corin treatment induces cell death, cell-cycle arrest, and a cellular differentiation phenotype and drives transcriptional changes correlating with increased survival time in DIPG patients. These data suggest a strategy for treating DIPG by simultaneously inhibiting LSD1 and HDACs., (Copyright © 2019 Elsevier Inc. All rights reserved.)

High-grade gliomas are lethal brain cancers whose progression is robustly regulated by neuronal activity. Activity-regulated release of growth factors promotes glioma growth, but this alone is insufficient to explain the effect that neuronal activity exerts on glioma progression. Here we show that neuron and glioma interactions include electrochemical communication through bona fide AMPA receptor-dependent neuron-glioma synapses. Neuronal activity also evokes non-synaptic activity-dependent potassium currents that are amplified by gap junction-mediated tumour interconnections, forming an electrically coupled network. Depolarization of glioma membranes assessed by in vivo optogenetics promotes proliferation, whereas pharmacologically or genetically blocking electrochemical signalling inhibits the growth of glioma xenografts and extends mouse survival. Emphasizing the positive feedback mechanisms by which gliomas increase neuronal excitability and thus activity-regulated glioma growth, human intraoperative electrocorticography demonstrates increased cortical excitability in the glioma-infiltrated brain. Together, these findings indicate that synaptic and electrical integration into neural circuits promotes glioma progression.

Objectives: To describe the structural characteristics and challenges associated with home telehealth (HT) use in the US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program., Design: We designed a national survey to collect information about HBPC program structural characteristics. The survey included eight organizational and service domains, one of which was HT. HBPC program directors were surveyed online using REDCap., Participants: We received 232 surveys from 394 HBPC sites (59% response rate)., Methods: HBPC structural domains were compared between sites using and not using HT technology. Open-ended responses were analyzed using content analysis., Results: A total of 127 sites (76%) used HT, which was more likely when HBPC sites were aligned organizationally with the VA's Geriatrics and Extended Care Services division, when there were more disciplines on the HBPC team, and when primary care providers made home visits. Program directors overwhelmingly viewed HT as contributing to managing veterans' complex chronic conditions (81%), yet HT data were not readily integrated into care planning (24%). Challenges to HT use included veterans' acceptance and adherence, device issues, and collaboration between HBPC teams and HT staff., Conclusion: Corresponding to HBPC's complexity, HT use is primarily a self-organizing process that shapes the patterns of integration at each site. Although HT technology is compatible with core structures of the HBPC model, usability varies, and overall is low. To optimize HT use in HBPC, there are opportunities to redesign systems to mitigate challenges to adoption. As the Centers for Medicare and Medicaid Services' strives to increase access to both HBPC and telehealth benefits, evidenced by the continuation of its successful Independence at Home demonstration and the final changes in the proposed rule in April 2019 incorporating additional telehealth benefits for beneficiaries, this information will be relevant to VA and non-VA alike. J Am Geriatr Soc 67:1928-1933, 2019., (© 2019 The American Geriatrics Society.)

Objective: The objective of this retrospective review was to evaluate the perioperative and procedural management of patients with pulmonary alveolar proteinosis (PAP) who presented for whole-lung lavage (WLL)., Design: The records of all adult patients with PAP who underwent WLL between January 1, 1988 and August 20, 2017 were reviewed and pertinent demographic, preoperative, anesthetic, procedural, and postoperative data were recorded., Setting: Large academic tertiary referral center., Participants: Forty patients with PAP underwent 79 WLL procedures., Interventions: Patients with PAP undergoing WLL., Measurements: Successful WLL, defined by visual clearing of lavage fluid, was completed in 91% of cases. Whole-lung lavage was terminated prematurely in 9% of cases (refractory hypoxia most common), while 8% of cases were found to have 30-day complications. There were no cases of intraoperative death, hemodynamic collapse, pneumothorax or hydrothorax, or need for emergent reintubation. Postoperative clinical follow-up at the authors' institution within 6 months of WLL showed 68% of patients reported improvement in symptoms and/or functional status., Conclusion: The authors here present a retrospective study describing the perioperative and procedural management of PAP patients undergoing WLL to help familiarize providers with the management of this population (Fig 1). The findings of this study outline a successful and consistent approach to WLL using a multidisciplinary team experienced in this procedure. Even in experienced hands, procedural complications and 30-day postoperative complications emphasize the risk in this complex patient population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Psychopathy is characteristically associated with impairments in recognizing others' facial expressions of emotion, and there is some evidence that these difficulties are specific to the callousness features of the disorder. However, it remains unclear whether these difficulties are accompanied by reductions in autonomic reactivity when viewing others' emotional expressions, and whether these impairments are particular to expressions showing another's distress or are more pervasive across different emotional expressions. In this study, 73 adult male prisoners with histories of serious sexual or violent offenses-who ranged across the psychopathy continuum-completed a facial emotion recognition task. For the first time in a convicted offender sample, we used pupillometry techniques to measure changes in the pupil dilation response, a measure of sympathetic autonomic arousal to affective stimuli. We found that the callousness features of psychopathy were related to impaired recognition of fearful faces. Strikingly, we also showed that increasing callousness was associated with a reduction in the pupil dilation response and that this was pervasive across different emotional expressions. Our results highlight a potential role of the locus coeruleus-noradrenaline system in the pathophysiology of psychopathy and demonstrate the potential of the pupillary response as a technique for understanding attention-emotion interactions in psychopathy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives: Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. We evaluated the effect of a high-intensity telemedicine program that delivers care for acute illnesses on ED use rates for individuals with dementia who reside in senior living communities (SLCs; independent and assisted living)., Design: We performed a secondary analysis of data for patients with dementia from a prospective cohort study over 3.5 years that evaluated the effectiveness of high-intensity telemedicine for acute illnesses among SLC residents., Setting and Participants: We studied patients cared for by a primary care geriatrics practice at 22 SLCs in a northeastern city. Six SLCs were selected as intervention facilities and had access to patient-to-provider high-intensity telemedicine services to diagnose and treat illnesses. Patients at the remaining 15 SLCs served as controls. Participants were considered to have dementia if they had a diagnosis of dementia on their medical record problem list, were receiving medications for the indication of dementia, or had cognitive testing consistent with dementia., Measures: We compared the rate of ED use among participants with dementia and access to high-intensity telemedicine services to control participants with dementia but without access to services., Results: Intervention group participants had 201 telemedicine visits. In participants with dementia, it is estimated that 1 year of access to telemedicine services is associated with a 24% decrease in ED visits (rate ratio 0.76, 95% confidence interval 0.61, 0.96)., Conclusions/implications: Telemedicine in SLCs can effectively decrease ED use by individuals with dementia, but further research is needed to confirm this secondary analysis and to understand how to best implement and optimize telemedicine for patients with dementia suffering from acute illnesses., (Published by Elsevier Inc.)

Studies have highlighted differences in the victim choice, offender, and offense characteristics of female and male sexual offenders. However, little is known about how solo and co-offending females differ from solo male sexual offenders. We compared the characteristics of 20 solo and 20 co-offending females (co-offended with a male and/or female accomplice), and 40 male sexual offenders against children. We found that solo female offenders showed the most evidence of personal problems, including depression and sexual dissatisfaction. Compared with male offenders, female co-offenders showed poorer self-management, but better sexual self-regulation. Male offenders had a greater history of offending and showed more evidence of sexual abuse supportive cognitions relative to both solo and co-offending females. These results are consistent with the need for a gender-specific approach to working with sexual offenders and may have implications for understanding the often complex treatment needs of these clients.

Objectives: This document offers guidance to clinicians and facilities on the use of telemedicine to deliver medically necessary evaluation and management of change of condition for nursing home residents., Settings and Participants: Members of the telemedicine workgroup of AMDA-The Society for Post-Acute Long-Term Medicine-developed this guideline through both telephonic and face-to-face meetings between April 2017 and September 2018. The guideline is based on the currently available research, experience, and expertise of the workgroup's members, including a summary of a recently completed systematic mixed studies literature review to determine evidence for telemedicine to reduce emergency department visits or hospitalizations of nursing home residents., Results: Research and experience to date support the use of telemedicine as a tool in change of condition assessment and management as a means of reducing unnecessary emergency department visits and hospitalization. Telemedicine-delivered care should be integrated into the primary care of the resident and delivered by providers with competency in post-acute long-term care. The development and sustainability of telemedicine programs is heavily dependent on financial implications. Quality measures should be defined for telemedicine programs in nursing homes., Conclusions/implications: Telemedicine programs in nursing homes can contribute to the delivery of timely, high quality medical care, which reduces unnecessary hospitalization. Reimbursement for telemedicine-driven care should be based upon medical necessity of visits to care and the maintenance of quality standards. More studies are needed to understand which telemedicine tools and processes are most effective in improving outcomes for nursing home residents., (Published by Elsevier Inc.)

Objectives: This qualitative study describes the structure and processes of providing care to U.S. Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) enrollees with mental health care needs; explains the role of the HBPC psychologist; and describes how mental health treatment is integrated into care from the perspective of HBPC team members., Design: HBPC programs were selected for in-person site visits based on initial surveys and low hospitalization rates., Setting: Programs varied in setting, geographic locations, and primary care model., Participants: Eight site visits were completed. During visits, key informants including HBPC program directors, medical directors, team members, and other key staff involved with the HBPC program participated in semi-structured individual and group interviews., Measurements: Recorded interviews, focus groups, and field observation notes., Results: Qualitative thematic content analysis revealed four themes: 1) HBPC Veterans have not only complex physical needs but also co-occurring mental health needs; 2) the multi-faceted role of psychologists on HBPC teams, that includes providing care for Veterans and support for colleagues; 3) collaboration between medical and mental health providers as a means of caring for HBPC Veterans with mental health needs; and 4) gaps in providing mental health care on HBPC teams, primarily related to a lack of team psychiatrists and/or need for specialized medication management for psychiatric illness., Conclusions: Mental health providers are essential to HBPC teams. Given the significant mental health care needs of HBPC enrollees and the roles of HBPC mental health providers, HBPC teams should integrate both psychologists and consulting psychiatrists., (Copyright © 2018. Published by Elsevier Inc.)