To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps.

We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient’s geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression.

There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22–1.63), public insurance (OR 1.29; 95% CI 1.14–1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08–1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52–0.74).

Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.

To develop a fully automated algorithm using data from the Veterans’ Affairs (VA) electrical medical record (EMR) to identify deep-incisional surgical site infections (SSIs) after cardiac surgeries and total joint arthroplasties (TJAs) to be used for research studies.

Retrospective cohort study.

This study was conducted in 11 VA hospitals.

Patients who underwent coronary artery bypass grafting or valve replacement between January 1, 2010, and March 31, 2018 (cardiac cohort) and patients who underwent total hip arthroplasty or total knee arthroplasty between January 1, 2007, and March 31, 2018 (TJA cohort).

Relevant clinical information and administrative code data were extracted from the EMR. The outcomes of interest were mediastinitis, endocarditis, or deep-incisional or organ-space SSI within 30 days after surgery. Multiple logistic regression analysis with a repeated regular bootstrap procedure was used to select variables and to assign points in the models. Sensitivities, specificities, positive predictive values (PPVs) and negative predictive values were calculated with comparison to outcomes collected by the Veterans’ Affairs Surgical Quality Improvement Program (VASQIP).

Overall, 49 (0.5%) of the 13,341 cardiac surgeries were classified as mediastinitis or endocarditis, and 83 (0.6%) of the 12,992 TJAs were classified as deep-incisional or organ-space SSIs. With at least 60% sensitivity, the PPVs of the SSI detection algorithms after cardiac surgeries and TJAs were 52.5% and 62.0%, respectively.

Considering the low prevalence rate of SSIs, our algorithms were successful in identifying a majority of patients with a true SSI while simultaneously reducing false-positive cases. As a next step, validation of these algorithms in different hospital systems with EMR will be needed.

The presentation aims at summarizing current knowledge about sleep in children and adolescents and at describing possible factors influencing their sleep.

For preschoolers, there is evidence that objectively assessed (sleep-EEG, actigraphy) poor sleep is associated with increased endocrine activity; this is to say, with increased morning cortisol secretion, an associative pattern observed so far only in adults. Furthermore, poor sleep and increased cortisol secretion are associated with emotional and behavioral difficulties.

During life span, notable changes occur with respect to sleep quantity and quality. Compared to childhood, in adolescence, three prominent changes occur: First, sleep quantity declines from about 10 hours at 10 years of age to between 6.5 and 8.5 hours in older adolescents. Second, a marked shift towards a longer sleep duration and later bed time from school nights to weekend nights is observable. Third, daytime sleepiness (20%) and insomnia symptoms (25%) are common among adolescents.

Among a variety of factors affecting adolescents’ sleep, we could show that negative parenting styles unfavorably influenced adolescents’ sleep quality, suggesting that even 18 years old adolescents may be far away from been emotionally independent from their parents. Furthermore, the so-called weekend-shift was correlated with increased sleepiness during the week, suggesting that irregular sleep schedules may negatively influence sleep quality and daytime functioning.

Last, if compared to healthy controls, children and adolescents after cleft lip and palate (CLP) repair were not at risk reporting sleep difficulties; rather, irrespective of the presence of CLP, sleep was affected by psychological strain.

Fluid intelligence expresses the capacity for interpretation of novel stimuli and flexible behavioral adaptation to such cues. Phasic dopamine firing closely matches a temporal difference prediction error (PE) signal important for learning and rapid behavioral adaptation. Both fluid intelligence and dopaminergic neurotransmission decline with age. So far, no study investigated the relationship between fluid IQ, PE signal and direct measures of dopaminergic neurotransmission. Here we used a multimodal imaging approach that combines positron emission tomography and functional magnetic resonance imaging.

A group of healthy controls was investigated with both 6-[18F]FluoroDOPA PET and functional MRI with a probabilistic reversal task. The task required a constant behavioral adaptation to changes in reward contingencies, while choosing between two abstract stimuli. A reinforcement learning algorithm was used to compute a trial-by-trial prediction error, which was the used as a regressor in the fMRI data analysis with SPM8.

The prediction error signal was associated with functional activation in the basal ganglia including the ventral striatum and putamen. Fluid intelligence was associated with the PE signal in the ventral striatum, which correlated with age-related changes in dopamine synthesis capacity in the prefrontal cortex.

These findings provide insight into the role of age-related changes in dopaminergic neurotransmission on behavioral adaptation. The multimodal imaging approach allows the characterization of interactions between dopamine metabolism and learning-related neuronal activation and may thus be a useful tool to clarify mechanisms underlying learning and plasticity in old age, which are crucial to our understanding of successful aging.

In alcoholism, one relevant mechanism contributing to relapse is the exposure to stimuli that are associated with alcohol intake. Such conditioned cues can elicit conditioned responses like alcohol craving and consumption. In the last decade, considerable progress has been made in identifying basic neuronal mechanisms that underlie cue-induced alcohol craving.

We explored whether functional brain activation during exposure to alcohol-associated stimuli is related to the prospective relapse risk in detoxified alcohol-dependent patients.

46 alcohol-dependent and 46 healthy volunteers participated in a fMRI study using a cue reactivity paradigm, in which visual alcohol-related and control stimuli were presented. Patients were followed for 3 months. Afterwards data was analysed regarding the subsequent relapse, resulting in 16 abstainers and 30 relapsers.

Alcohol-related versus neutral stimuli activated a frontocortical-limbic network including inferior, medial and middle frontal gyrus as well as putamen in the group of patients relative to healthy controls. Moreover, abstainers showed a stronger activation in orbitofrontal cortex as well as midbrain during the presentation of alcohol-related cues whereas relapsers revealed a stronger activation of cingulate gyrus.

This study suggests that cue-induced activation of orbitofrontal cortex and dopaminergic innervated midbrain is negatively associated with the prospective relapse risk in alcohol-dependent patients. This could indicate a more pronounced and conscious processing of alcohol cues which might serve as a warning signal and a behavioural controlling function. In contrast, prospective relapsers showed a stronger activation of cingulate gyrus, a region involved in the attribution of motivational value.

A dimensional approach in psychiatry strives to identify neurobiological signatures of core (dys)functions such as responses to emotional stimuli across nosological boundaries.

We compared responses to emotional stimuli between major psychiatric disorders and investigated whether there is a psychopathological correlate irrespective of diagnostic group.

We used functional magnetic resonance imaging (fMRI) to assess the functional correlates of responses to unexpected pleasant and aversive emotional pictures in n=175 subjects suffering from alcohol dependence (n=29), schizophrenia (n=37), major depressive disorder (MDD; n=25), bipolar disorder (acute manic episode; n=12), panic disorder (n=12) or attention deficit/hyperactivity disorder (ADHD; n=20) and in healthy controls (n=40). The level of anxiety was measured in all diagnostic groups with the State-Trait Anxiety Inventory, and severity of depressive mood was measured with Beck's depressions inventory in all diagnostic groups with the exception of bipolar patients.

Over all diagnostic groups, a significant activation of BA10 was observed during the presentation of unexpected pleasant pictures, whereas a significant activation of the left amygdala and left insula was found during the presentation of unexpected aversive pictures. We did not find significant effects of group, nor a correlation of neuronal activation with depressed mood or anxiety.

In spite of reported alterations in emotion processing in different psychiatric diseases, responses to emotional pictures did not differ across nosological boundaries in our study. However, a dimensional approach that targets e.g. personality traits or basic learning mechanisms and their neuropsychological correlates across traditional disease categories may be more promising.

The development and maintenance of an alcohol addiction is a complex interaction between genetic and environmental factors. Genetic effects seem to contribute substantially to the risk of developing an addiction, but also to its course and patients’ responses to different treatments. Recent studies identified associations between polymorphisms in the genes of glutamate and μ-opioid receptors and addiction risk. Those receptors are of special interest, because they are targets of therapeutic agents, such as acamprosate and topiramate.

Several studies were conducted, in order to further determine the effects of genetic polymorphisms in glutamate and opioid receptor genes on addictive behavior, neural response to alcohol cues and relapse risk.

Genetic effects were investigated in samples of alcohol-dependent patients using functional imaging techniques, neuropsychological tests and follow-up investigation after standard clinical treatment. Data on clinical parameters, neuronal response to alcohol cues, functional neuronal connectivity and relapse risk were collected and analyzed.

Results demonstrate effects of genetic polymorphisms in glutamate and opioid receptors on neuronal response to alcohol cues in frontal and mesolimbic brain areas, subjective craving and time to first relapse. Current findings will be discussed in the light of existing evidence on the contribution of genetic effects to treatment outcome and patient stratification.

The investigation of genetic risk factors and mechanisms by which they affect addiction related phenotypes seems to be a promising tool to identify molecular treatment targets and predictors for successful treatment strategies.

The authors have not supplied their declaration of competing interest.

Patients with a first episode psychosis (FEP) have repeatedly been shown to have gray matter (GM) volume alterations. Some of these neuroanatomical abnormalities are already evident in the at-risk mental state (ARMS) for psychosis. Not only GM alterations but also neurocognitive impairments predate the onset of frank psychosis with verbal learning and memory (VLM) being among the most impaired domains. Yet, their interconnection with alterations in GM volumes remains ambiguous.

To evaluate associations of different subcortical GM volumes in the medial temporal lobe with VLM performance in ARMS and FEP patients.

Data were collected within the prospective Früherkennung von Psychosen (FePsy) study, which aims to improve the early detection of psychosis. VLM was assessed using the California Verbal Learning Test (CVLT) and its latent variables Attention Span (AS), Learning Efficiency (LE), Delayed Memory (DM) and Inaccurate Memory (IM). Structural images were acquired using a 3 Tesla magnetic resonance imaging scanner.

Data from 59 ARMS and 47 FEP patients were analysed. Structural equation models revealed significant associations between the amygdala and AS, LE and IM; thalamus and LE and IM; and the caudate, hippocampus and putamen with IM. However, none of these significant results withstood correction for multiple testing.

Although VLM is among the most impaired cognitive domains in emerging psychosis, we could not find an association between low performance in this domain and reductions in subcortical GM volumes. Our results suggest that deficits in this domain may not stem from alterations in subcortical structures.

The authors have not supplied their declaration of competing interest.

Alcohol relapse is often occurring to regulate negative affect during withdrawal. On the neurobiological level, alcoholism is associated with gray matter (GM) abnormalities in regions that regulate emotional experience such as the orbitofrontal cortex (OFC). However, no study to our knowledge has investigated the neurobiological unpinning of affect in alcoholism at early withdrawal and the associations of OFC volume with long-term relapse risk.

One hundred and eighty-two participants were included, 95 recently detoxified alcohol dependent patients (ADP) and 87 healthy controls (HC). We measured affective states using the positive and negative affect schedule (PANAS). We collected T1-weighted brain structural images and performed Voxel-based morphometry (VBM).

Findings revealed GM volume decrease in alcoholics in the prefrontal cortex (including medial OFC), anterior cingulate gyrus, and insula. GM volume in the medial OFC was positively associated with NA in the ADP group. Cox regression analysis predicted that risk to heavy relapse at 6 months increases with decreased GM volume in the medial OFC.

Negative affect during alcohol withdrawal was positively associated with OFC volume. What is more, increased GM volume in the OFC also moderated risk to heavy relapse at 6 months. Reduced GM in the OFC poses as risk to recovery from alcohol dependence and provides valuable insights into transient negative affect states during withdrawal that can trigger relapse. Implications exist for therapeutic interventions signifying the OFC as a neurobiological marker to relapse and could explain the inability of ADP to regulate internal negative affective states.