Caring for Refugees with Mental Health Problems: Difficulties Encountered by Providers Requesting Exemptions from United States Citizenship Examinations.

Mental health providers caring for refugees should be aware that obtaining citizenship is critical to stability and safety for their patients. In the United States (U.S.), obtaining citizenship requires applicants to pass an examination exhibiting working knowledge of English and foundational knowledge of U.S. civics. For refugees with mental health disorders that impair cognition, this may present insurmountable barriers. The United States Customs and Immigration Services (USCIS) offers form N-648 to request exemption from these requirements. However, the form can be difficult to complete in a manner acceptable to USCIS. In this paper, the authors present preliminary data on citizenship-related mental health evaluations and subsequent applications for 40 patients seen in a university-based refugee mental health clinic. We simplify the process into three phases, and present three cases highlighting specific complexities involved. Our experiences and recommendations may help other mental health providers prepare to advocate for their refugee patients.

Disrupted basal ganglia output during movement preparation in hemiparkinsonian mice is consistent with behavioral deficits.

Parkinsonian motor deficits are associated with elevated inhibitory output from the basal ganglia (BG). However, several features of Parkinson's disease (PD) have not been accounted for by this simple "classical rate model" framework, including the observation in patients with PD that movements guided by external stimuli are less impaired than otherwise identical movements generated based on internal goals. Is this difference due to divergent processing within the BG itself or due to the recruitment of extra-BG pathways by sensory processing? In addition, surprisingly little is known about precisely when, in the sequence from selecting to executing movements, BG output is altered by PD. Here, we address these questions by recording activity in the substantia nigra pars reticulata (SNr), a key BG output nucleus, in hemiparkinsonian mice performing a well-controlled behavioral task requiring stimulus-guided and internally specified directional movements. We found that hemiparkinsonian mice exhibited a bias ipsilateral to the side of dopaminergic cell loss that was stronger when movements were internally specified rather than stimulus guided, consistent with clinical observations in patients with Parkinson's disease. We further found that changes in parkinsonian SNr activity during movement preparation were consistent with the ipsilateral behavioral bias, as well as its greater magnitude for internally specified movements. Although these findings are inconsistent with some aspects of the classical rate model, they are accounted for by a related "directional rate model" positing that SNr output phasically overinhibits motor output in a direction-specific manner. These results suggest that parkinsonian changes in BG output underlying movement preparation contribute to the greater deficit in internally specified than stimulus-guided movements.NEW & NOTEWORTHY Movements of patients with Parkinson's disease are often less impaired when guided by external stimuli than when generated based on internal goals. Whether this effect is due to distinct processing in the basal ganglia (BG) or due to compensation from other motor pathways is an open question with therapeutic implications. We recorded BG output in behaving parkinsonian mice and found that BG activity during movement preparation was consistent with the differences between these forms of movement.

Associations Between School-Based Substance Use Treatment and Academic Outcomes.

Objectives: Evaluate the association between school-based treatment of substance use disorders and academic outcomes by developing a system of simple and easily tracked academic performance metrics coinciding with an established substance use treatment program. Methods: This study provided treatment to 75 high school students enrolled without exclusion who voluntarily sought care for substance use disorders. Participants were enrolled in a 12-week program of individual motivational interviewing, acceptance and commitment therapy, family sessions, case management, contingency management, and psychiatric consultation at school-based health centers. We tracked distinct metrics of substance use treatment, including urine drug screens and self-reported use, along with three key metrics of academic performance referred to as the ABCs: attendance (No. of missed classes and percentage of days attended), behavior (No. of behavioral incidents per semester), and credits (grade-point average). Results: Participants in the study attended an average of 6.4 sessions and nearly 50% attained a negative urine drug screen. Participants demonstrated a significant reduction in behavioral incidents with an average decrease from 1.2 to 0.41 incidents per semester (p < 0.01). In addition, there was a reduction in the mean number of missed classes from 148 per semester to 127 (p = 0.001). Conclusions: School-based substance use treatment appears to be associated with a reduction in behavioral incidents and improved class attendance. This study provides the foundation for development of a robust school-based substance treatment program that can be rigorously evaluated against a control group for students with substance use disorders.

Spatial representations in the superior colliculus are modulated by competition among targets.

Selecting and moving to spatial targets are critical components of goal-directed behavior, yet their neural bases are not well understood. The superior colliculus (SC) is thought to contain a topographic map of contralateral space in which the activity of specific neuronal populations corresponds to particular spatial locations. However, these spatial representations are modulated by several decision-related variables, suggesting that they reflect information beyond simply the location of an upcoming movement. Here, we examine the extent to which these representations arise from competitive spatial choice. We recorded SC activity in male mice performing a behavioral task requiring orienting movements to targets for a water reward in two contexts. In "competitive" trials, either the left or right target could be rewarded, depending on which stimulus was presented at the central port. In "noncompetitive" trials, the same target (e.g., left) was rewarded throughout an entire block. While both trial types required orienting movements to the same spatial targets, only in competitive trials do targets compete for selection. We found that in competitive trials, pre-movement SC activity predicted movement to contralateral targets, as expected. However, in noncompetitive trials, some neurons lost their spatial selectivity and in others activity predicted movement to ipsilateral targets. Consistent with these findings, unilateral optogenetic inactivation of pre-movement SC activity ipsiversively biased competitive, but not noncompetitive, trials. Incorporating these results into an attractor model of SC activity points to distinct pathways for orienting movements under competitive and noncompetitive conditions, with the SC specifically required for selecting among multiple potential targets.

Basal ganglia output reflects internally-specified movements.

How movements are selected is a fundamental question in systems neuroscience. While many studies have elucidated the sensorimotor transformations underlying stimulus-guided movements, less is known about how internal goals - critical drivers of goal-directed behavior - guide movements. The basal ganglia are known to bias movement selection according to value, one form of internal goal. Here, we examine whether other internal goals, in addition to value, also influence movements via the basal ganglia. We designed a novel task for mice that dissociated equally rewarded internally-specified and stimulus-guided movements, allowing us to test how each engaged the basal ganglia. We found that activity in the substantia nigra pars reticulata, a basal ganglia output, predictably differed preceding internally-specified and stimulus-guided movements. Incorporating these results into a simple model suggests that internally-specified movements may be facilitated relative to stimulus-guided movements by basal ganglia processing.

An integrative role for the superior colliculus in selecting targets for movements.

A fundamental goal of systems neuroscience is to understand the neural mechanisms underlying decision making. The midbrain superior colliculus (SC) is known to be central to the selection of one among many potential spatial targets for movements, which represents an important form of decision making that is tractable to rigorous experimental investigation. In this review, we first discuss data from mammalian models-including primates, cats, and rodents-that inform our understanding of how neural activity in the SC underlies the selection of targets for movements. We then examine the anatomy and physiology of inputs to the SC from three key regions that are themselves implicated in motor decisions-the basal ganglia, parabrachial region, and neocortex-and discuss how they may influence SC activity related to target selection. Finally, we discuss the potential for methodological advances to further our understanding of the neural bases of target selection. Our overarching goal is to synthesize what is known about how the SC and its inputs act together to mediate the selection of targets for movements, to highlight open questions about this process, and to spur future studies addressing these questions.

Crystal structure of QscR, a Pseudomonas aeruginosa quorum sensing signal receptor.

Acyl-homoserine lactone (AHL) quorum sensing controls gene expression in hundreds of Proteobacteria including a number of plant and animal pathogens. Generally, the AHL receptors are members of a family of related transcription factors, and although they have been targets for development of antivirulence therapeutics there is very little structural information about this class of bacterial receptors. We have determined the structure of the transcription factor, QscR, bound to N-3-oxo-dodecanoyl-homoserine lactone from the opportunistic human pathogen Pseudomonas aeruginosa at a resolution of 2.55 Å. The ligand-bound QscR is a dimer with a unique symmetric "cross-subunit" arrangement containing multiple dimerization interfaces involving both domains of each subunit. The QscR dimer appears poised to bind DNA. Predictions about signal binding and dimerization contacts were supported by studies of mutant QscR proteins in vivo. The acyl chain of the AHL is in close proximity to the dimerization interfaces. Our data are consistent with an allosteric mechanism of signal transmission in the regulation of DNA binding and thus virulence gene expression.