Revealing motor insensitivity to food in Anorexia Nervosa as a potential mechanism contributing to calorie restriction: A mobile Approach Avoidance Task study.

A change in implicit behavioural tendencies toward foods may contribute to the maintenance of calorie restriction in Anorexia Nervosa (AN). To test this hypothesis, we assessed approach-avoidance tendencies toward different categories of stimuli using a novel mobile version of the approach-avoidance task (AAT). The sample included 66 patients with restrictive AN and 84 healthy controls, all females. All participants performed the AAT in which they were required to approach or avoid stimuli (high-calorie foods, low-calorie foods, and neutral objects) by respectively pulling their phone towards themselves of pushing it away. Both the response time and the force of each movement were collected by means of the smartphone's accelerometer. The results revealed that patients with AN had a reduced tendency to approach food stimuli compared to healthy controls, who instead presented faster and stronger movements in approaching rather than avoiding foods as compared to neutral objects. This finding was particularly pronounced in patients with greater levels of malnutrition. No differences were instead observed comparing high-calorie and low-calorie foods. The observed reduction in the natural tendency to approach food stimuli is consistent with patients' eating behaviour and may contribute to the maintenance of calorie restriction, thus representing a possible target for novel therapeutic approaches.

The Brief Experiential Avoidance Questionnaire: Validation of the French Version in Non-clinical Adults.

Introduction: Various studies indicate the role of experiential avoidance (EA) in the onset and maintenance of mental health disorders such as depression or anxiety disorders. The Brief Experiential Avoidance Questionnaire (BEAQ) is a quick tool to assess EA. Objective: This study aimed to translate the BEAQ into French and to validate it in a sample of non-clinical adults. Method: The BEAQ was translated from English into French using the translation and back-translation technique. The translated questionnaire was submitted to 93 psychology students to identify unclear/ambiguous items. Then, the final French and the original versions of the BEAQ were administered to 64 bilingual individuals two weeks apart to assess the scale's content validity and test-retest reliability. Finally, the BEAQ-French and other scales were administered to 580 non-clinical adults to assess its factor structure and its convergent and discriminant validity. Results: Results showed no significant difference between the English and French versions of the BEAQ. The BEAQ demonstrated high internal consistency and good test-retest reliability. Confirmatory factor analyses did not support the one-factor structure of the BEAQ. Exploratory factor analyses revealed a two-factor structure. The BEAQ presented satisfactory convergent and discriminant validity with related measures and measures of neuroticism, negative affect and mental health problems. Conclusion: The results suggest that the BEAQ-French is a reliable tool for assessing EA. Unlike the original version, the BEAQ-French exhibits a two-factor rather than a one-factor structure. Further research is needed to confirm this two-factor structure and to assess more precisely the convergent validity of the scale.

Ascending Vagal Sensory and Central Noradrenergic Pathways Modulate Retrieval of Passive Avoidance Memory in Male Rats.

Visceral feedback from the body is often subconscious, but plays an important role in guiding motivated behaviors. Vagal sensory neurons relay "gut feelings" to noradrenergic (NA) neurons in the caudal nucleus of the solitary tract (cNTS), which in turn project to the anterior ventrolateral bed nucleus of the stria terminalis (vlBNST) and other hypothalamic-limbic forebrain regions. Prior work supports a role for these circuits in modulating memory consolidation and extinction, but a potential role in retrieval of conditioned avoidance remains untested. To examine this, adult male rats underwent passive avoidance conditioning. We then lesioned gut-sensing vagal afferents by injecting cholecystokinin-conjugated saporin toxin (CSAP) into the vagal nodose ganglia (Experiment 1), or lesioned NA inputs to the vlBNST by injecting saporin toxin conjugated to an antibody against dopamine-beta hydroxylase (DSAP) into the vlBNST (Experiment 2). When avoidance behavior was later assessed, rats with vagal CSAP lesions or NA DSAP lesions displayed significantly increased conditioned passive avoidance. These new findings support the view that gut vagal afferents and the cNTSNA-to-vlBNST circuit play a role in modulating the expression/retrieval of learned passive avoidance. Overall, our data suggest a dynamic modulatory role of vagal sensory feedback to the limbic forebrain in integrating interoceptive signals with contextual cues that elicit conditioned avoidance behavior.

Lifetime and Daily Weight Stigma among Higher Weight Sexual Minority Women: Links to Daily Weight-based Concerns, Avoidance, and Negative Affect.

Background: Weight stigma is associated with a range of adverse health outcomes (e.g., disordered eating). Women, sexual minorities, and higher-weight individuals are at increased risk of experiencing weight stigma, but little is known about its influence on emotions, cognitions, and behaviors in real-world contexts, particularly among multiply marginalized individuals such as higher-weight sexual minority women (SMW). The current study examined how lifetime and daily weight stigma experiences relate to momentary weight/shape concerns, size-based avoidance, and negative affect in this population. Methods: Fifty-five higher-weight (BMI > 25 kg/m2) SMW completed a baseline survey and a five-day Ecological Momentary Assessment protocol (five prompts per day) assessing weight stigma events, weight/shape concerns, size-based avoidance, and negative affect. Results: Greater frequency of lifetime weight stigma experiences was significantly associated with greater odds of engaging in size-based avoidance at least once during the 5-day period. Reporting momentary weight stigma events at any given prompt was significantly associated with greater odds of reporting momentary weight/shape concerns, but not negative affect, at the same prompt. Greater frequency of lifetime weight stigma experiences was also marginally associated with greater odds of reporting momentary weight/shape concerns at any given prompt. Conclusions: Both lifetime and momentary experiences of weight stigma are linked to negative consequences (e.g., weight/shape concerns, size-based avoidance) among higher-weight SMW. Although structural interventions are needed to reduce weight stigma at its source, individual interventions can help higher-weight SMW to cope with weight stigma in ways that may reduce its negative consequences.

Adverse childhood experiences and profiles of healthy orthorexia versus orthorexia nervosa: towards an explanatory model of orthorexia as a multidimensional eating style.

BACKGROUND: Orthorexia is a complex phenomenon comprising distinct dimensions, including orthorexia nervosa (ON) and healthy orthorexia (HO). However, little is known about the factors influencing these dimensions, their disparities, and the psychological factors underlying orthorexia behaviours. OBJECTIVES: This study aims to explore ON versus HO dimensions and the predictive role of adverse childhood experiences (ACEs) in a nationally representative sample of Polish individuals. In addition, we aim to investigate the mediating roles of alexithymia, embodiment, and experiential avoidance levels in this association. METHODS: A representative sample of Polish adults (n = 3557) participated in this study. Dimensions of orthorexia (HO, ON) were assessed using the Teruel Orthorexia Scale, while ACEs were evaluated using the Adverse Childhood Experiences Questionnaire. Levels of alexithymia were measured using the Toronto Alexithymia Scale, experiential avoidance through the Acceptance and Action Questionnaire, and embodiment intensity via the Experience of Embodiment Scale. RESULTS: Cluster analysis identified two distinctive orthorexia profiles in the whole sample, i.e., HO (n = 469) and ON (n = 1217), alongside three intermediate HO/ON profiles (n = 1871). The number of ACEs predicted ON tendencies as opposed to HO behaviours in participants. The mediating role of alexithymia, experiential avoidance, and embodiment in the association between ACEs and ON was also observed. CONCLUSIONS: Our study suggests that orthorexia is a multidimensional eating style shaped by socio-cultural factors. Adverse childhood experiences may be related to ON behaviours by mediating psychological factors such as experiential avoidance, alexithymia, and embodiment. Effective education and collaborative support are necessary for addressing ON tendencies.

Depressive symptoms, avoidant coping, and alcohol use: differences based on gender and posttraumatic stress disorder in emerging adults.

Trauma exposure and alcohol use often co-occur. Unveiling predictors of drinking behavior, including among those with varying levels of trauma exposure, can inform behavioral health prevention and treatment efforts in at-risk populations. The current study examined associations between depressive symptoms, avoidant coping, gender, and alcohol use among emerging adults with and without trauma exposure and posttraumatic stress disorder (PTSD). Participants were 238 emerging adults between the ages of 21 and 30 years (M = 24.75; SD = 2.61) in one of three groups: trauma-exposed with PTSD (n = 70); trauma-exposed with no PTSD (n = 83); or a no trauma (control) group (n = 85). Demographics, parental alcohol problems, depressive symptoms, and avoidant coping were examined as predictors of drinks per drinking day. Chi-square, t-test, bivariate, and group path analysis were conducted. Among participants, men consumed greater amounts of alcohol than women across all three groups. Group assignment based on trauma history and PTSD significantly moderated the association between avoidant coping and alcohol use such that avoidant coping had a significant effect on alcohol use among participants in the trauma-exposed and PTSD groups. There was also a significant group × gender × avoidant coping interaction such that, among participants in the control group, men had attenuated alcohol use at low levels of avoidant coping and increased at high levels of avoidant coping. No effects of race were observed. Results highlight the importance of avoidant coping as a risk factor for problematic drinking, unveiling a specific intervention target for reducing co-occurring PTSD and problematic alcohol use.

The psychosocial background of dental care avoidance: A qualitative study.

INTRODUCTION: Dental care avoidance affects individuals' oral health status. There is limited literature examining the context of dental avoidance behavior. AIM: The aim of the study is to examine attitudes toward dental care services among adults. METHODS: Overall, 16 patients participated in semi-structured interviews. The interviews were analyzed using inductive thematic analysis. Through independent reviews of the themes that comprise the patients' experience, a consensus was established among the researchers. RESULTS: Ten major themes were identified that encapsulate patients' attitudes toward dental care attendance: Effect of environment and equipment, Fear and anesthesia, Procrastination, Dissatisfaction with the dental care system, Expectations of dentists, Quality of dental care, Edentulousness and social status, Financial involvement, Aesthetics, and Dentists' behavior. Compliance with oral health maintenance can be enhanced by specific training for professionals and dentistry students and by fine tuning the dental care system. CONCLUSIONS: This is the first comprehensive study in Hungary investigating attitudes among dentist patients toward dental care. The results suggest that there are many factors that may affect dental care attendance. Thus, these findings make a potentially fundamental contribution to the improvement of dental care and support practitioners in enriching their understanding of dental avoidance behavior.

Predator perception of aposematic and cryptic color morphs in two Oophaga species.

Animals that are toxic often advertise their unprofitability to potential predators through bright aposematic colors while cryptic ones blend in with their natural background to avoid predators. In the poison dart frogs, Oophaga pumilio and O. granulifera, some populations in Costa Rica and Panama display cryptic green and aposematic red color morphs. We herein used reflectance spectra from the dorsum of red and green morphs of these frogs to estimate their perception by the visual systems of three potential predators (birds, lizards, and crabs) against three natural backgrounds (leaves, trunks and leaf litter). Statistical analyses revealed no strong differences in color contrast against backgrounds between the two frog species. However, strong effects of frog morph, predator, background, and their interactions were observed. When viewed against diverse backgrounds, red frogs of both Oophaga species are more color conspicuous to birds and Anoline lizards than to crabs. A strong effect of species was observed on luminance contrast. Concerning the latter, green frogs particularly in O. granulifera appear more conspicuous than red frogs, while birds perceive higher brightness contrasts than lizards or crabs. Our results further support the importance of birds and lizards as Oophaga predators and provide a first quantitative comparison of conspicuousness between these two frog species.

Change in the collision avoidance performance of autonomous emergency braking systems.

OBJECTIVE: This study quantifies the change in collision avoidance performance of autonomous emergency braking (AEB) systems for traffic accidents in Japan since 2015. METHOD: This study used data on Japanese traffic accidents compiled by Japan's National Police Agency. The data included only accidents involving loss of or injury to human life; accidents involving only property damage were excluded. We restricted our analysis to collisions between two 4-wheel vehicles and considered only collisions for which we could determine whether the primary party's car was equipped with an AEB system. Both Poisson and negative binomial mixed-effects regression analyses were conducted using the data for 2021 and 2022 to measure the collision avoidance performance of first registered cars in 2015 to 2020 equipped with AEB systems compared with cars without AEB systems first registered in 2015. Collision avoidance performance was measured for 2 types of intervehicle collisions: rear-end collisions and right-turn collisions. Collision avoidance performance for rear-end collisions was also measured for each of the 3 car types-Standard, small, and light cars. RESULTS: The collision reduction rate for rear-end collisions increases with the year of first registration and for cars equipped with AEB systems first registered in 2020 compared with non-AEB-equipped cars first registered in 2015 is 69.2% (95% confidence interval [CI] 67.0%-71.1%), indicating that the performance of AEB systems has dramatically improved in terms of preventing rear-end collisions. For right-turn collisions, the rate increased to 20.4% (95% CI 5.9%-32.6%) for cars equipped with AEB systems first registered in 2019. However, no clear trend is observed. CONCLUSIONS: This study evaluated a time series of the collision reduction performance of AEB systems using an original methodology. Japan's New Car Assessment Program (JNCAP) has included AEB's effectiveness in reducing damage from traffic collisions as an evaluation item since FY2014. The results could demonstrate the effectiveness of JNCAP.

Basolateral amygdala inputs to the nucleus accumbens shell modulate the consolidation of cued-response and inhibitory avoidance learning.

The basolateral amygdala (BLA) modulates different types of memory consolidation via distinct projections to downstream brain regions in multiple memory systems. Prior studies indicate that the BLA projects to the nucleus accumbens shell (NAshell) and that these regions interact to influence some types of behavior. Moreover, previous pharmacological work suggests the BLA and NAshell interact to influence memory. However, the precise role of the BLA-NAshell pathway has never been directly investigated in the consolidation of different types of memory including cued-response, spatial, or inhibitory avoidance (IA) learning. To address this, male and female Sprague-Dawley rats received optogenetic manipulations of the BLA or BLA-NAshell pathway immediately following training in different learning tasks. An initial experiment found that optogenetically inhibiting the BLA itself immediately after training impaired cued-response retention in a Barnes maze task in males and females, confirming earlier pharmacological work in males alone. Subsequent experiments found that BLA-NAshell pathway inhibition impaired retention of cued-response and IA learning but had no effect on retention of spatial learning. However, the present work did not observe any effects of pathway stimulation immediately after cued-response or IA learning. Together, the present findings suggest the BLA modulates the consolidation of cued-response and IA, but not spatial, memory consolidation via NAshell projections.

Memory tract sparing using Diffuse tensor imaging in radiation planning of primary brain tumors.

INTRODUCTION: Radiation therapy (RT) is a critical treatment modality for both primary and metastatic brain tumors, yet approximately 30% of patients experience cognitive decline post-radiotherapy. This cognitive toxicity is linked to low radiation doses affecting the hippocampal dentate gyrus. Hippocampal Avoidance (HA)-Whole Brain Radiotherapy (WBRT) combined with Memantine has shown promising outcomes in preserving cognitive function and quality of life (QOL) in patients with brain metastases. Nowadays, it is the standard of care for those with good performance status and no hippocampal metastases. METHODS: We conducted a prospective trial approved by the IRB (SMC0307-23), including patients aged 18 and above with primary brain tumors post-resection or biopsy. Exclusion criteria included multifocal glioma crossing to the other hemisphere. RT was delivered to a total dose of 59.4Gy in 33. Diffusion tensor imaging (DTI) was performed to map hippocampal-associated white matter tracts. Using Eclipse treatment planning software, memory fiber tracts and hippocampi were contoured and integrated into RT planning. Dosimetric analyses compared two plans with memory fiber constraints and one without. The primary endpoints were safety and dosimetric feasibility. RESULTS: Twelve patients with low-grade gliomas were included, and the contouring of memory fibers and hippocampi was successful. VMAT treatment plans met-dose constraints for memory fibers, with an average mean dose of 10.1 Gy. The average MoCA score before RT was 27.1 and 26.4 at eight months post-treatment, with a p-value of 0.07. Excluding one patient, the scores were 27.1 and 26.6, respectively (p=0.13). CONCLUSION: MRI planning using DTI for memory fiber detection and incorporation into RT planning via VMAT techniques enables hippocampal and associated white fiber sparing, potentially preserving cognitive function. Preliminary cognitive data are promising, supporting the need for further validation in a larger cohort.

Bereavement guilt among young adults impacted by caregivers' cancer: Associations with attachment style, experiential avoidance, and psychological flexibility.

OBJECTIVES: This paper focuses on the experiences of bereavement guilt among young adults bereaved by a caregiver's cancer, examining associations with attachment style, experiential avoidance, and psychological flexibility with the aim of informing psychosocial interventions for this population. METHODS: Ninety-seven young adults (18-25 years) bereaved by a parent/guardian's cancer completed an online survey, including measures of bereavement guilt, attachment style, experiential avoidance, and psychological flexibility. Mediation analyses explored the associations between attachment style (anxious, avoidant) and bereavement guilt, and if these associations were mediated by experiential avoidance or psychological flexibility. RESULTS: Bereavement guilt was significantly positively associated with anxious, but not avoidant, attachment to the deceased; the relationship between anxious attachment and bereavement guilt was partially mediated by experiential avoidance. Bereavement guilt was also negatively associated with psychological flexibility and engagement with bereavement counseling. SIGNIFICANCE OF RESULTS: Given the limited literature on cancer-related bereavement in young adulthood, this study offers important theoretical and clinical insights into factors associated with more complex aspects of grief in this population. Specifically, this work identified that anxious attachment is associated with ongoing bereavement complications in the years following the death of a caregiver to cancer, with experiential avoidance partially mediating this relationship. While further research is needed to better understand the interaction between these factors and other related constructs, such as psychological flexibility, these findings may be helpful in selecting therapeutic approaches to use with this population.

Sibling bullying victimization and subjective well-being among children across 13 countries: The mediating roles of perceived social support and the moderating role of uncertainty avoidance culture.

BACKGROUND: While sibling bullying victimization has been recognized as a significant factor detrimentally impacting children's subjective well-being, the underlying mechanisms have yet to be fully elucidated. OBJECTIVE: This study seeks to investigate the potential mediating role of perceived social support, encompassing support from family, friend, teacher, and neighbor, as well as the moderating influence of uncertainty avoidance culture. PARTICIPANTS AND SETTING: A sample of 19,328 children was obtained from Wave Three of Children's Worlds: International Survey of Children's Well-being in 13 countries. METHODS: The structural equation model (SEM) was used to investigate the mediating role of perceived social support in the relationship between sibling bullying victimization and children's subjective well-being. The multiple group analysis was carried out to assess the moderating role of uncertainty avoidance culture. RESULTS: This study reveals a negative association between sibling bullying victimization and children's subjective well-being (ß = -0.138, p < 0.001). Perceived support from family, friend, teacher, and neighbor emerges as a mediating mechanism in this relationship. Uncertainty avoidance culture moderates this relationship, and this association is stronger for children raised in a strong uncertainty avoidance culture (ß = -0.085, p < 0.001). CONCLUSIONS: The results of this study contribute to our comprehension of the nexus between sibling bullying victimization and children's subjective well-being. Moreover, this study extends the current body of knowledge by delving into the cultural disparities spanning various countries.

Challenging the law of least effort.

Popular conceptions hold that effort is costly and aversive, causing people to generally avoid effort unless justified. We critically discuss evolutionary, phenomenological, and behavioral arguments supporting this "law of least effort", proposing that people may approach effort without direct extrinsic benefits. First, a "need for effort" is functional for health and learning. Second, experiencing contingency of effort and reward in the context of broader goals may lead to effort-seeking behavior. Moreover, beliefs with implications for the meaning of effort (e.g., as signaling difficulty or lack of talent) predict effort preferences. Thus, evolutionary, developmental, and social-cognitive factors may drive the pursuit of challenging goals that lie beyond life necessities but are essential for improvement and long-term development.

Understanding mental health help-seeking and stigma among Hungarian adults: A network perspective.

BACKGROUND: Hungarians exhibit more negative attitudes toward help-seeking for mental health problems compared to other European countries. However, research on help-seeking in Hungary is limited, and it is unclear how stigma relates to help-seeking when considering demographic and clinical characteristics. We used a network analytic approach to simulate a stigma model using hypothesized constructs in a sizable sample of Hungarian adults. METHODS: Participants were 345 adults recruited from nine primary care offices across Hungary. Participants completed self-report measures assessing public stigma, self-stigma, experiential avoidance (EA), attitudes toward seeking professional psychological help, anxiety, depression, demographics, prior use of mental health services, and whether they have a family member or friend with a mental health condition. RESULTS: EA and anxiety were the most central nodes in the network. The network also revealed associations between greater EA with greater public stigma, anxiety, depression, and having a family member or friend with a mental health condition. More positive attitudes toward seeking help were associated with lower self-stigma, public stigma, and having received psychological treatment in their lifetime. Being female was associated with lower income, higher education, and having received psychological treatment in their lifetime. Finally, having a family member or friend with a mental health condition was associated with having received psychological treatment in their lifetime and greater public stigma. CONCLUSIONS: The strength centrality and associations of EA with clinical covariates and public stigma implicate its importance in stigma models. Findings also suggest that while some aspects of existing stigma models are retained in countries like Hungary, other aspects may diverge.

Plant competition cues activate a singlet oxygen signaling pathway in Arabidopsis thaliana.

Oxidative stress responses of Arabidopsis to reflected low red to far-red signals (R:FR ≈ 0.3) generated by neighboring weeds or an artificial source of FR light were compared with a weed-free control (R:FR ≈1.6). In the low R:FR treatments, induction of the shade avoidance responses (SAR) coincided with increased leaf production of singlet oxygen (1O2). This 1O2 increase was not due to protochlorophyllide accumulation and did not cause cell death. Chemical treatments, however, with 5-aminolevulinic acid (the precursor of tetrapyrrole biosynthesis) and glutathione (a quinone A reductant) enhanced cell death and growth inhibition. RNA sequencing revealed that transcriptome responses to the reflected low R:FR light treatments minimally resembled previously known Arabidopsis 1O2 generating systems that rapidly generate 1O2 following a dark to light transfer. The upregulation of only a few early 1O2 responsive genes (6 out of 1931) in the reflected low R:FR treatments suggested specificity of the 1O2 signaling. Moreover, increased expression of two enzyme genes, the SULFOTRANSFERASE ST2A (ST2a) and the early 1O2-responsive IAA-LEUCINE RESISTANCE (ILR)-LIKE6 (ILL6), which negatively regulate jasmonate level, suggested that repression of bioactive JAs may promote the shade avoidance (versus defense) and 1O2 acclimation (versus cell death) responses to neighboring weeds.

The impact of health information echo chambers on older adults avoidance behavior: the mediating role of information fatigue and the moderating role of trait mindfulness.

Background: In the digital media era, the prevalence of algorithm-driven content push has intensified the health information echo chambers phenomenon, characterized by excessive homogenization and overload of information. This phenomenon may negatively impact the older adults, a "digitally vulnerable" group, by limiting their access to diverse health information and potentially inducing health information avoidance behaviors. However, the psychological mechanisms within this impact process remain unclear, and this study aims to explore them. Additionally, current study introduces trait mindfulness as a potential intervention tool in reducing health information avoidance behavior among the older adults. Methods: This study constructs an impact model based on the Stress-Coping Theory and the Stress-Strain-Outcome (SSO) framework. It identifies health information similarity, relevance, and overload as characteristics of the echo chamber, constituting the Stress part; information fatigue as the Strain; and health information avoidance as the Outcome, with trait mindfulness serving as a moderating factor between Strain and Outcome. A cross-sectional survey of 236 older adults individuals aged 60 and above was conducted, and the collected data were analyzed using SmartPLS and SPSS. Results: The study found that health information similarity and overload significantly increased health information fatigue among the older adults, thereby promoting avoidance behavior, but no significant correlation was found between relevance and fatigue. While there was no significant correlation between trait mindfulness and health information fatigue, it effectively moderated the avoidance behavior induced by fatigue. Conclusion: Current study reveals the impact of the health information echo chamber phenomenon on health information avoidance behavior among the older adults and the moderating role of trait mindfulness. It emphasizes the importance of breaking the health information echo chamber and promoting diverse information dissemination to improve the health information behavior of the older adults. Furthermore, the moderating role of trait mindfulness demonstrates positive intervention potential, providing the older adults with a psychological adjustment mechanism to accept and process health information with a more open attitude, thereby reducing unproductive avoidance behavior.

Mitigating radiation-induced cognitive toxicity in brain metastases: More questions than answers.

The emergence of advanced systemic therapies added to the use of cranial radiation techniques has significantly improved outcomes for cancer patients with multiple brain metastases (BM), leading to a considerable increase in long-term survivors. In this context, the rise of radiation-induced cognitive toxicity (RICT) has become increasingly relevant. In this critical narrative review, we address the controversies arising from clinical trials aimed at mitigating RICT. We thoroughly examine interventions such as memantine, hippocampal avoidance irradiation during BM treatment or in a prophylactic setting, and the assessment of cognitive safety in stereotactic radiosurgery (SRS). Our focus extends to recent neuroscience research findings, emphasizing the importance of preserving not only the hippocampal cortex but also other cortical regions involved in neural dynamic networks and their intricate role in encoding new memories. Despite treatment advancements, effectively managing patients with multiple BM and determining the optimal timing and integration of radiation and systemic treatments remain areas requiring further elucidation. Future trials are required to delineate optimal indications and ensure SRS safety. Additionally, the impact of new systemic therapies and the potential effects of delaying irradiation on cognitive functioning also need to be addressed. Inclusive trial designs, encompassing patients with multiple BM and accounting for diverse treatment scenarios, are essential for advancing effective strategies in managing RICT and the treatment of BM patients.

An examination of the protective role of internalizing symptoms in adolescent substance use.

Although psychological symptoms are broadly considered to be risk factors for substance use, internalizing symptoms may be associated with lower risk for adolescent substance use after controlling for co-occurring externalizing symptoms. The present study explored two potential mediators of this protective association between internalizing symptoms and adolescent substance use: popularity and harm avoidance. The study used data from the Colorado Longitudinal Twin Study (LTS) and Colorado Adoption Project (CAP). Annual assessments of internalizing and externalizing symptoms and social competence were completed by parents and teachers at participant ages 7 to 16. Harm avoidance and substance use were assessed at age 17. In this sample, internalizing symptoms were associated with less frequent substance use, controlling for externalizing symptoms. We did not find evidence that popularity or harm avoidance accounts for the protective association of internalizing symptoms with adolescent substance use. Teacher-reported popularity was associated with less frequent substance use, suggesting that social connectedness in the school context may be a protective factor for adolescent substance use. Harm avoidance was not associated with substance use after accounting for internalizing and externalizing symptoms.