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Purpose: Autoimmune polyendocrine syndrome type I (APS-1) is a devastating autoimmune disease characterised by mutations in the AIRE gene. Because of failure of negative selection, these patients produce autoreactive B and T cells against affected tissues, which lead to a range of autoimmune manifestations. The rarity of APS-1 and inaccessibility of thymic tissue have limited immunological studies. We here hypothesized that lack of AIRE expression in thymus affect immune cells in blood. Methods: Whole blood microarray analysis (N=16 APS-I patients vs 16 controls) and qPCR of molecules in affected pathways. Single cell sequencing of naïve B cells and flow cytometry analysis of a B cell panel in PBMCs to investigate properties of B cells in APS-I patients compared to age and sex matched healthy controls. Results: We here show significant downregulation of B cell and IFN-I responses in APS-I patients compared to healthy donors in microarray and system biology deconvolution experiments. Single B cell transcriptomics support downregulation of several of the same molecules including CD74, CD40 and CD79A. Flow cytometry protein experiments revealed an imbalance of plasma (higher) vs transitional B cells (lower) in APS-I patients, followed up by a lower level of CD79b within transitional B cells in patients, but a non-consistent higher level of CD74 within this subset. Conclusion: We found disturbances in blood immune cell subsets from APS-I patients. Harmonious lower blood cell levels of the B-cell associated CD79A/B were found compared to healthy controls, but further studies are needed to verify the consistency of our findings.

ObjectiveThis study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population.MethodsTwo cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression.ResultsThe DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety.Significance of resultsThe DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.

Background A diagnosis of cancer may increase mortality salience and provoke death-related distress. Primary brain tumor (PBT) patients may be at particular risk for such distress given the certainty of tumor progression, lack of curative treatments, and poor survival rates. This study is the first to examine the prevalence of death-related distress and its correlates in PBT patients. Methods Adult PBT patients (N = 105) enrolled in this cross-sectional study and completed the Death Distress Scale (subscales: Death Depression, Death Anxiety, Death Obsession), Generalized Anxiety Disorder–7, and Patient Health Questionnaire–9. Prevalence and predictors of death-related distress, and the relationships of demographic variables to clusters of distress, were explored. Results The majority of PBT patients endorsed clinically significant death-related distress in at least one domain. Death anxiety was endorsed by 81%, death depression by 12.5%, and death obsession by 10.5%. Generalized anxiety was the only factor associated with global death-related distress. Cluster analysis yielded 4 profiles: global distress, emotional distress, resilience, and existential distress. Participants in the resilience cluster were significantly further out from diagnosis than those in the existential distress cluster. There were no differences in cluster membership based on age, sex, or tumor grade. Conclusions PBT patients appear to have a high prevalence of death-related distress, particularly death anxiety. Further, 4 distinct profiles of distress were identified, supporting the need for tailored approaches to addressing death-related distress. A shift in clusters of distress based on time since diagnosis also suggest the need for future longitudinal assessment.

This article investigates whether residents of central Wisconsin perceive language variation within their state and, if they do, what it looks like according to them. To achieve these aims, this study examines the perspectives of one central Wisconsin community regarding internal language differentiation within the state. It follows the perceptual dialectology paradigm, based on work by Dennis Preston, in that it studies how nonlinguists view language variation within Wisconsin. Respondents completed Preston’s draw-a-map task, which additionally asked them to label each indicated area. The drawn boundaries were digitalized using ArcGIS to create composite maps to allow for systematic comparison. The labels provided by the respondents were analyzed to see how this group of Wisconsin residents views the speech of each identified region and thus to see whether there are distinctly enregistered dialects within Wisconsin for these respondents. Findings show three distinctly perceived areas within the state: the Milwaukee area, the north of the state, and the participants’ own area, central Wisconsin. The analysis of the labels indicates that an urban-rural divide is at play for perception of the first two mentioned areas, whereas perceptioin of the latter identified area reflects the belief in a regionally located standard variety.

Developing tools for attack identification in large-scale networked control systems is a research area of increasing significance for the secure and reliable operation of autonomous control systems. Due to scalability limits and privacy issues of individual subsystems, attack identification methods should not rely on global model knowledge. We address systems of interconnected nonlinear subsystems with coupled dynamics or constraints in a distributed control setup. The local controllers share information about the coupling variables of the subsystems and are designed to be robust towards attacks and uncertain influences through neighboring subsystems. We present a scalable hierarchical attack identification method which monitors the evolution of the coupling variables after an attack occurred in some unknown subsystem. Based on the mutual exchange of local sensitivity information among the subsystems, the propagation of the attack through the network is approximated. The propagation equations are used to formulate a quadratic program whose solution determines the attack signal that explains the observed network evolution best. The developed approach is applied to the IEEE 30 bus system to illustrate attack identification in power systems with faulty buses.

The Mini-Mental Status Examination (MMSE) is routinely used in neuro-oncology clinics to rule out cognitive impairment. However, the MMSE is known to have poor sensitivity to mild cognitive impairment, raising concern regarding its continued use. More comprehensive cognitive screeners are available, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and may be better able to assess for cognitive dysfunction.This retrospective cross-sectional study compared the relative rates of impairment using the MMSE-2 and RBANS in a sample of neuro-oncology patients (N = 81). A preliminary analysis of the sensitivity and specificity of the MMSE-2 to the level of cognitive impairment identified on the RBANS was conducted; in addition, we examined whether an adjustment of the MMSE-2 cut-off score improved consensus with a positive screening on the RBANS.The MMSE-2 failed to identify over half of the patients with cognitive dysfunction that were identified on the RBANS. Further analysis showed limited sensitivity of the MMSE-2 to the level of impairment detected on the RBANS, and an adjustment of the cut-off score did not improve the sensitivity or specificity of the MMSE-2.These results provide caution for neuro-oncology clinics using the MMSE. If providers continue to rely on the MMSE to screen for cognitive impairment alone, they may fail to identify individuals with mild cognitive impairments.

INTRODUCTION A brain tumor diagnosis brings about emotional distress, including significant fear of cancer recurrence (FCR). Three evidence-based interventions that target FCR exist, but all excluded patients with brain tumors (PwBT) from their efficacy trials. Preliminary evidence suggests that FCR may be categorically different in PwBT compared to other cancer populations, thereby necessitating tailored intervention development. For these reasons, we convened a neuro-oncology Expert Advisory Board (EAB) to assist in the creation of a psychotherapeutic intervention targeting FCR in PwBT. METHODS The EAB included neuro-oncology professionals, patients, and caregivers (N=7). To facilitate open dialogue, the patients and caregivers (n=3) met separately from the professionals (n=4). The EAB met virtually over five consecutive weeks to discuss three evidence-based FCR manuals, identify topic applicability, determine medical relevance, and discuss necessary adaptations to meet the specific needs of PwBT. Readings were provided in advance, two moderators (ARL & SEB) led group discussions, and all sessions were recorded following consent. RESULTS The EAB determined the content contained in the three FCR intervention required tailoring to meet the distinct needs of PwBT. Hypervigilance patterns were determined to be unique for PwBT (e.g., headache, fatigue, word-finding, auras). Language surrounding uncertainty of progression and inclusion of healthcare providers in therapy were less relevant in PwBT. Strategies and skills to enhance acceptance of existential themes were spotlighted. Mindfulness practices were requested. Results called for a blend of three therapeutic orientations: cognitive behavioral therapy, existential therapy, and mindfulness-based therapy. Professionals promoted group intervention delivery, whereas patients and caregivers promoted individual or dyadic sessions. Caregiver participation was unanimously supported. CONCLUSION The development of a psychotherapeutic intervention targeting FCR in PwBT offers a distinct opportunity for interdisciplinary and community collaboration. Results from the EAB were overwhelmingly informative, and recommendations will be incorporated into the newly developed FCR intervention for PwBT: FearLess.

BACKGROUND: CogMed Working Memory Training (CWMT) is a computer-based program shown to improve working memory (WM) among those with cognitive impairments. No study to date has investigated its feasibility, acceptability, and satisfaction in adult patients with glioma, despite the well-documented incidence of WM impairment in this population. METHODS: Twenty patients with glioma and objective and/or perceived WM deficits enrolled in the study: 52% high-grade, 60% female, Mage = 47 (range = 21–72 years). Adverse events were monitored to determine safety. Feasibility and acceptability were assessed based on established metrics. Satisfaction was explored by exit-interviews. Neurocognitive tests and psychological symptoms were analyzed at baseline and post-CWMT to estimate effect sizes. RESULTS: Of 20 enrolled patients, 16 completed the intervention (80% retention rate). Reasons for withdrawal included time burden (n = 2); tumor-related fatigue (n = 1) or loss to follow-up (n = 1). No adverse events were determined to be study-related. Adherence was 69% with reasons for nonadherence similar to those for study withdrawal. The perceived degree of benefit was only moderate. Baseline to post-CWMT assessments showed medium to large effects on neurocognitive tasks. Psychological symptoms remained stable throughout the study period. CONCLUSIONS: CWMT was found to be safe and acceptable in adult patients with glioma. Enrollment, retention rates, and treatment adherence were all adequate and comparable to studies recruiting similar populations. Only moderate perceived benefit was reported despite demonstrated improvements in objectively-assessed WM. This may indicate that the time commitment and intervention intensity (5 weeks of 50-min training sessions on 5 days/week) outweighed the perceived benefits of the program. (Trial Registration Number: NCT03323450 registered on 10/27/2017).

Autoimmune polyendocrine syndrome type 1 (APS-1) is a rare but severe monogenetic autoimmune endocrine disease caused by failure of the Autoimmune Regulator (AIRE). AIRE regulates the negative selection of T cells in the thymus, and the main pathogenic mechanisms are believed to be T cell-mediated, but little is known about the role of B cells. Here, we give an overview of the role of B cells in thymic and peripheral tolerance in APS-1 patients and different AIRE-deficient mouse models. We also look closely into which autoantibodies have been described for this disorder, and their implications. Based on what is known about B cell therapy in other autoimmune disorders, we outline the potential of B cell therapies in APS-1 and highlight the unresolved research questions to be answered.

Objective The present study investigated demographic differences in performance validity test (PVT) failure in a Veteran sample. Method Data were extracted from clinical neuropsychological evaluations. Only veterans who identified as men, as either European American/White (EA) or African American/Black (AA) were included (n = 1261). We investigated whether performance on two frequently used PVTs, the Test of Memory Malingering (TOMM), and the Medical Symptom Validity Test (MSVT), differed by age, education, and race using separate logistic regressions. Results Veterans with younger age, less education, and Veterans Affairs (VA) service-connected disability were significantly more likely to fail both PVTs. Race was not a significant predictor of MSVT failure, but AA patients were significantly more likely than EA patients to fail the TOMM. For all significant demographic predictors in the models, effects were small. In a subsample of patients who were given both PVTs (n = 461), the effects of race on performance remained. Conclusions Performance on the TOMM and MSVT differed by age and level of education. Performance on the TOMM differed between EA and AA patients, whereas performance on the MSVT did not. These results suggest that demographic factors may play a small but measurable role in performance on specific PVTs.

Background The COVID-19 pandemic induced rapid adoption of telemedicine services for neuro-oncology patients at an increased risk of infection. Neuropsychological assessment is important to neuro-oncology care yet challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored in limited populations and proven feasible and reliable. Conducting TNP visits directly to patients’ home (DTH) had minimal prior study. Methods We used two voluntary surveys to examine acceptance (patients) and feasibility (providers) of DTH-TNP at two regionally diverse medical institutions providing neuropsychological services to neuro-oncology patients from April to September 2020. Results A total of 119 patients were scheduled during the study period, 79 of whom completed neuropsychological testing via DTH-TNP. Neuropsychology providers completed surveys on 68 of these encounters (86%). In 98% of cases, neuropsychologists were able to achieve or partially achieve the individually defined goals of their assessment. Common problems reported included patient dysregulation (16%) and slow/unreliable internet (15%). Of the 52 patients who responded, 98% were satisfied with the DTH-TNP experience, and 92% would recommend the virtual visit to others. All respondents felt understood by the examiner (100%) and the majority denied technical difficulties (90%), communication challenges (94%), or privacy concerns (98%). Patients reported reduced risk of infection and saved travel time as favorable aspects of DTH-TNP. Conclusions These preliminary results suggest neuro-oncology patients find DTH-TNP acceptable and neuropsychologists find it a feasible practice, while also recognizing its limitations. Results suggest that further study of DTH-TNP (eg, reliability, validity) for neuro-oncology patients is warranted.

Background Neurocognitive assessments have become integral to comprehensive neuro-oncology care. Existing screening tools may be insensitive to cognitive changes caused by medical treatments. Research supports the clinical value and psychometric properties of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in various medical populations; however, there is minimal evidence for its use in neuro-oncology. The purpose of the current study was to further explore the cognitive profile of patients with primary brain tumor (PBT) using the RBANS and to assess rates of below-expectation performance compared to normative data and estimated intellectual functioning. Methods Data were collected on 82 PBT patients (54% male; age range, 19-81 years). All patients were administered the RBANS-Update and the Advanced Clinical Solutions–Test of Premorbid Functioning (TOPF) according to standardized instructions. Cognitive strengths and weaknesses were identified for PBT patients. Descriptive analyses, t tests, and chi-squared tests were utilized to identify and compare cognitive profiles. Results Overall, cognitive performance was low average for PBT patients. When compared to standardization data, PBT patients performed significantly worse across all 5 RBANS indexes, with Attention and Memory showing the largest discrepancies. Estimated intelligence analyses reflected greater deficits in cognitive functioning than when compared to a normal distribution. Conclusions Preliminary research demonstrates the RBANS is an efficient screening tool to assess cognitive deficits in PBT patients. Data also support the importance of comparison to self, rather than normative distribution in ensuring proper identification and classification of patients.

Primary brain tumor (PBT) patients may experience existential distress; however, few studies have examined this issue. The objectives of this study were to (1) systematically review PBT representation in psycho-oncology literature regarding fear/anxiety related to progression, recurrence, and death and (2) preliminarily assess the prevalence of fear of dying in a sample of PBT patients. Systematic searching of three databases yielded 1555 articles for review. Of these, 327 studies met inclusion criteria (patient sample N = 132,951). Only eight studies (0.18% of the participants) included patients with a PBT diagnosis, potentially due to exclusion criteria such as cognitive impairment or specific treatment parameters which may prohibit PBT patient participation. Review of the results from the eight included studies revealed mixed methods and limited demographic analyses; existential distress was correlated with heightened depression and anxiety, and overall worsened quality of life. From the original data collection, approximately one-third of PBT patients endorsed fear of dying, which was positively related to depression severity. Taken together, results suggest that PBT patients are considerably underrepresented in existential psycho-oncology literature, despite preliminary findings suggesting prevalence of these concerns. Future research on existential distress in neuro-oncology is warranted.

Objective Fear of cancer recurrence (FCR) is related to psychological distress and poor quality of life in cancer patients and their caregivers. However, no studies have investigated FCR in neuro-oncology. Given the varied prognosis, treatment, and disease trajectory of brain cancer, FCR may affect patients and their caregivers differently. Methods Eighty adult primary brain tumor (PBT) patients and 52 caregivers completed questionnaires assessing FCR and psychological distress (depressive symptoms, generalized anxiety, and death anxiety). Differences in patient and caregiver FCR by demographic and medical characteristics were examined. Using multilevel modeling, the Actor-Partner Interdependence Model (APIM) was used to investigate the interrelationship between patient and caregiver FCR with demographics and psychological distress measures. Results Caregivers reported significantly higher FCR than patients. There were no effects of demographic or medical characteristics on patient FCR. Time since diagnosis was negatively related to caregiver FCR. All measures of psychological distress exerted a significant actor effect on FCR among both patients and caregivers. Two partner effects were found: caregiver depressive symptoms and death anxiety negatively predicted patients' FCR. Conclusions This is the first investigation of FCR in PBT patients and their caregivers. Most demographic and medical characteristics were not related to patient or caregiver FCR. Caregiver FCR may be higher at the time of diagnosis and decrease over time. APIMs revealed actor effects on patient and caregiver FCR for all measures of psychological distress. Results demonstrated the dyadic effects of a brain tumor diagnosis, emphasizing the need to include caregivers in psychotherapy for neuro-oncology patients.

As demonstrated in the previous chapter, the interviewees mentioned a few different phonetic items that they thought to be salient features of a Wisconsin English variety. The ones that were most frequently named were TRAP raising, GOAT monophthongization as well as MOUTH raising. This chapter follows perceptual dialectologists’ call to let “nonlinguists guide research into the actual patterns of variation in speech” by examining how these three features pattern linguistically as well as socially in Marathon County.

This chapter lays out the perceptual dialectology aspect of the analysis, thus discussing all overt language related perceptions interviewees voiced. Particularly, the draw-a-map task data will be discussed and contextualized with qualitative interview data which provides a more thorough insight into respondents’ perceptions and attitudes than the draw-a-map data alone.

This chapter elaborates on general trends relating to the local culture and attitudes, including different perceived cultural regions within the county and the Midwest, ancestral heritage, as well as stereotypes relating to (central) Wisconsinites themselves. A description of these themes is included not only to get a sense of the place and its people, but also because culture and language are inseparably interconnected and these aspects will, thus, reemerge repeatedly throughout this book.

BACKGROUND Posttraumatic Growth (PTG) refers to the positive psychological change following a trauma and may include a heightened appreciation for life, greater value in meaningful relationships, and/ or spiritual development. A brain cancer diagnosis may be experienced as a traumatic event given the high risk of tumor progression, lack of curative treatments, and ultimately unexpected disheartening prognosis; however, there is limited research on PTG in neuro-oncology. The aim of this study was to determine the profile of PTG in patients diagnosed with primary brain tumors (PBTs). METHODS Patients with PBTs (N = 53, Mage = 48.17, 52.8% male) completed the Post Traumatic Growth Inventory (PTGI) during routine neuro-oncology clinic visits. Descriptive statistics and frequencies for the five factors of the PTGI and PTGI total were calculated. RESULTS PTG was evident across all domains with the most growth reported in appreciation for life and the least growth in new possibilities. Most patients endorsed low levels of growth across the five factors; 29-49% of patients endorse moderate-to-high severity in at least one PTG domain. Lastly, the average total score (M = 46.10) of this sample met the established cutoff for moderate-to-high PTG (> 46). CONCLUSIONS The results suggest that patients with PBTs may perceive positive psychological growth following the traumatic event of a brain tumor diagnosis. Specifically, patients may experience a greater appreciation for life but relatively less growth in new possibilities, perhaps due to the poor prognosis of many PBTs. In non-CNS cancer populations, patients with higher PTG reported better quality of life and lower distress. Further research to expand our knowledge of PTG and the associated factors, including the demographic, medical, and psychological correlates, will better equip providers to promote positive change in PBT patients.

Many autonomous control systems are frequently exposed to attacks, so methods for attack identification are crucial for a safe operation. To preserve the privacy of the subsystems and achieve scalability in large-scale systems, identification algorithms should not require global model knowledge. We analyze a previously presented method for hierarchical attack identification, that is embedded in a distributed control setup for systems of systems with coupled nonlinear dynamics. It is based on the exchange of local sensitivity information and ideas from sparse signal recovery. In this paper, we prove sufficient conditions under which the method is guaranteed to identify all components affected by some unknown attack. Even though a general class of nonlinear dynamic systems is considered, our rigorous theoretical guarantees are applicable to practically relevant examples, which is underlined by numerical experiments with the IEEE~30 bus power system., in Proc. of the 2020 Conference on Decision and Control

ZusammenfassungPrimäre Kopfschmerzerkrankungen wie Spannungskopfschmerzen und Migräne beginnen in der Kindheit und werden mit der Einschulung und Pubertät häufiger. Bei Spannungskopf-schmerzen spielt die zentrale Schmerzsensibilisierung und Aktivierung zentraler nozizeptiver Neurone eine wichtige Rolle. Die Migräne ist eine primäre Erkrankung des Gehirns mit Auffälligkeiten schmerzmodulierender Systeme und der kortikalen Reizverarbeitung. Bei beiden Kopfschmerzformen spielen bio-psycho-soziale Faktoren eine entscheidende Rolle. Sekundäre Kopfschmerzen durch eine entzündliche oder strukturelle hirnorganische Ursache sind selten. Die Diagnose erfolgt anhand der Anamnese und der körperlichen Untersuchung sowie apparativer Untersuchungen bei Auffälligkeiten. Bei Spannungskopfschmerzen steht die multimodale Schmerztherapie im Vordergrund, bei Migräne die medikamentöse Therapie der Attacken und bei sekundären Kopfschmerzen die Behandlung der Grunderkrankung. Behandlungsziele sind die Minderung der Schmerzwahrnehmung, Förderung von Kontroll- und Selbstwirksamkeitserfahrungen, die Steigerung der körperlichen Leistungsfähigkeit sowie die Wiederaufnahme normaler Alltagsstrukturen und sozialer Kontakte als Voraussetzung für eine zunehmende Schmerzminderung.

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.

BACKGROUND Patients with high-grade glioma report substantial psychological distress, yet are frequently excluded from psycho-oncology research. Managing Cancer and Living Meaningfully (CALM) is an expressive-supportive psychotherapy designed to address the inevitable challenges that patients with advanced cancer face. CALM was shown in a large randomized controlled trial to reduce depression and death-related distress, but brain cancer was an exclusion criterion. METHODS In this ongoing ORBIT Model Phase Ib Refine trial, 10 adults with high-grade glioma and heightened distress (PHQ/DADDS) participated in CALM. Feasibility and acceptability were assessed based on established metrics, satisfaction was explored by surveys and exit-interviews, and preliminary efficacy of reducing distress was analyzed by pre to post-CALM paired t-tests; effect sizes estimated using Cohen’s d. RESULTS Of 11 patients referred and screened, 10 enrolled in the study (91% enrollment rate; 70% GBM; 70% female; M age =55yrs). Reasons for withdrawal was disinterest in intervention topics (n=2). Eight patients completed baseline assessments and at least one CALM session. To date, seven have completed treatment. Retention is 63%, with one participant still in active treatment. No adverse events were determined to be study-related. Perceived benefit was high (4.8/5), and all participants reported they would recommend program to others. Pre- to post-CALM analyses show medium-to-large effects on reducing depression (d=1.2), anxiety (d=.74), and death-related distress (d=.54). Small effects were seen for quality-of-life improvement (d=.26). Fear of cancer recurrence worsened (d=.75). CONCLUSIONS Preliminary data suggests that CALM is both feasible and acceptable in adult patients with high-grade glioma. Enrollment and retention rates were adequate. Patients reported high benefit and recommendation to others. Depression, generalized anxiety, and death-related distress all improved with medium-to-large effects, suggesting CALM may be a promising intervention for high-grade glioma patients as they navigate the challenges of brain cancer. Adjunctive treatment may be necessary to address fear of cancer recurrence.

BACKGROUND CogMed Working Memory Training (CWMT) is a computer-based program shown to improve working memory (WM) among those with cognitive impairment. No study to date has investigated its feasibility, acceptability, and satisfaction in adult patients with glioma, despite the well-documented incidence of WM impairment in this population. METHODS Twenty patients with glioma and objective and/or perceived WM deficits enrolled in the study: 52% high-grade, 57% female, Mage=47 (range=21-72 years). Adverse events were monitored to determine safety. Feasibility and acceptability were assessed based on established metrics. Satisfaction was explored by exit-interviews. Neurocognitive tests and measures of psychological distress were administered pre-/post-CWMT to assess preliminary efficacy. RESULTS Of 20 enrolled patients, 16 completed the study protocol (80% retention rate). Reasons for withdrawal included time burden (n=2); tumor-related fatigue (n=1) or lost to follow-up (n=1). No adverse events were determined to be study-related. Adherence was 69%. The perceived degree of benefit was only moderate. Pre- to post-CWMT assessments showed medium to large effects on near-transfer tasks (h p 2 =.35, p=.01 and h p 2 =.25, p=.04) and far-transfer tasks (h p 2 =.20, p=.07 and h p 2 =.16, p=.12) but small to no effects on perceived WM (h p 2 =.01, p=.79) and psychological distress (h p 2 =.01-.06, p=.35-.79). CONCLUSION CWMT was found to be safe and acceptable in adult patients with glioma. Enrollment, retention rates, and treatment adherence were all adequate, yet only moderate perceived benefit was reported. Given that objective measures of WM improved but psychological distress did not, it may be worth considering a less burdensome CWMT protocol, perhaps investigating a less time intensive intervention with respect to both frequency and length of training sessions.

Key Points Question Does a psychosocial aftercare program (PAC) after in-hospital intensive interdisciplinary pain treatment (IIPT) for pediatric patients with chronic pain improve functional outcomes? Findings In this randomized clinical trial including 419 patients aged 8 to 17 years randomized and 222 patients analyzed at 6 months, PAC significantly improved all pain-related as well as emotional outcome parameters compared with treatment as usual. Meaning These findings suggest PAC should be considered in IIPT for pediatric chronic pain and its effectiveness tested in other pediatric psychosomatic conditions., This randomized clinical trial evaluates the effectiveness of a psychosocial aftercare program for pediatric patients with severe chronic pain vs usual care after discharge from intensive interdisciplinary pain treatment., Importance Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients. Objective To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. Design, Setting, and Participants This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. Interventions Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. Main Outcomes and Measures The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. Results A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = −8.84; P

Sarah E Braun,1 Stephen M Auerbach,1 Bruce Rybarczyk,1 Bennett Lee,2 Stephanie Call2 1Department of Psychology, School of Humanities and Sciences, VirginiaCommonwealth University, Richmond, VA, USA; 2Department of Internal Medicine, Division of General Medicine, Virginia Commonwealth University, Richmond, VA, USA Purpose: Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents.Methods: Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory.Results: Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the “acting with awareness” facet of dispositional mindfulness significantly predicted meeting burnout criteria χ2(5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the “system-based practices” and “professionalism” domains and negative effects on a milestone from the “patient care” domain.Conclusion: Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed. Keywords: burnout, mindfulness, internal medicine residents, performance evaluations

Background Health-care professional (HCP) students experience high levels of burnout, characterized by work- and school-related stress. Burnout is associated with a host of negative psychological and health outcomes. It may also contribute to cognitive dysfunction and decreased work productivity and may be related to trait mindfulness. This study cross-sectionally explored psychological distress and its correlates in a sample of interdisciplinary HCP students using cluster analysis. Method Fifty-seven interdisciplinary HCP students completed validated measures of burnout, depressive and anxiety symptoms, perceived stress, and rumination, which were entered into a cluster analysis. A neuropsychological test measured executive function; validated questionnaires assessed work productivity and trait mindfulness. Relationships between cluster membership and classroom productivity, executive function, and trait mindfulness were investigated. Results Burnout, depressive symptoms, and perceived stress were reported at high rates in this sample. The cluster analysis yielded 4 clusters, categorized as follows: Healthy, Ruminative Healthy, Moderate Distress, and High Distress. Cluster membership significantly differed based on trait mindfulness and classroom productivity. Trait mindfulness was related to classroom productivity. Although not significant, there were small to medium associations between executive function and both cluster membership and trait mindfulness. Discussion Cluster membership was highly related to trait mindfulness and classroom productivity, suggesting these are important correlates of psychological distress in HCP students. Taken together, these results underscore the need for interventions, especially ones that are mindfulness-based, to manage stress and work-relevant functioning in HCP students.