Reservoir-computing based associative memory and itinerancy for complex dynamical attractors.

Traditional neural network models of associative memories were used to store and retrieve static patterns. We develop reservoir-computing based memories for complex dynamical attractors, under two common recalling scenarios in neuropsychology: location-addressable with an index channel and content-addressable without such a channel. We demonstrate that, for location-addressable retrieval, a single reservoir computing machine can memorize a large number of periodic and chaotic attractors, each retrievable with a specific index value. We articulate control strategies to achieve successful switching among the attractors, unveil the mechanism behind failed switching, and uncover various scaling behaviors between the number of stored attractors and the reservoir network size. For content-addressable retrieval, we exploit multistability with cue signals, where the stored attractors coexist in the high-dimensional phase space of the reservoir network. As the length of the cue signal increases through a critical value, a high success rate can be achieved. The work provides foundational insights into developing long-term memories and itinerancy for complex dynamical patterns.

White-nose syndrome, winter duration, and pre-hibernation climate impact abundance of reproductive female bats.

White-nose syndrome (WNS) is an infectious disease that disrupts hibernation in bats, leading to premature exhaustion of fat stores. Though we know WNS does impact reproduction in hibernating female bats, we are unsure how these impacts are exacerbated by local climate factors. We compiled data from four southeastern U.S. states and used generalized linear mixed effects models to compare effects of WNS, pre-hibernation climate variables, and winter duration on the number of reproductive females in species across the range of WNS susceptibility. We predicted we would see a decline in the number of reproductive females in WNS-susceptible species, with the effect exaggerated by longer winter durations and pre-hibernation climate variables that lead to reductions in foraging. We found that the number of reproductive females in WNS-susceptible species was positively correlated with pre-hibernation local climate conditions conducive to foraging; however, WNS-susceptible species experienced an overall decline with the presence of WNS and as winter duration increased. Our long-term dataset provides evidence that pre-hibernation climate, specifically favorable summer weather conditions for foraging, greatly influences the reproduction, regardless of WNS status.

"Integrated behavioral health plus": The best of the worlds of collaborative care management, primary care behavioral health, and primary care.

INTRODUCTION: Discussions comparing the components and virtues of models of integrated behavioral health (IBH), that is, collaborative care management and primary care behavioral health, have been ongoing. In this conceptual article, we recommend shifting the focus to a broader set of components we have found essential to serve the needs of our patients, and hopefully the broader aims of dissemination and implementation of IBH. METHOD: We detail our 20-year experience including the personnel, program components, challenges, successes, and plans for the future that will meet our patients' behavioral health needs and serve primary care. RESULTS: We compare our "IBH Plus" approach using the central tenets of primary care known as the "six Cs" (6Cs) to two dominant models, illustrating differences and similarities among them. The "6Cs" are first contact/accessibility, continuity, comprehensiveness, coordination, context-based, and accountability. We detail how each of these "6Cs" guides the structure and functioning of IBH Plus in the team-based patient-centered medical home setting. DISCUSSION: We believe IBH Plus more clearly relates to and supports the rest of the primary care transformation movement while integrating components of the most popular models of IBH and may support greater implementation of IBH. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Successful Management of Angioinvasive Deep Fungal Infections of the Penis: A Multidisciplinary Approach with Intraoperative Frozen Margins.

BACKGROUND Mucormycosis, a cause of opportunistic infections in immunocompromised patients, is rarely identified in the penis. The literature often describes drastic surgical interventions or rapid patient demise, with scant mention of surgical management specifics. The objective of this report is to detail our experience with this unique infection and highlight the utility of intraoperative frozen margins during surgical management. CASE REPORT Herein, we describe successful treatment of a 55-year-old man with biopsy-proven B-cell acute lymphoblastic leukemia (B-ALL) undergoing Hyper-CVAD (Cyclophosphamide, Vincristine, Adriamycin, and Dexamethasone) therapy who initially presented with an asymptomatic violaceous lesion of the penis. Differential diagnoses ranged from infectious, vasculogenic, and pharmacologic in nature. Ultimately, a punch biopsy tissue culture confirmed angioinvasive fungal infection with Rhizopus and Fusarium species. Initial debridement combined with intravenous antifungal therapy was unsuccessful. However, partial penectomy with use of intraoperative frozen margins, a 5-week course of antifungal therapy, and continued B-ALL treatment allowed effective and lasting resolution of the infection, with partial penile preservation. CONCLUSIONS This case supports a multidisciplinary approach as the primary treatment for penile angioinvasive fungal infections. This includes treatment of the underlying immunocompromising condition, appropriate intravenous antifungal therapy, and urgent operative debridement. This report highlights the importance of utilizing intraoperative frozen sections to ensure negative margins and to optimize overall tissue sparing in this anatomically sensitive area.

Noradrenaline tracks emotional modulation of attention in human amygdala.

The noradrenaline (NA) system is one of the brain's major neuromodulatory systems; it originates in a small midbrain nucleus, the locus coeruleus (LC), and projects widely throughout the brain.1,2 The LC-NA system is believed to regulate arousal and attention3,4 and is a pharmacological target in multiple clinical conditions.5,6,7 Yet our understanding of its role in health and disease has been impeded by a lack of direct recordings in humans. Here, we address this problem by showing that electrochemical estimates of sub-second NA dynamics can be obtained using clinical depth electrodes implanted for epilepsy monitoring. We made these recordings in the amygdala, an evolutionarily ancient structure that supports emotional processing8,9 and receives dense LC-NA projections,10 while patients (n = 3) performed a visual affective oddball task. The task was designed to induce different cognitive states, with the oddball stimuli involving emotionally evocative images,11 which varied in terms of arousal (low versus high) and valence (negative versus positive). Consistent with theory, the NA estimates tracked the emotional modulation of attention, with a stronger oddball response in a high-arousal state. Parallel estimates of pupil dilation, a common behavioral proxy for LC-NA activity,12 supported a hypothesis that pupil-NA coupling changes with cognitive state,13,14 with the pupil and NA estimates being positively correlated for oddball stimuli in a high-arousal but not a low-arousal state. Our study provides proof of concept that neuromodulator monitoring is now possible using depth electrodes in standard clinical use.

Task sequencing does not systematically affect the factor structure of cognitive abilities.

Latent variable analyses of cognitive abilities are among the major means by which cognitive psychologists test theories regarding the structure of human cognition. Models are fit to observed variance-covariance structures, and the fit of those models are compared to assess the merits of competing theories. However, an often unconsidered and potentially important methodological issue is the precise sequence in which tasks are delivered to participants. Here we empirically tested whether differences in task sequences systematically affect the observed factor structure. A large sample (N = 587) completed a battery of 12 cognitive tasks measuring four constructs: working memory, long-term memory, attention control, and fluid intelligence. Participants were assigned to complete the assessment in one of three sequences: fixed and grouped by construct vs. fixed and interleaved across constructs vs. random by participant. We generated and tested two hypotheses: grouping task sequences by construct (i.e., administering clusters of tasks measuring a cognitive construct consecutively) would (1) systematically increase factor loadings and (2) systematically decrease interfactor correlations. Neither hypothesis was supported. The measurement models were largely invariant across the three conditions, suggesting that latent variable analyses are robust to such subtle methodological differences as task sequencing.

Application of a fluorescence EEM-PARAFAC model for direct and indirect potable water reuse monitoring: Multi-stage ozone-biofiltration without reverse osmosis at Gwinnett County, Georgia, USA.

Periods of drought coupled with increasing population growth have prompted increased interest in potable water reuse in Gwinnett County, Georgia, USA. However, such inland water recycling facilities are challenged with treatment approaches where reverse osmosis (RO) membrane concentrate disposal is a barrier to implementation of potable reuse. To evaluate alternative treatment processes, testing of two side-by-side pilot systems using multi-stage ozone and biological filtration without RO was conducted to compare indirect potable reuse (IPR) to direct potable reuse (DPR). Two water sources were investigated-influent from Lake Lanier for the IPR pilot, and a blend of 25 % reclaimed water mixed with lake water (75 %) for the DPR pilot. To assess the nature of organic matter removed during potable reuse, excitation-emission matrix (EEM) fluorescence spectroscopy/PARAllel FACtor (PARAFAC) analyses were examined as a fingerprinting tool. The objectives were to determine (a) if a DPR scenario, when preceded by advanced wastewater treatment, could achieve drinking water quality comparable to IPR and (b) if water quality monitoring using EEM/PARAFAC methods could predict results for DPR and IPR water quality, comparable to parameters obtained in a supplementary study that required more expensive, time-consuming, and complicated analytical techniques. Sample scores representing relative concentrations of fluorescing organic matter derived from the EEM-PARAFAC model decreased in the order of reclaimed water > lake water > DPR pilot > IPR pilot, demonstrating that EEM/PARAFAC could distinguish between DPR and IPR water quality. An assessment of a comprehensive list of individual organic compounds (reported separately) validated that blend ratios of 25 % reclaimed water, or higher mixed with lake water (75 %) did not meet primary and secondary drinking water standards. Likewise, in this study, EEM/PARAFAC analysis demonstrated the 25 % blend did not provide drinking water quality indicating this simple, inexpensive method could be used for potable reuse monitoring.

Testing locus coeruleus-norepinephrine accounts of working memory, attention control, and fluid intelligence.

The current set of studies examined the relationship among working memory capacity, attention control, fluid intelligence, and pupillary correlates of tonic arousal regulation and phasic responsiveness in a combined sample of more than 1,000 participants in two different age ranges (young adults and adolescents). Each study was designed to test predictions made by two recent theories regarding the role of the locus coeruleus-norepinephrine (LC-NE) system in determining individual differences in cognitive ability. The first theory, proposed by Unsworth and Robison (2017a), posits two important individual differences: the moment-to-moment regulation of tonic arousal, and the phasic responsiveness of the system to goal-relevant stimuli. The second theory, proposed by Tsukahara and Engle (2021a), argues that people with higher cognitive abilities have greater functional connectivity between the LC-NE system and cortical networks at rest. These two theories are not mutually exclusive, but they make different predictions. Overall, we found no evidence consistent with a resting-state theory. However, phasic responsiveness was consistently correlated with working memory capacity, attention control, and fluid intelligence, supporting a prediction made by Unsworth and Robison (2017a). Tonic arousal regulation was not correlated with working memory or fluid intelligence and was inconsistently correlated with attention control, which offers only partial support for Unsworth and Robison's (2017a) second prediction.

An assessment of learning rates in habitual prospective memory.

Most laboratory research in the field of prospective memory has focused on newly formed (episodic) intentions that are carried out in the experimental context once or only a small number of times. However, many naturalistic prospective memories are carried out many times and these types of (habitual) intentions have been studied much less in the laboratory. In the current study, our aim was to extend prior work examining habitual intentions in laboratory prospective memory paradigms. Participants formed a typical prospective memory intention and then completed an ongoing task in which the intention could be executed up to 63 times. We examined changes in performance across trials in three traditionally important prospective memory metrics: cue detection, task interference, and cue interference. Across repeated performance of the prospective memory task, we observed an increase in cue detection, elimination of task interference, and elimination of cue interference. These results provide key insights into the operation of learning mechanisms in prospective memory paradigms and promote theory development by showing that many of the resource-demanding processes that are theorized to be necessary for successful prospective memory play much less of a role when intentions are repeatedly completed.

Multiparametric Quantitative Imaging Biomarker as a Multivariate Descriptor of Health: A Roadmap.

Multiparametric quantitative imaging biomarkers (QIBs) offer distinct advantages over single, univariate descriptors because they provide a more complete measure of complex, multidimensional biological systems. In disease, where structural and functional disturbances occur across a multitude of subsystems, multivariate QIBs are needed to measure the extent of system malfunction. This paper, the first Use Case in a series of articles on multiparameter imaging biomarkers, considers multiple QIBs as a multidimensional vector to represent all relevant disease constructs more completely. The approach proposed offers several advantages over QIBs as multiple endpoints and avoids combining them into a single composite that obscures the medical meaning of the individual measurements. We focus on establishing statistically rigorous methods to create a single, simultaneous measure from multiple QIBs that preserves the sensitivity of each univariate QIB while incorporating the correlation among QIBs. Details are provided for metrological methods to quantify the technical performance. Methods to reduce the set of QIBs, test the superiority of the mp-QIB model to any univariate QIB model, and design study strategies for generating precision and validity claims are also provided. QIBs of Alzheimer's Disease from the ADNI merge data set are used as a case study to illustrate the methods described.

ASCENIV utilization in a primary immunodeficiency patient with recurrent viral infections.

Primary immunodeficiency (PI) patients may still experience persistent viral and bacterial respiratory infections with ongoing treatments. We report a challenging case of a PI patient who experienced recurrent viral respiratory infections despite receiving standard immunoglobulin replacement therapy. The patient was subsequently managed with immune globulin intravenous, human-slra (ASCENIV™) that contains elevated antibodies against multiple respiratory pathogens. The patient demonstrated significant clinical improvement with a resolution of persistent and debilitating viral respiratory infections and associated sequela.

Multiparametric Quantitative Imaging Biomarkers for Phenotype Classification: A Framework for Development and Validation.

This manuscript is the third in a five-part series related to statistical assessment methodology for technical performance of multi-parametric quantitative imaging biomarkers (mp-QIBs). We outline approaches and statistical methodologies for developing and evaluating a phenotype classification model from a set of multiparametric QIBs. We then describe validation studies of the classifier for precision, diagnostic accuracy, and interchangeability with a comparator classifier. We follow with an end-to-end real-world example of development and validation of a classifier for atherosclerotic plaque phenotypes. We consider diagnostic accuracy and interchangeability to be clinically meaningful claims for a phenotype classification model informed by mp-QIB inputs, aiming to provide tools to demonstrate agreement between imaging-derived characteristics and clinically established phenotypes. Understanding that we are working in an evolving field, we close our manuscript with an acknowledgement of existing challenges and a discussion of where additional work is needed. In particular, we discuss the challenges involved with technical performance and analytical validation of mp-QIBs. We intend for this manuscript to further advance the robust and promising science of multiparametric biomarker development.

Midbrain-Hippocampus Structural Connectivity Selectively Predicts Motivated Memory Encoding.

Motivation is a powerful driver of learning and memory. Functional MRI studies show that interactions among the dopaminergic midbrain substantia nigra/ventral tegmental area (SN/VTA), hippocampus, and nucleus accumbens (NAc) are critical for motivated memory encoding. However, it is not known whether these effects are transient and purely functional, or whether individual differences in the structure of this circuit underlie motivated memory encoding. To quantify individual differences in structure, diffusion-weighted MRI and probabilistic tractography were used to quantify SN/VTA-striatum and SN/VTA-hippocampus pathways associated with motivated memory encoding in humans. Male and female participants completed a motivated source memory paradigm. During encoding, words were randomly assigned to one of three conditions, reward ($1.00), control ($0.00), or punishment (-$1.00). During retrieval, participants were asked to retrieve item and source information of the previously studied words and were rewarded or penalized according to their performance. Source memory for words assigned to both reward and punishment conditions was greater than those for control words, but there were no differences in item memory based on value. Anatomically, probabilistic tractography results revealed a heterogeneous, topological arrangement of the SN/VTA. Tract density measures of SN/VTA-hippocampus pathways were positively correlated with individual differences in reward-and-punishment-modulated memory performance, whereas density of SN/VTA-striatum pathways showed no association. This novel finding suggests that pathways emerging from the human SV/VTA are anatomically separable and functionally heterogeneous. Individual differences in structural connectivity of the dopaminergic hippocampus-VTA loop are selectively associated with motivated memory encoding.SIGNIFICANCE STATEMENT Functional MRI studies show that interactions among the SN/VTA, hippocampus, and NAc are critical for motivated memory encoding. This has led to competing theories that posit either SN/VTA-NAc reward prediction errors or SN/VTA-hippocampus signals underlie motivated memory encoding. Additionally, it is not known whether these effects are transient and purely functional or whether individual differences in the structure of these circuits underlie motivated memory encoding. Using diffusion-weighted MRI and probabilistic tractography, we show that tract density measures of SN/VTA-hippocampus pathways are positively correlated with motivated memory performance, whereas density of SN/VTA-striatum pathways show no association. This finding suggests that anatomic individual differences of the dopaminergic hippocampus-VTA loop are selectively associated with motivated memory encoding.

IRP commission: sexual minorities and mental health: global perspectives.

Sexual orientation is a key determinant of the identity of human beings. It has also been seen as a social determinant of health. People whose sexual orientation is non-heterosexual or sexual minorities or sexually diverse are included in the broad umbrella term LGBT (Lesbian, Gay, Bisexual, and Transgender) which is a commonly used acronym in activism, social policy, and subsequently cultural literature. For this reason, this Commission focuses primarily on sexual orientation i.e. lesbian, gay and bisexual (LGB) groups. We have used terms non-heterosexual, sexual minorities or sexual variation interchangeably. We have not considered asexual individuals as research in the field is too limited. We are cognisant of the fact that topics relating to mental health and sexual orientation discussed in this Commission will intersect with other issues of personal, cultural and social identity, and will thus be relevant to individuals including many transgender individuals. The inclusion of mental health issues relevant to gender-diverse individuals as well as gender identity is important and deserves its own separate detailed discussion. The exact number of sexually diverse individuals in a population is often difficult to estimate but is likely to be somewhere around 5% of the population. Rates of various psychiatry disorders and suicidal ideation and acts of suicide in LGB populations are higher than general population and these have been attributed to minority stress hypothesis. Elimination of inequality in law can lead to reduction in psychiatric morbidity in these groups. However, these are all diverse groups but even within each group there is diversity and each individual has a distinct and unique experiences, upbringing, responses to their own sexual orientation, and generating varying responses from families, peers and friends as well as communities (including healthcare professionals). The mental healthcare needs of sexual minority individuals vary and these variations must be taken into account in design, development and delivery of healthcare and policies. Improving access to services will help engagement and outcomes and also reduce stigma. The commission recommends that there is no role for so-called conversion therapies and other recommendations are made for clinicians, researchers and policymakers.

Individual differences in working memory capacity, attention control, fluid intelligence, and pupillary measures of arousal.

The present study examined individual differences in 3 cognitive abilities: attention control (AC), working memory capacity (WMC), and fluid intelligence (gF) as they relate the tendency to experience task-unrelated thoughts (TUTs) and the regulation of arousal. Cognitive abilities were measured with a battery of 9 laboratory tasks, TUTs were measured via thought probes inserted into 2 tasks, and arousal regulation was measured via pupillometry. Recent theorizing (Unsworth & Robison, 2017b) suggests that 1 reason why some people experience relatively frequent TUTs and relatively poor cognitive performance-especially AC and WMC-is that they exhibit dysregulated arousal. Here, we examined how arousal regulation might predict both AC and WMC, but also higher-order cognitive abilities like gF. Further, we examine direct and indirect associations with these abilities via a mediating influence of TUT. Participants who reported more TUTs also tended to exhibit poorer AC, lower WMC, and lower gF. Arousal dysregulation correlated with more TUTs and lower AC. However, there was no direct correlation between arousal regulation and WMC, nor between arousal regulation and gF. The association between arousal regulation and gF was indirect via TUT. We discuss the implications of the results in light of the arousal regulation theory of individual differences and directions for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acupuncture in the emergency department for pain management: A BraveNet multi-center feasibility study.

PURPOSE: Pain accounts for up to 78% of emergency department (ED) patient visits and opioids remain a primary method of treatment despite risks of addiction and adverse effects. While prior acupuncture studies are promising as an alternative opioid-sparing approach to pain reduction, successful conduct of a multi-center pilot study is needed to prepare for a future definitive randomized control trial (RCT). METHODS: Acupuncture in the Emergency Department for Pain Management (ACUITY) is funded by the National Center for Complementary and Integrative Health. The objectives are to: conduct a multi-center feasibility RCT, examine feasibility of data collection, develop/deploy a manualized acupuncture intervention and assess feasibility/implementation (barrier/facilitators) in 3 EDs affiliated with the BraveNet Practice Based Research Network.Adults presenting to a recruiting ED with acute non-emergent pain (e.g., musculoskeletal, back, pelvic, noncardiac chest, abdominal, flank or head) of ≥4 on a 0-10-point Numeric Rating Scale will be eligible. ED participants (n = 165) will be equally randomized to Acupuncture or Usual Care.At pre-, post-, and discharge time-points, patients will self-assess pain and anxiety using the Numeric Rating Scale. Pain, anxiety, post-ED opioid use and adverse events will be assessed at 1 and 4 weeks. Opioid utilization in the ED and discharge prescriptions will be extracted from patients' electronic medical records.Acupuncture recipients will asked to participate in a brief qualitative interview about 3 weeks after their discharge. ED providers and staff will also be interviewed about their general perspectives/experiences related to acupuncture in the ED and implementation of acupuncture in ACUITY. RESULTS: Recruitment began on 5/3/21. As of 12/7/21: 84 patients have enrolled, the responsive acupuncture intervention has been developed and deployed, and 26 qualitative interviews have been conducted. CONCLUSION: Successful conduct of ACUITY will provide the necessary framework for conducting a future, multi-center, definitive RCT of acupuncture in the ED. CLINICAL TRIALSGOV: NCT04880733 https://clinicaltrials.gov/ct2/show/NCT04880733.

The impact of divided attention on automatic postural responses: A systematic review and meta-analysis.

Quick responses to a loss of balance or "automatic postural responses" (APRs) are critical for fall prevention. The addition of a distracting task- dual-tasking (DT), typically worsens performance on mobility tasks. However, the effect of DT on APRs is unclear. We conducted a systematic review and meta-analyses to examine the effects of DT on spatial, temporal, and neuromuscular components of APRs and the effect of DT on cognitive performance. A Meta-analysis of 19 cohorts (n = 329) showed significant worsening in spatial kinematic features of APRs under DT conditions (P = 0.01), and a meta-analysis of 9 cohorts (n = 123) demonstrated later muscle onset during DT (P = 0.003). No significant DT effect was observed for temporal kinematic outcomes in 18 cohorts (n = 328; P = 0.47). Finally, significant declines in cognitive performance were evident in 20 cohorts (n = 400; P = 0.002). These results indicate that, despite the somewhat reactive nature of APRs, the addition of a secondary task negatively impacts some aspects of the response. These findings underscore the importance of cortical structures in APR generation. Given the importance of APRs for falls, identifying aspects of APRs that are altered under DT may inform fall-prevention treatment approaches.

Development and evaluation of safety and effectiveness of novel cancer screening tests for routine clinical use with applications to multicancer detection technologies.

Multicancer screening is a promising approach to improving the detection of preclinical disease, but current technologies have limited ability to identify precursor or early stage lesions, and approaches for developing the evidentiary chain are unclear. Frameworks to enable development and evaluation from discovery through evidence of clinical effectiveness are discussed.

Development of a fluorescence EEM-PARAFAC model for potable water reuse monitoring: Implications for inter-component protein-fulvic-humic interactions.

Measuring the surrogate parameters total organic carbon and dissolved organic carbon (TOC/DOC) is not adequate, alone, to reveal nuances in organic character for optimizing treatment in potable water reuse. Alternatively, analyzing each organic compound contributing to the surrogate measurement is not possible. As an additional analytical tool applied between these extremes, the use of excitation-emission matrix fluorescence spectroscopy with PARAllel FACtor (EEM-PARAFAC) analysis was investigated in this research to track categories (components) or families of organic compounds during treatment in recycled water schemes. Although not all organic molecules fluoresce, many do, and fluorescence helps track their fate through water treatment processes. The sites investigated in this research were Lake Lanier, in Gwinnett County, Georgia, USA; the F. Wayne Hill Water Resources Center (FWH WRC) advanced wastewater treatment facility; and two pilot facilities operated in parallel representing the current indirect potable reuse (IPR) scheme as well as a pilot that evaluated direct potable reuse (DPR). A four-component nonnegativity PARAFAC model-elucidating protein-like (including tyrosine- and tryptophan-like fluorescence in a single component), soluble microbial product (SMP)-like, fulvic-like, and humic-like components-was fitted to the data. Each of the four components was spectrally and mathematically separated, implying that the fluorescing SMP-like component was not comprised of protein-, fulvic-, or humic-like components. PARAFAC excitation loadings with dual (double) pairs of fluorescing regions centered at the same emission wavelengths but different excitation wavelengths oriented parallel to the excitation axis and perpendicular to the emission axis were attributed to individual PARAFAC components. Significantly, the observation of PARAFAC emission loadings with multiple peaks-where the protein-like component exhibited fluorescence in both protein and fulvic/humic regions-is proposed to signify an intermolecular energy transfer (< 10 nm). Correct identification of EEM-PARAFAC components is fundamental to understanding water treatment.