Axonal self-sorting without target guidance in Drosophila visual map formation.

The idea of guidance toward a target is central to axon pathfinding and brain wiring in general. In this work, we show how several thousand axonal growth cones self-pattern without target-dependent guidance during neural superposition wiring in Drosophila. Ablation of all target lamina neurons or loss of target adhesion prevents the stabilization but not the development of the pattern. Intravital imaging at the spatiotemporal resolution of growth cone dynamics in intact pupae and data-driven dynamics simulations reveal a mechanism by which >30,000 filopodia do not explore potential targets, but instead simultaneously generate and navigate a dynamic filopodial meshwork that steers growth directions. Hence, a guidance mechanism can emerge from the interactions of the axons being guided, suggesting self-organization as a more general feature of brain wiring.

Predictors of Mortality in Head-Preserving Treatment for Dislocated Proximal Humerus Fractures: A Retrospective Analysis of 522 Cases with a Minimum Follow-Up of 5 Years.

PURPOSE: Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, but there is still inadequate knowledge about mortality risk factors after such injuries. In order to provide the best possible therapy, individual risk factors have to be considered and evaluated thoroughly. There is still controversy regarding treatment decisions for proximal humerus fractures, particularly for the elderly. METHODS: In this study, patient data from 522 patients with proximal humerus fractures were obtained from 2004 to 2014 at a Level 1 trauma centre. After a minimum follow-up of 5 years, the mortality rate was assessed, and independent risk factors were evaluated. RESULTS: A total of 383 patients (out of 522) were included in this study. For our patient collective, the mean follow-up was at 10.5 ± 3.2 years. The overall mortality rate was 43.8% in our respondent group and was not significantly impacted by concomitant injuries. The binary logistic regression model showed an increased risk for mortality by 10% per life year, a 3.9 times higher mortality risk for men and a 3.4 times higher risk for conservative treatment. The most powerful predictor was a Charlson Comorbidity Index of more than 2, with a 20 times higher mortality risk. CONCLUSIONS: Outstanding independent predictors of death in our patient collective were serious comorbidities, male patients, and conservative treatment. This patient-related information should influence the process of decision making for the individual treatment of patients with PHFs.

Self-Reported Voluntary Blame-Taking: Kinship Before Friendship and No Effect of Incentives.

Inspired by theories of prosocial behavior, we tested the effect of relationship status and incentives on intended voluntary blame-taking in two experiments (Experiment 2 was pre-registered). Participants (N E1 = 211 and N E2 = 232) imagined a close family member, a close friend, or an acquaintance and read a scenario that described this person committing a minor traffic offense. The person offered either a monetary, social, or no incentive for taking the blame. Participants indicated their willingness to take the blame and reasons for and against blame-taking. Overall, a sizable proportion of participants indicated to be willing to take the blame (E1: 57.8%; E2: 34.9%). Blame-taking rates were higher for family members than close friends or acquaintances in both experiments, as expected. Unexpectedly, there was no difference between a close friend and an acquaintance in Experiment 2. Social incentives did not have an effect on voluntary blame-taking in either experiment. Neither did we find an interaction between relationship status and incentives. The results highlight the importance of kin relationships in the context of voluntary blame-taking.

Assessing readiness to drive in adolescents with narcolepsy: what are providers doing?

PURPOSE: There are no universally accepted guidelines for assessing driving readiness in adolescents with narcolepsy. The purpose of the present study was to survey pediatric sleep medicine providers regarding their current practice patterns for assessing driving readiness in adolescents with narcolepsy, knowledge of their state laws regarding physician reporting of unsafe drivers, and opinions regarding what physician duty ought to be. METHODS: This was an anonymous web-based survey distributed via the PedSleep listserv, which serves as a hub of communication for pediatric sleep medicine providers. RESULTS: A total of 52 pediatric sleep providers from 25 different states completed the survey. Eighty-eight percent of providers routinely assess driving readiness in adolescents with narcolepsy. Factors rated as "absolutely essential" by at least 50% of respondents included the following: history of previous fall-asleep crash or near miss, sleepiness (reported by patient), sleepiness (reported by caregiver), and cataplexy (reported by patient). Providers included maintenance of wakefulness testing: never (34%), if patient reports no/mild sleepiness (10%), if patient reports moderate/severe sleepiness (25%), or always regardless of patient symptoms (30%), and the median minimally acceptable result was 30 min (25-75th: 20-40 min). There was substantial lack of knowledge regarding legal obligations for reporting. CONCLUSIONS: These results demonstrate great variability in practice patterns among pediatric sleep medicine providers for assessing driving readiness in adolescents with narcolepsy. In addition, it shows limited knowledge of the providers about their respective states' laws. Further studies are required to identify the best approach to assess residual sleepiness in this population.

Do Treatment Attitudes and Decisions of Psychotherapists-in-Training Depend on a Patient's Age?

OBJECTIVE: The objective of this study was to analyze how psychotherapists' treatment attitudes and decisions depend on a patient's age. METHODS: A sample of psychotherapists-in-training (N = 97) responded to questions concerning a naturalistic case vignette of a female patient with symptoms of depression and anxiety. The patient was described as being either 79 or 47 years old. RESULTS: Results revealed no evidence that psychotherapists-in-training had more negative treatment attitudes towards an older relative to a younger patient. However, the patient's age had an influence on participants' therapeutic approach. Specifically, psychotherapists-in-training recommended short- as opposed to long-term therapy, considered motivational clarification less important, and viewed clarifying techniques as less appropriate for an older patient. CONCLUSIONS: The stereotype of the rigid and resigned old person appears to be an important and potentially problematic factor in psychotherapy. Interventions to help therapists to reflect on their individual representations of aging may increase the likelihood of successful psychotherapy.