Adult medulloblastoma is a rare entity with a predilection for the development of radiation-induced malignant glioma (RIMG). Management of RIMG in the setting of prior craniospinal irradiation is a challenging scenario.

We report a case of a 51-year-old male with short-interval development of multicentric malignant glioma with MET mutation who previously underwent craniospinal radiation for adult medulloblastoma. Due to radiographic findings, linear accelerator (LINAC)-based fractionated stereotactic/IMRT was delivered to the right temporal lesion alongside systemic therapy. The patient had interval development of an IDH wildtype, high-grade left cerebellar glioma and underwent surgical resection and subsequent gamma knife stereotactic radiosurgery (GKRS) to the cavity.

GKRS targeting the surgical cavity was delivered with a fractionated regimen of 27 Gy in 3 fractions to the margin. One year after completion of GKRS, the patient had not developed any symptomatic radiation necrosis or neuroimaging changes reflective of treatment toxicity. In this patient, GKRS to minimise the integral dose exposure of normal tissues surrounding the target volume proved to be particularly advantageous in the setting of prior craniospinal irradiation.

RIMG poses significant challenges for radiation oncologists, particularly in the reirradiation setting. Decision-making involving multidisciplinary input balanced the necessity of dose escalation achieved by GKRS, while minimising the cumulative dose in the setting of prior craniospinal irradiation.

Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.

In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.

The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.

Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

Guideline-based tobacco treatment is infrequently offered. Electronic health record-enabled patient-generated health data (PGHD) has the potential to increase patient treatment engagement and satisfaction.

We evaluated outcomes of a strategy to enable PGHD in a medical oncology clinic from July 1, 2021 to December 31, 2022. Among 12,777 patients, 82.1% received a tobacco screener about use and interest in treatment as part of eCheck-in via the patient portal.

We attained a broad reach (82.1%) and moderate response rate (30.9%) for this low-burden PGHD strategy. Patients reporting current smoking (n = 240) expressed interest in smoking cessation medication (47.9%) and counseling (35.8%). As a result of patient requests via PGHD, most tobacco treatment requests by patients were addressed by their providers (40.6–80.3%). Among patients with active smoking, those who received/answered the screener (n = 309 ) were more likely to receive tobacco treatment compared with usual care patients who did not have the patient portal (n = 323) (OR = 2.72, 95% CI = 1.93–3.82, P < 0.0001) using propensity scores to adjust for the effect of age, sex, race, insurance, and comorbidity. Patients who received yet ignored the screener (n = 1024) compared with usual care were also more likely to receive tobacco treatment, but to a lesser extent (OR = 2.20, 95% CI = 1.68–2.86, P < 0.0001). We mapped observed and potential benefits to the Translational Science Benefits Model (TSBM).

PGHD via patient portal appears to be a feasible, acceptable, scalable, and cost-effective approach to promote patient-centered care and tobacco treatment in cancer patients. Importantly, the PGHD approach serves as a real world example of cancer prevention leveraging the TSBM.

Research faculty often experience poor mentoring, low vitality, and burnout. We report on our logic model inputs, activities, measurable outcomes, and impact of a novel mentoring intervention for biomedical research faculty: the C-Change Mentoring & Leadership Institute. We present a) a detailed description of the curriculum and process, b) evaluation of the program’s mentoring effectiveness from the perspective of participants, and c) documentation of mentoring correlated with key positive outcomes.

A yearlong facilitated group peer mentoring program that convened quarterly in person was conducted twice (2020–2022) as part of an NIH-funded randomized controlled study. The culture change intervention aimed to increase faculty vitality, career advancement, and cross-cultural competence through structured career planning and learning of skills essential for advancement and leadership in academic medicine. Participants were 40 midcareer MD and PhD research faculty, half women, and half underrepresented by race or ethnicity from 27 US medical schools.

Participants highly rated their mentoring received at the Institute. Extent of effective mentoring experienced correlated strongly with the measurable outcomes of enhanced vitality, self-efficacy in career advancement, research and work-life integration, feelings of inclusion in the program, valuing diversity, and skills for addressing inequity.

The mentoring model fully included men and women and historically underrepresented persons in medicine and minimized problems of power, gender, race, and ethnicity discordance. The intervention successfully addressed the urgencies of sustaining faculty vitality, developing faculty careers, facilitating cross-cultural engagement and inclusion, and contributing to cultivating cultures of inclusive excellence in academic medicine.

Tetralogy of Fallot is the most common cyanotic congenital malformation of the heart. The right ventricular outflow tract is of great interest in this setting, but most of the focus on this feature has been on the size of the so-called pulmonary valvar “annulus”. We aimed to characterise other aspects of the morphology of the pulmonary root in heart specimens with tetralogy of Fallot.

We reviewed archived hearts with tetralogy of Fallot from four registries. The pulmonary root was examined with specific attention to the number of sinuses, the number of leaflets, presence of any fusion of leaflets, and the direction of the zone of apposition between the leaflets. Cluster analyses were then conducted to see if the features permitted segregation into groups.

We examined a total of 155 hearts. The pulmonary valve had two leaflets in 62%, three leaflets in 34%, and one leaflet in 3%. Irrespective of leaflet morphology, most hearts had two sinuses. Cluster analysis permitted segregation into three groups, with the direction of the zone of apposition being the most important feature for segregation.

In two-thirds of our hearts with tetralogy of Fallot, the pulmonary valve had two leaflets. Most frequently there were three sinuses. In the setting of a valve with two sinuses, the zone of apposition between the leaflets pointing towards the aorta. Cluster analysis permitted statistically sound segregation of the heart and highlights the importance of delineating these features, specifically the leaflet and sinus morphology, with clinical imaging.