Cardiac function in a large animal model of myocardial infarction at 7 T: deep learning based automatic segmentation increases reproducibility.

Cardiac magnetic resonance (CMR) imaging allows precise non-invasive quantification of cardiac function. It requires reliable image segmentation for myocardial tissue. Clinically used software usually offers automatic approaches for this step. These are, however, designed for segmentation of human images obtained at clinical field strengths. They reach their limits when applied to preclinical data and ultrahigh field strength (such as CMR of pigs at 7 T). In our study, eleven animals (seven with myocardial infarction) underwent four CMR scans each. Short-axis cine stacks were acquired and used for functional cardiac analysis. End-systolic and end-diastolic images were labelled manually by two observers and inter- and intra-observer variability were assessed. Aiming to make the functional analysis faster and more reproducible, an established deep learning (DL) model for myocardial segmentation in humans was re-trained using our preclinical 7 T data (n = 772 images and labels). We then tested the model on n = 288 images. Excellent agreement in parameters of cardiac function was found between manual and DL segmentation: For ejection fraction (EF) we achieved a Pearson's r of 0.95, an Intraclass correlation coefficient (ICC) of 0.97, and a Coefficient of variability (CoV) of 6.6%. Dice scores were 0.88 for the left ventricle and 0.84 for the myocardium.

A novel antisymmetric 16-element transceiver dipole antenna array for parallel transmit cardiac MRI in pigs at 7 T.

To improve parallel transmit (pTx) and receive performance for cardiac MRI (cMRI) in pigs at 7 T, a dedicated transmit/receive (Tx/Rx), 16-element antisymmetric dipole antenna array, which combines L-shaped and straight dipoles, was designed, implemented, and evaluated in both cadavers and animals in vivo. Electromagnetic-field simulations were performed with the new 16-element dipole antenna array loaded with a pig thorax-shaped phantom and compared with an eight-element array of straight dipoles. The new dipole array was interfaced to a 7 T scanner in pTx mode (8Tx/16Rx). Imaging performance of the novel array was validated through MRI measurements in a pig phantom, an 85 kg pig cadaver, and two pigs in vivo (74 and 81 kg). Due to the improved decoupling between interleaved L-shaped and straight dipole elements, the 16-element dipole array fits within the same outer dimensions as an eight-element array of straight dipoles. This provides improvement of both transmit and receive characteristics and additional degrees of freedom for B1+ shimming. The antisymmetric dipole array demonstrated efficient suppression of destructive interferences in the B1+ field, with up to 25% improvement in the B1+ homogeneity achieved using static pTx-RFPA B1+ shimming in comparison with the hardware-adjusted state, which was optimized for single transmit. High-resolution (0.5 × 0.5 × 4 mm3 ) anatomical images of the heart after cardiac arrest proved good transmit and receive characteristics of the novel array design. Parallel imaging with an acceleration factor up to R = 6 was possible while maintaining a mean g factor of 1.55 within the pig heart. CINE images acquired in vivo in two pigs demonstrated SNR and parallel imaging capabilities similar to those of a reference 8Tx/16Rx dedicated loop array for cMRI in pigs.

[Examination of the Multidimensional Anxiety Inventory for Children and Adolescents (MAICA) in Clinical Samples]. / Überprüfung des Mehrdimensionalen Angstinventars für Kinder und Jugendliche (MAI-KJ) an klinischen Stichproben.

Questionnaires such as the Multidimensional Anxiety Inventory for Children and Adolescents (MAICA) provide a diagnostic approach to alert for anxiety- or depression-related problems. The aim is to examine the MAICA within two clinical samples.We first investigated whether children having anxiety- or depression-related problems (n = 94) scored higher on anxiety (i.e., emotionality and worry) and depression (i.e., dysthymia and low joy) than a non-clinical control group (n = 282). Then, we contrasted a clinical sample with other mental disorders unrelated to anxiety or depression (n = 45) with another non-clinical control group (n = 135). Across all scales of the MAICA, children with anxiety- or depression-related problems showed less favourable values than the non-clinical control group (d = 0.34 to 0.54 for anxiety, 0.55 to 0.68 for depression). Children with other mental problems showed no differences in either the anxiety or depression scales. For the use as a screening instrument, preliminary cutoff scores for identifying anxiety- or depression-related problems with the MAICA are given.

Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases-an Augsburg University Medical Center experience.

PURPOSE: External-beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50-kV x­rays is an alternative way to focally irradiate the resection cavity after BM surgery, with the option of shortening the overall treatment time and limiting normal tissue irradiation. METHODS: We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50-kV x­ray IORT between 2013 and 2020 at Augsburg University Medical Center. RESULTS: We identified 40 patients with 44 resected BM treated with 50-kV x­ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5-5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3­monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for alive patients of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1­year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1­year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1­year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%. CONCLUSION: IORT with 50-kV x­rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM, with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

On the way to routine cardiac MRI at 7 Tesla - a pilot study on consecutive 84 examinations.

INTRODUCTION: Cardiac magnetic resonance (CMR) at ultrahigh field (UHF) offers the potential of high resolution and fast image acquisition. Both technical and physiological challenges associated with CMR at 7T require specific hardware and pulse sequences. This study aimed to assess the current status and existing, publicly available technology regarding the potential of a clinical application of 7T CMR. METHODS: Using a 7T MRI scanner and a commercially available radiofrequency coil, a total of 84 CMR examinations on 72 healthy volunteers (32 males, age 19-70 years, weight 50-103 kg) were obtained. Both electrocardiographic and acoustic triggering were employed. The data were analyzed regarding the diagnostic image quality and the influence of patient and hardware dependent factors. 50 complete short axis stacks and 35 four chamber CINE views were used for left ventricular (LV) and right ventricular (RV), mono-planar LV function, and RV fractional area change (FAC). Twenty-seven data sets included aortic flow measurements that were used to calculate stroke volumes. Subjective acceptance was obtained from all volunteers with a standardized questionnaire. RESULTS: Functional analysis showed good functions of LV (mean EF 56%), RV (mean EF 59%) and RV FAC (mean FAC 52%). Flow measurements showed congruent results with both ECG and ACT triggering. No significant influence of experimental parameters on the image quality of the LV was detected. Small fractions of 5.4% of LV and 2.5% of RV segments showed a non-diagnostic image quality. The nominal flip angle significantly influenced the RV image quality. CONCLUSION: The results demonstrate that already now a commercially available 7T MRI system, without major methods developments, allows for a solid morphological and functional analysis similar to the clinically established CMR routine approach. This opens the door towards combing routine CMR in patients with development of advanced 7T technology.

The traveling heads 2.0: Multicenter reproducibility of quantitative imaging methods at 7 Tesla.

OBJECT: This study evaluates inter-site and intra-site reproducibility at ten different 7 T sites for quantitative brain imaging. MATERIAL AND METHODS: Two subjects - termed the "traveling heads" - were imaged at ten different 7 T sites with a harmonized quantitative brain MR imaging protocol. In conjunction with the system calibration, MP2RAGE, QSM, CEST and multi-parametric mapping/relaxometry were examined. RESULTS: Quantitative measurements with MP2RAGE showed very high reproducibility across sites and subjects, and errors were in concordance with previous results and other field strengths. QSM had high inter-site reproducibility for relevant subcortical volumes. CEST imaging revealed systematic differences between the sites, but reproducibility was comparable to results in the literature. Relaxometry had also very high agreement between sites, but due to the high sensitivity, differences caused by different applications of the B1 calibration of the two RF coil types used were observed. CONCLUSION: Our results show that quantitative brain imaging can be performed with high reproducibility at 7 T and with similar reliability as found at 3 T for multicenter studies of the supratentorial brain.

Sensitivity analysis for interpretation of machine learning based segmentation models in cardiac MRI.

BACKGROUND: Image segmentation is a common task in medical imaging e.g., for volumetry analysis in cardiac MRI. Artificial neural networks are used to automate this task with performance similar to manual operators. However, this performance is only achieved in the narrow tasks networks are trained on. Performance drops dramatically when data characteristics differ from the training set properties. Moreover, neural networks are commonly considered black boxes, because it is hard to understand how they make decisions and why they fail. Therefore, it is also hard to predict whether they will generalize and work well with new data. Here we present a generic method for segmentation model interpretation. Sensitivity analysis is an approach where model input is modified in a controlled manner and the effect of these modifications on the model output is evaluated. This method yields insights into the sensitivity of the model to these alterations and therefore to the importance of certain features on segmentation performance. RESULTS: We present an open-source Python library (misas), that facilitates the use of sensitivity analysis with arbitrary data and models. We show that this method is a suitable approach to answer practical questions regarding use and functionality of segmentation models. We demonstrate this in two case studies on cardiac magnetic resonance imaging. The first case study explores the suitability of a published network for use on a public dataset the network has not been trained on. The second case study demonstrates how sensitivity analysis can be used to evaluate the robustness of a newly trained model. CONCLUSIONS: Sensitivity analysis is a useful tool for deep learning developers as well as users such as clinicians. It extends their toolbox, enabling and improving interpretability of segmentation models. Enhancing our understanding of neural networks through sensitivity analysis also assists in decision making. Although demonstrated only on cardiac magnetic resonance images this approach and software are much more broadly applicable.

B0 shimming of the human heart at 7T.

PURPOSE: Inhomogeneities of the static magnetic B0 field are a major limiting factor in cardiac MRI at ultrahigh field (≥ 7T), as they result in signal loss and image distortions. Different magnetic susceptibilities of the myocardium and surrounding tissue in combination with cardiac motion lead to strong spatio-temporal B0 -field inhomogeneities, and their homogenization (B0 shimming) is a prerequisite. Limitations of state-of-the-art shimming are described, regional B0 variations are measured, and a methodology for spherical harmonics shimming of the B0 field within the human myocardium is proposed. METHODS: The spatial B0 -field distribution in the heart was analyzed as well as temporal B0 -field variations in the myocardium over the cardiac cycle. Different shim region-of-interest selections were compared, and hardware limitations of spherical harmonics B0 shimming were evaluated by calibration-based B0 -field modeling. The role of third-order spherical harmonics terms was analyzed as well as potential benefits from cardiac phase-specific shimming. RESULTS: The strongest B0 -field inhomogeneities were observed in localized spots within the left-ventricular and right-ventricular myocardium and varied between systolic and diastolic cardiac phases. An anatomy-driven shim region-of-interest selection allowed for improved B0 -field homogeneity compared with a standard shim region-of-interest cuboid. Third-order spherical harmonics terms were demonstrated to be beneficial for shimming of these myocardial B0 -field inhomogeneities. Initial results from the in vivo implementation of a potential shim strategy were obtained. Simulated cardiac phase-specific shimming was performed, and a shim term-by-term analysis revealed periodic variations of required currents. CONCLUSION: Challenges in state-of-the-art B0 shimming of the human heart at 7 T were described. Cardiac phase-specific shimming strategies were found to be superior to vendor-supplied shimming.

Memory for pictures of sexual assault: Sensitive maintenance of ambiguous stimuli.

Individual differences in dispositional coping might influence how ambiguous situations involving interactions of men and women are interpreted and remembered. Specifically, we hypothesized that women with a sensitive coping style actively maintain ambiguously threatening stimuli in their memory, showing so-called sensitive maintenance. As a prerequisite to investigate this hypothesis, two surveys (Studies 1 and 2; N = 151 and N = 252) were conducted to answer the questions whether fear of sexual assault is of relevance for young women in Germany and whether ambiguous (rather than only unambiguously threatening) situations are experienced to a significant extent. After confirming this for our target population, our main hypothesis was tested in Study 3 (N = 192) by combining tasks assessing the appraisal and the forgetting of nonthreatening, threatening, and ambiguous pictures showing interactions of men and women, and by varying the cognitive load during the retention interval. Whereas fear of rape predicted the appraisal of pictures, coping dispositions predicted forgetting of ambiguously and unambiguously threatening pictures in the hypothesized way. Results are discussed from the perspective of adaptivity and functionality of memory.

Development of magnesium implants by application of conjoint-based quality function deployment.

Biodegradable magnesium-based implants are the subject of a great deal of research for different orthopedic and vascular applications. The targeted design and properties depend on the specific medical function and location in the body. Development of the biomaterial requires a comprehensive understanding of the biological interaction between the implant and the host tissue, as well as of the behavior in the physiological environment in vivo. Research into and the development of innovative magnesium implants entails interdisciplinary research efforts and communication between materials science, bioscience, and medical experts. The present study provides a transparent planning and communication tool for market-oriented implant development processes. The objective was to identify medical needs at an early stage of the development process and to quantify the importance of the engineering characteristics of different research fields that cater to specific implant requirements. The method is demonstrated by the performance of a survey-based conjoint analysis, which was integrated into a quality function deployment approach. Twenty-seven medical professionals and 29 biomaterial scientists assessed the importance of identified medical requirements, whereby the control of mechanical integrity and degradation along with nontoxicity and nonimmunogenicity showed the highest number of preferences. The evaluation of implant options by 31 experts indicated that the engineering characteristic with the highest importance was the condition and sterilization of the surface. These values can be used to set priorities in strategic decisions. Research trials can be aligned to medical preferences, ensuring high product quality and an effective development process. This is the first paper to report on the application of conjoint-based quality function deployment in biomaterial research.

Fear of Being Laughed at in Children and Adolescents: Exploring the Importance of Overweight, Underweight, and Teasing.

Weight bias toward obese youths is often accompanied by the experience of psychological stress in those affected. Therefore, the fear of being laughed at (i.e., gelotophobia) in overweight children and adolescents can be rather serious. In four explorative studies, the importance of relative weight, self-awareness of weight (incl. satisfaction with weight), experiences of teasing and ridicule, as well as the role of social-evaluative situations in school were analyzed with regard to gelotophobia. In two online interviews of adults with pronounced gelotophobia (Study I: 102 English-speaking participants, Study II: 22 German-speaking participants) relating to reasons they assumed for their development of gelotophobia, there was evidence of injurious appearance-related experiences during childhood and adolescence. In Study III (75 Swiss adolescents) associations between the experience of weight-related teasing and mockery with overweight, self-perceptions of weight, and gelotophobia were analyzed. Especially in girls, overweight was associated with the experience of weight-related teasing and ridicule, which in turn was accompanied by gelotophobia. Study IV included 178 German adolescents who were asked to report their body image ("Do you think you are… too thin, just the right weight, or too fat?"). In addition, gelotophobia, teasing, BMI based on self-reports, and joy at school were measured. In particular, girls who felt too fat and boys who felt too thin reported teasing. Teasing was related to diminished joy at school and to gelotophobia. Among boys, underweight mediated by weight-related teasing contributed to gelotophobia. The results suggest that more research should be devoted to gelotophobia and the experience of weight-related teasing and mocking to better understand factors contributing to the well-being of children and adolescents with weight problems.

Differentiating anxiety and depression: the State-Trait Anxiety-Depression Inventory.

The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity (NA), but differ with respect to bodily hyperarousal (specific to anxiety) and anhedonia (lack of positive affect; specific to depression). In contrast to the tripartite model, NA is subdivided into worry (characteristic for anxiety) and dysthymia (characteristic for depression), which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster analysis based on a large nation-wide representative German sample (N = 3150) substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed.

Continuity and discontinuity in memory for threat.

Using a paradigm that allows a quasi-continuous tracking of memory performance over time, two experiments were designed to test the hypotheses that (a) persons with a cognitively avoidant style of coping with threat manifest a dissociation between (intact) short-term and (reduced) long-term retrieval of aversive information and (b) persons with a vigilant coping style recall aversive information particularly well after long retention intervals, provided they are free to think about aversive events. Study 1 (N = 75) showed that avoiders manifest a poor memory for aversive pictures after long retention intervals only. Study 2 (N = 95) replicated this finding. In addition, manipulation of the cognitive load during the retention interval influenced vigilants' recall of aversive information in the predicted way. Results indicate that processes occurring during the retention interval are essential for individual difference in memory for aversive information and require similar attention as encoding, appraisal, and retrieval processes.

The Effects of a Comprehensive Reading Program on Reading Outcomes for Middle School Students With Disabilities.

Reading achievement scores for adolescents with disabilities are markedly lower than the scores of adolescents without disabilities. For example, 62% of students with disabilities read below the basic level on the NAEP Reading assessment, compared to 19% of their nondisabled peers. This achievement gap has been a continuing challenge for more than 35 years. In this article, we report on the promise of a comprehensive 2-year reading program called Fusion Reading. Fusion Reading is designed to significantly narrow the reading achievement gap of middle school students with reading disabilities. Using a quasi-experimental design with matched groups of middle school students with reading disabilities, statistically significant differences were found between the experimental and comparison conditions on multiple measures of reading achievement with scores favoring the experimental condition. The effect size of the differences were Hedges's g = 1.66 to g = 1.04 on standardized measures of reading achievement.

The Relevance of Emotional Intelligence in Personnel Selection for High Emotional Labor Jobs.

Although a large number of studies have pointed to the potential of emotional intelligence (EI) in the context of personnel selection, research in real-life selection contexts is still scarce. The aim of the present study was to examine whether EI would predict Assessment Center (AC) ratings of job-relevant competencies in a sample of applicants for the position of a flight attendant. Applicants' ability to regulate emotions predicted performance in group exercises. However, there were inconsistent effects of applicants' ability to understand emotions: Whereas the ability to understand emotions had a positive effect on performance in interview and role play, the effect on performance in group exercises was negative. We suppose that the effect depends on task type and conclude that tests of emotional abilities should be used judiciously in personnel selection procedures.

Sensitive maintenance: a cognitive process underlying individual differences in memory for threatening information.

Dispositional styles of coping with threat influence memory for threatening information. In particular, sensitizers excel over repressors in their memory for threatening information after long retention intervals, but not after short ones. We therefore suggested that sensitizers, but not repressors, employ active maintenance processes during the retention interval to selectively retain threatening material. Sensitive maintenance was studied in 2 experiments in which participants were briefly exposed to threatening and nonthreatening pictures (Experiment 1, N = 128) or words (Experiment 2, N = 145). Following, we administered unannounced recognition tests before and after an intervening task that generated either high or low cognitive load, assuming that high cognitive load would impede sensitizers' memory maintenance of threatening material. Supporting our hypotheses, the same pattern of results was obtained in both experiments: Under low cognitive load, sensitizers forgot less threat material than repressors did; no such differences were observed under high cognitive load.

Effective literacy instruction for adults with specific learning disabilities: implications for adult educators.

Adults with learning disabilities (LD) attending adult basic education, GED programs, or community colleges are among the lowest performers on measures of literacy. For example, on multiple measures of reading comprehension, adults with LD had a mean reading score at the third grade level, whereas adults without LD read at the fifth grade level. In addition, large numbers of adults perform at the lowest skill levels on quantitative tasks. Clearly, significant instructional challenges exist for adults who struggle with literacy issues, and those challenges can be greater for adults with LD. In this article, the literature on adults with LD is reviewed, and evidenced-based instructional practices that significantly narrow the literacy achievement gap for this population are identified. Primary attention is given to instructional factors that have been shown to affect literacy outcomes for adults with LD. These factors include the use of explicit instruction, instructional technology, and intensive tutoring in skills and strategies embedded in authentic contexts.

Construct validity of the Anxiety Sensitivity Index-3 in clinical samples.

Using two clinical samples of patients, the presented studies examined the construct validity of the recently revised Anxiety Sensitivity Index-3 (ASI-3). Confirmatory factor analyses established a clear three-factor structure that corresponds to the postulated subdivision of the construct into correlated somatic, social, and cognitive components. Participants with different primary clinical diagnoses differed from each other on the ASI-3 subscales in theoretically meaningful ways. Specifically, the ASI-3 successfully discriminated patients with anxiety disorders from patients with nonanxiety disorders. Moreover, patients with panic disorder or agoraphobia manifested more somatic concerns than patients with other anxiety disorders and patients with nonanxiety disorders. Finally, correlations of the ASI-3 scales with other measures of clinical symptoms and negative affect substantiated convergent and discriminant validity. Substantial positive correlations were found between the ASI-3 Somatic Concerns and body vigilance, between Social Concerns and fear of negative evaluation and socially inhibited behavior, and between Cognitive Concerns and depression symptoms, anxiety, fear of negative evaluation, and subjective complaints. Moreover, Social Concerns correlated negatively with dominant and intrusive behavior. Results are discussed with respect to the contribution of the ASI-3 to the assessment of anxiety-related disorders.

Efficacy of learning strategies instruction in adult basic education.

Results from randomized controlled trials of learning strategies instruction with 375 adult basic education (AE) participants are reported. Reading outcomes from whole group strategic instruction in one of four learning strategies were compared to outcomes of reading instruction delivered in the context of typical adult education units on social studies, history, and science. Both experimental and control conditions experienced high attrition and low attendance, resulting in only 105 control and 100 experimental participants' data in outcome analyses for the trials of the four learning strategies. Reading outcomes for these completers were not significantly different between experimental and control conditions, and each group achieved minimal gains. We discuss possible reasons for the non-significant effect from the intervention, including insufficient instructional dosage.

Coping with threat and memory for ambiguous information: testing the repressive discontinuity hypothesis.

Two studies examined the influence of coping dispositions (repression, sensitization, and nondefensiveness) and anxiety on the encoding and memory representation of ambiguous threat-related stimuli. In Study 1, memory was tested shortly after encoding. Study 2 contrasted immediate and delayed testing. Repressers showed evidence of "mixed" affective reactions to ambiguous stimuli at encoding, accompanied by weak memory representation of potentially threatening implications of these stimuli. In contrast, sensitizers and anxious individuals manifested a processing bias in favor of threatening implications of ambiguous stimuli. Influences of coping on memory were most pronounced for delayed testing. Anxiety influences on memory were weak. An expectancy-based account of individual differences in processing ambiguous stimuli is discussed.