New Framework for Understanding Cross-Brain Coherence in Functional Near-Infrared Spectroscopy (fNIRS) Hyperscanning Studies.

Despite the growing body of functional near-infrared spectroscopy (fNIRS) hyperscanning studies, the assessment of coupling between two neural signals using wavelet transform coherence (WTC) seems to ignore the directionality of the interaction. The field is currently lacking a framework that allows researchers to determine whether a high coherence value obtained using a WTC function reflects in-phase synchronization (i.e., neural activation is seen in both members of the dyad at the same time), lagged synchronization (i.e., neural activation is seen in one member of the dyad prior to the other member), or anti-phase synchronization (i.e., neural activation is increased in one member of the dyad and decreased in the other). To address this need, a complementary and more sensitive approach for analyzing the phase coherence of two neural signals is proposed in this work. The toolbox allows investigators to estimate the coupling directionality by classifying the phase angle values obtained using traditional WTC into in-phase synchronization, lagged synchronization, and anti-phase synchronization. The toolbox also allows researchers to assess how the dynamics of interactions develop and change throughout the task. Using this novel WTC approach and the toolbox will advance our understanding of complex social interactions through their uses in fNIRS hyperscanning studies.

Exploring the feasibility of tensor decomposition for analysis of fNIRS signals: a comparative study with grand averaging method.

The analysis of functional near-infrared spectroscopy (fNIRS) signals has not kept pace with the increased use of fNIRS in the behavioral and brain sciences. The popular grand averaging method collapses the oxygenated hemoglobin data within a predefined time of interest window and across multiple channels within a region of interest, potentially leading to a loss of important temporal and spatial information. On the other hand, the tensor decomposition method can reveal patterns in the data without making prior assumptions of the hemodynamic response and without losing temporal and spatial information. The aim of the current study was to examine whether the tensor decomposition method could identify significant effects and novel patterns compared to the commonly used grand averaging method for fNIRS signal analysis. We used two infant fNIRS datasets and applied tensor decomposition (i.e., canonical polyadic and Tucker decompositions) to analyze the significant differences in the hemodynamic response patterns across conditions. The codes are publicly available on GitHub. Bayesian analyses were performed to understand interaction effects. The results from the tensor decomposition method replicated the findings from the grand averaging method and uncovered additional patterns not detected by the grand averaging method. Our findings demonstrate that tensor decomposition is a feasible alternative method for analyzing fNIRS signals, offering a more comprehensive understanding of the data and its underlying patterns.

Patients' experience and utilization patterns of diclofenac gel in Germany: a real-world study with a prospective longitudinal survey and a retrospective analysis of pharmacy data.

OBJECTIVE: Describe and characterize treatment patterns, satisfaction, improvement in pain and functional impairment (health-related quality of life [HRQoL]) in users of over the counter (OTC) Voltaren gel diclofenac (VGD) 2.32% and 1.16% in a real-world setting. METHODS: This observational real-world German study had prospective and retrospective components. The prospective data were collected from electronic surveys completed by adults who purchased VGD to treat their musculoskeletal pain at baseline and 4 and 12 weeks after baseline. Retrospective data were from a 12-month (March 2019 to February 2020) abstraction from dispensing software platforms used in select German pharmacies. RESULTS: Surveys from 467 participants (mean age 60.8 years) were analyzed. Average pain severity at baseline was 6.0 on an 11-point Numeric Rating Scale (0 = no pain, 10 = worst possible pain), improving by 0.8 and 1.2 points at Weeks 4 and 12, respectively. Performance of functional activities (daily/physical/social activities and errands/chores) improved and the proportion of participants with at least moderate interference decreased at both follow-up timepoints. Retrospective analyses indicated that majority of patients receiving VGD (n = 95,085) were ≥65 years old (67.9%), had one dispensed tube (70.8%) and did not switch to another topical treatment (including other NSAIDs) (77.3%), and were co-prescribed at least one cardiovascular medication (74.3%). CONCLUSIONS: This study provides the first real-world insights into OTC VGD use in Germany. The participants using VGD reported a decrease in pain severity and an improvement of HRQoL while under treatment, as well as resulting satisfaction with treatment. Patients infrequently switched to alternate topical therapies/NSAIDs.

When I move, you move: Associations between automatic and person-coded measures of infant-mother synchrony during free-play using virtual in-home data collection.

The relationship between movement synchrony and global scores of behavioral synchrony were investigated during a naturalistic free-play between 33 infants (ages 12- to 24-months) and their mothers using a video-conferencing platform. We assessed movement synchrony by applying an automatic tool, motion-energy analysis (MEA), to the obtained video data. Dyadic movement synchrony was associated with higher levels of maternal sensitivity, infant involvement, dyadic reciprocity, and a child-led interaction pattern. This demonstrates the feasibility of using MEA as an automatic tool for assessing movement synchrony in mother-infant dyads and its application for investigating naturalistic at-home free play sessions in a remote setting.

Cortical Activation to Social and Mechanical Stimuli in the Infant Brain.

From the early days of life infants distinguish between social and non-social physical entities and have different expectations for the way these two entities should move and interact. At the same time, we know very little about the cortical systems that support this early emerging ability. The goal of the current research was to assess the extent to which infant's processing of social and non-social physical entities is mediated by distinct information processing systems in the temporal cortex. Using a cross-sectional design, infants aged 6-9 months (Experiment 1) and 11-18 months (Experiment 2) were presented with two types of events: social interaction and mechanical interaction. In the social interaction event (patterned after Hamlin et al., 2007), an entity with googly eyes, hair tufts, and an implied goal of moving up the hill was either helped up, or pushed down, a hill through the actions of another social entity. In the mechanical interaction event, the googly eyes and hair tufts were replaced with vertical black dots and a hook and clasp, and the objects moved up or down the hill via mechanical interactions. FNIRS was used to measure activation from temporal cortex while infants viewed the test events. In both age groups, viewing social and mechanical interaction events elicited different patterns of activation in the right temporal cortex, although responses were more specialized in the older age group. Activation was not obtained in these areas when the objects moved in synchrony without interacting, suggesting that the causal nature of the interaction events may be responsible, in part, to the results obtained. This is one of the few fNIRS studies that has investigated age-related patterns of cortical activation and the first to provide insight into the functional development of networks specialized for processing of social and non-social physical entities engaged in interaction events.

Understanding the migraine treatment landscape prior to the introduction of calcitonin gene-related peptide inhibitors: Results from the Assessment of TolerabiliTy and Effectiveness in MigrAINe Patients using Preventive Treatment (ATTAIN) study.

BACKGROUND: Calcitonin gene-related peptide (CGRP) inhibitors were introduced in the United States (US) in 2018. To understand the changing patterns of preventive treatment following the introduction of these new agents, we must first characterize the patterns which preceded their introduction. OBJECTIVE: To characterize the burden, unmet need, and treatment patterns in patients with migraine initiating preventive migraine medications before the introduction of CGRP inhibitors in the US. METHODS: Between March 2016 and October 2017, we enrolled episodic (EM) and chronic migraine (CM) patients initiating or changing preventive treatment at primary care or neurology clinic visits in the US, in a real-world observational study using a prospective cohort design. At baseline and monthly thereafter for 6 months, we collected data from study sites and patients on migraine frequency, treatment modifications, migraine impact on functioning, and work productivity for a descriptive analysis of migraine patient experience and treatment patterns. RESULTS: From the sample of 234 completers, 118 had EM (50.4%) and 116 had CM (49.6%). Mean age at enrollment was 41 years (SD = 12) and mean age at first migraine diagnosis was 22 years (SD = 11). Most participants were females (n = 204/234; 87.2%) and white (n = 178/234; 76.1%). The majority (n = 164/234; 70.1%) had not used preventive migraine treatment in the 5 years prior to enrollment (treatment naïve). At baseline, mean monthly migraine days were 9.6 days (SD = 5.0) for the preventive treatment naïve group and 12.4 days (SD = 7.0) for treatment experienced patients. The majority had severe Migraine Disability Assessment (Grade IV, total score ≥21), including 67.1% (n = 110/164) of the preventive treatment naïve and 77.1% (n = 54/70) of the preventive treatment experienced patients. Headache Impact Test total scores indicating severe impairment (score >59) occurred in 88.4% (n = 145/164) of the treatment naïve and 88.6% (n = 62/70) of treatment experienced patients. Mean work productivity loss as measured by the Work Productivity and Activity Impairment questionnaire in the subsample of employed patients was 53.3% loss. The most used acute medications at baseline were nonsteroidal anti-inflammatory agents (n = 124/234; 53.0%), acetaminophen-based products (n = 112/234; 47.9%), and triptans (n = 105/234; 44.9%). The most commonly initiated preventive treatments were topiramate (n = 100/234; 42.7%), tricyclic antidepressants (n = 39/234; 16.7%), beta-blockers (n = 26/234; 11.1%), and onabotulinumtoxinA (n = 24/234; 10.3%). Over the 6-month follow-up period, almost half of patients (n = 116/234, 49.6%) modified their preventive treatment and discontinued treatment (n = 88/312 total modifications; 28.2%) or modified their pattern of use by increasing, decreasing, or skipping doses (n = 224/312 total modifications; 71.8%), often without seeking medical advice. Avoiding side effects was the main reason reported among patients who discontinued (n = 52/88; 59.1%), decreased frequency or dose (n = 37/89; 41.6%), and skipped doses (n = 29/86; 33.7%). Perceived lack of efficacy was another frequent reason reported among those who discontinued (n = 20/88; 22.7%), decreased frequency or dose (n = 15/89; 16.9%), and skipped doses (n = 18/86; 20.9%). Despite initiation of preventive treatment and improvements observed in number of headache and migraine days, migraine patients continued to experience substantial disability, headache impact, and reduced productivity throughout the 6-month follow-up period. CONCLUSIONS: Prior to 2018, the burden of migraine was high for patients initiating preventive treatments. Despite having more than 9 days of migraine per month on average, the majority (70.1%) of patients initiating prevention had been treatment naïve, indicating underuse of preventive treatments. The preventive treatments used in this study were poorly tolerated and were reported by patients to lack efficacy, resulting in suboptimal adherence. The high discontinuation rates suggest that the preventive medications being offered during the period of the study did not meet the treatment needs of patients. In addition, the decisions by about half of patients to alter their prescribed treatment plan without consulting their provider can pose substantial health risks. These findings pertain to the broad set of preventive treatments initiated in this study and do not support inferences about individual preventive treatments, due to limitations in sample size. These findings suggest the need for more effective and better tolerated preventive treatment options.

Tensor Decomposition of Functional Near-Infrared Spectroscopy (fNIRS) Signals for Pattern Discovery of Cognitive Response in Infants.

Functional near-infrared spectroscopy (fNIRS) provides an effective tool in neuroscience studies of cognition in infants. fNIRS signals are normally processed by applying ANOVA analysis on the grand average of the hemodynamic responses to investigate the cognitive-related differences between experimental groups. However, this averaging approach does not account for any differences in the temporal patterns of the responses. Therefore, we propose a new approach based on a combination of tensor decomposition and ANOVA. First, a four-way tensor of the hemodynamic responses is arranged as time × frequency × channel× subject and decomposed using Canonical Polyadic Decomposition (CPD). Next, ANOVA is applied to identify significant patterns between subjects. Instead of averaging, the CPD can capture the distinct patterns between groups in all the dimensions. We used fNIRS dataset of 70 infants who participated in an experiment to investigate cortical activation to an agent (i.e., mechanical claws vs. human hands) with different events (i.e., function and non-function). In the comparison with the traditional ANOVA, CPD+ANOVA identified the same significance factors. However, CPD+ANOVA discovered new information on the temporal and spatial patterns indicating a longer interval hemodynamic responses, which was missed using the traditional ANOVA. This new analysis of hemodynamic responses as captured using fNIRS will improve neuroscience and cognitive studies.

Women manifest more severe COPD symptoms across the life course.

BACKGROUND: Previous studies suggest that gender differences exist in COPD diagnosis and symptoms; these differences may be more pronounced in younger adults. Our objective was to explore age-associated gender differences across a range of COPD severities. MATERIALS AND METHODS: A total of 4,484 current and former smokers with COPD from the Genetic Epidemiology of COPD cohort were investigated using regression modeling to explore the association between gender, age, disease severity, and the contributing elements of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system (symptoms, exacerbation risk, airflow limitation). RESULTS: The age-gender interaction was observed across multiple age categories. Compared to men with COPD, younger women with COPD had a greater likelihood of more severe dyspnea, airflow limitation, greater risk for exacerbations, and categorization in GOLD groups B and D. These differences were less pronounced in older women with COPD. However, older women remained more likely to experience severe dyspnea and to manifest more severe COPD (B vs A) than older men, despite lower pack-years of smoking. CONCLUSION: These data demonstrate the significant symptom burden of COPD in women, especially younger women. More research is needed to understand the pathogenesis of increased severity of COPD in women and to develop gender-targeted clinical assessment and management approaches to improve outcomes for women and men with COPD at all ages.

Cortical responses to shape-from-motion stimuli in the infant.

Our ability to extract three-dimensional (3-D) object structure from motion-carried information is a basic visual capacity that is fundamental to object perception. Despite a rich body of behavioral work demonstrating that infants are sensitive to motion-carried information from the early months of life, little is known about the cortical networks that support infants' use of motion-carried information to extract 3-D object structure. This study assessed patterns of cortical activation in infants aged 4 to 6 months as they viewed two types of visual stimuli: (a) shape-from-motion (SFM) displays, where coherent motion of randomly distributed dots gave rise to the percept of 3-D shape and (b) random motion (RM) displays, where dots' motions lacked a coherent structure and gave rise to the percept of randomly moving dots. Functional near-infrared spectroscopy was used to assess activation in occipital, inferior parietal, and posterior temporal cortex. The optical imaging data revealed differential responding to SFM and RM in lower level object processing areas than typically observed in the adult. Possible explanations for this pattern of results are considered.

Evaluation of COPD Treatments: A Multicriteria Decision Analysis of Aclidinium and Tiotropium in the United States.

BACKGROUND: Comparisons of the use of aclidinium bromide and tiotropium bromide for the treatment of chronic obstructive pulmonary disease often concentrate on key end points (exacerbations) at the expense of other benefits and risks. Multicriteria decision analysis (MCDA) can help overcome this by using stakeholder preferences to combine multiple end points into an overall value estimate. OBJECTIVES: To evaluate the use of aclidinium bromide twice daily via Pressair™ (AstraZeneca Pharmaceuticals LP, Wilmington, DE) and of tiotropium once daily via HandiHaler® (Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT) from the perspective of patients using MCDA. METHODS: Literature reviews and clinician engagement were used to identify value criteria. Performance of criteria was estimated from a clinical trial and clinician opinion. Scores and swing weights came from six clinicians who, during a 2-day workshop, reflected their patients' preferences. Scenario and sensitivity analyses were used to explore uncertainty in model designs and inputs. RESULTS: Fourteen criteria, covering clinical effectiveness, safety, and convenience of the treatments of chronic obstructive pulmonary disease, were identified. Exacerbations and device preloading were identified as the most important to patients; the least important was rescue medication use. Tiotropium's higher overall clinical effectiveness score was offset by aclidinium's better performance on safety and convenience outcomes. The MCDA generated a -42 (worst performance) to 100 (best performance) scale. The net impact of benefits over risks of aclidinium (38.5) exceeded that of tiotropium (13.2), and patients preferred aclidinium 79.7% of the time. CONCLUSIONS: When considering clinical benefits and risks, aclidinium and tiotropium generate similar value to patients, but when convenience criteria are considered, aclidinium may be preferred. Further work is required to replicate these results, including eliciting preferences directly from patients.

Initiation of triple therapy maintenance treatment among patients with COPD in the US.

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends triple therapy (long-acting muscarinic receptor antagonists, long-acting beta-2 agonists, and inhaled corticosteroids) for patients with only the most severe COPD. Data on the proportion of COPD patients on triple therapy and their characteristics are sparse and dated. Objective 1 of this study was to estimate the proportion of all, and all treated, COPD patients receiving triple therapy. Objective 2 was to characterize those on triple therapy and assess the concordance of triple therapy use with GOLD guidelines. PATIENTS AND METHODS: This retrospective study used claims from the IMS PharMetrics Plus database from 2009 to 2013. Cohort 1 was selected to assess Objective 1 only; descriptive analyses were conducted in Cohort 2 to answer Objective 2. A validated claims-based algorithm and severity and frequency of exacerbations were used as proxies for COPD severity. RESULTS: Of all 199,678 patients with COPD in Cohort 1, 7.5% received triple therapy after diagnosis, and 25.5% of all treated patients received triple therapy. In Cohort 2, 30,493 COPD patients (mean age =64.7 years) who initiated triple therapy were identified. Using the claims-based algorithm, 34.5% of Cohort 2 patients were classified as having mild disease (GOLD 1), 40.8% moderate (GOLD 2), 22.5% severe (GOLD 3), and 2.3% very severe (GOLD 4). Using exacerbation severity and frequency, 60.6% of patients were classified as GOLD 1/2 and 39.4% as GOLD 3/4. CONCLUSION: In this large US claims database study, one-quarter of all treated COPD patients received triple therapy. Although triple therapy is recommended for the most severe COPD patients, spirometry is infrequently assessed, and a majority of the patients who receive triple therapy may have only mild/moderate disease. Any potential overprescribing of triple therapy may lead to unnecessary costs to the patient and health care system.

On the other hand: Increased cortical activation to human versus mechanical hands in infants.

There is a large body of work demonstrating that infants are sensitive to the distinction between human and mechanical entities from the early months of life, and have different expectations for the way these entities move and interact. The current work investigates the extent to which the functional organization of the immature brain reflects these early emerging sensitivities. Infants aged 8months watched two kinds of hands (human or mechanical) engage in two kinds of events (one with a functional outcome and one without). Using functional near-infrared spectroscopy (fNIRS), we assessed hemodynamic activation in the left and right temporal and temporal-occipital cortex in response to these events. The neuroimaging data revealed a significantly greater increase in activation in the right middle-posterior temporal cortex to events executed by the human than the mechanical hand; the event in which the hand engaged (function or non-function) did not significantly influence hemodynamic responses. In comparison, the left middle-temporal cortex showed significantly greater activation to events executed by the human than mechanical hand, but only when the events were functionally relevant. That is, the left middle-posterior temporal cortex responded selectively to human (as compared to mechanical) agents, but only in the context of functionally relevant actions on objects. These results reveal that the immature brain is functionally specialized to support infants' processing of human and non-human agents as distinct entities. These results also shed light on the cognitive and cortical mechanisms that guide infants' learning about agentive action and object function.

Infants Prefer Female Body Phenotypes; Infant Girls Prefer They Have an Hourglass Shape.

Adolescents and adults show preferences for male and female body shapes consistent with evolutionary theories of reproductive fitness and mate selection. However, when these preferences for females with narrow waists (i.e., 0.7 waist-to-hip ratio) and men with broad shoulders (i.e., mesomorphic body shape) emerge during the lifespan is largely unknown. To address this knowledge gap, eye-movements were tracked in 146 infants (3-18 months of age) during computer presentation of three-dimensional human figures varying in body features thought relevant for reproductive success (e.g., secondary sex characteristics, waist-to-hip ratio). When presented with pairs of figures differing in apparent sex, male and female infants looked significantly longer at the female figure compared to the male figure, a new finding that extends previous research showing preferences for female faces in infancy. When presented with same-sex figures differing in characteristics associated with mate value, male and female infants looked longer at a low mate value male (i.e., an endomorphic body type) compared to a high mate value male (i.e., a mesomorphic body type), a finding that replicates the results of previous research. In addition, the novel use of high and low mate value female figures showed a sex difference in visual attention, such that female infants looked longer at the high mate value female figure compared to the low mate female figure whereas male infants showed the opposite pattern of results. In sum, these findings suggest that infants generally do not possess preferences for adult-defined attractive male body shapes. However, infant girls' greater attention to a female figure with an adult-preferred waist-to-hip ratio raises the possibility that evolved preferences for 0.7 waist-to-hip ratio influence girls' later preference for toys representing females with an hourglass shape, perhaps supporting elaboration of adult social behaviors that enhance reproductive success (e.g., cooperative breeding).

Corrigendum: Functional Activation in the Ventral Object Processing Pathway during the First Year.

[This corrects the article on p. 180 in vol. 9, PMID: 26778979.].

The association of lung function and St. George's respiratory questionnaire with exacerbations in COPD: a systematic literature review and regression analysis.

BACKGROUND: This study investigated the relationship between changes in lung function (as measured by forced expiratory volume in one second [FEV1]) and the St. George's Respiratory Questionnaire (SGRQ) and economically significant outcomes of exacerbations and health resource utilization, with an aim to provide insight into whether the effects of COPD treatment on lung function and health status relate to a reduced risk for exacerbations. METHODS: A systematic literature review was conducted in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials of adult COPD patients published in English since 2002 in order to relate mean change in FEV1 and SGRQ total score to exacerbations and hospitalizations. These predictor/outcome pairs were analyzed using sample-size weighted regression analyses, which estimated a regression slope relating the two treatment effects, as well as a confidence interval and a test of statistical significance. RESULTS: Sixty-seven trials were included in the analysis. Significant relationships were seen between: FEV1 and any exacerbation (time to first exacerbation or patients with at least one exacerbation, p = 0.001); between FEV1 and moderate-to-severe exacerbations (time to first exacerbation, patients with at least one exacerbation, or annualized rate, p = 0.045); between SGRQ score and any exacerbation (time to first exacerbation or patients with at least one exacerbation, p = 0.0002) and between SGRQ score and moderate-to-severe exacerbations (time to first exacerbation or patients with at least one exacerbation, p = 0.0279; annualized rate, p = 0.0024). Relationships between FEV1 or SGRQ score and annualized exacerbation rate for any exacerbation or hospitalized exacerbations were not significant. CONCLUSIONS: The regression analysis demonstrated a significant association between improvements in FEV1 and SGRQ score and lower risk for COPD exacerbations. Even in cases of non-significant relationships, results were in the expected direction with few exceptions. The results of this analysis offer health care providers and payers a broader picture of the relationship between exacerbations and mean change in FEV1 as well as SGRQ score, and will help inform clinical and formulary-making decisions while stimulating new research questions for future prospective studies.

A meta-analysis of four randomized clinical trials to confirm the reliability and responsiveness of the Shortness of Breath with Daily Activities (SOBDA) questionnaire in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by non-reversible airflow limitation. A common symptom of COPD is dyspnea or shortness of breath. Dyspnea may vary daily, with a large impact on patients' lives. Previous clinical trials used patient-reported outcome (PRO) measures that quantified dyspnea at discrete intervals and hence did not reflect this variability. Recently the Shortness of Breath with Daily Activities (SOBDA) questionnaire was developed as a PRO measure of dyspnea utilizing a daily diary. This confirmatory post hoc meta-analysis of SOBDA data from a large clinical study program further supports the questionnaire and clarifies the minimum threshold of SOBDA response. METHODS: Data from four clinical trials (DB2113361, NCT01313637; DB2113373, NCT01313650; DB2113360, NCT01316900; DB2113374, NCT01316913) were analyzed. These 24-week trials were randomized, blinded studies investigating the efficacy and safety of several COPD treatments. These post hoc analyses focused on the SOBDA questionnaire properties. This electronic-diary consists of 13 items completed daily, in which patients rate their breathlessness level during common daily activities. Resultant SOBDA scores were compared with related, commonly used assessments: modified Medical Research Council Research Dyspnea Scale (mMRC), Baseline Dyspnea Index (BDI), Transition Dyspnea Index (TDI), St George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and trough forced expiratory volume in 1 s (FEV1). The consistency, reliability, validity (convergent, known groups), and responsiveness of the SOBDA questionnaire was assessed. RESULTS: In total, 4967 patients with COPD provided data for these analyses. The SOBDA questionnaire had high internal consistency (Cronbach's alpha = 0.936), high test-retest reliability (Pearson's correlation coefficient = 0.86) and convergent validity with related measures (SGRQ total score, Pearson's correlation coefficient = 0.59; CAT, Spearman rank-order correlation coefficient = 0.50). SOBDA scores were statistically significantly lower in responders (as defined by TDI, SGRQ, CAT, and trough FEV1 levels) versus non-responders (p < 0.001 for all assessments and all time points). Using an anchor-based method, the threshold of a minimum response was calculated as a SOBDA score change of -0.2 (SOBDA score range = 1-4). CONCLUSIONS: The reliability, validity, and responsiveness of the SOBDA questionnaire as a PRO measure to quantify dyspnea was supported in a large clinical trial population of patients with moderate-very severe COPD.

fNIRS in the developmental sciences.

With the introduction of functional near-infrared spectroscopy (fNIRS) into the experimental setting, developmental scientists have, for the first time, the capacity to investigate the functional activation of the infant brain in awake, engaged participants. The advantages of fNIRS clearly outweigh the limitations, and a description of how this technology is implemented in infant populations is provided. Most fNIRS research falls into one of three content domains: object processing, processing of biologically and socially relevant information, and language development. Within these domains, there are ongoing debates about the origins and development of human knowledge, making early neuroimaging particularly advantageous. The use of fNIRS has allowed investigators to begin to identify the localization of early object, social, and linguistic knowledge in the immature brain and the ways in which this changes with time and experience. In addition, there is a small but growing body of research that provides insight into the neural mechanisms that support and facilitate learning during the first year of life. At the same time, as with any emerging field, there are limitations to the conclusions that can be drawn on the basis of current findings. We offer suggestions as to how to optimize the use of this technology to answer questions of theoretical and practical importance to developmental scientists.

Acne-Related Quality of Life Among Female Adults of Different Races/Ethnicities.

BACKGROUND: Acne impairs quality of life, but its effect on different races/ethnicities is unclear. This study evaluated racial/ethnic differences in acne-related quality of life and psychological symptoms among female adults. METHODS: A Web-based survey was conducted with U.S. female adults (25-45 years old) with facial acne (≥25 visible lesions). Outcomes included sociodemographics, clinical characteristics, acne-related quality of life (Acne-Specific Quality of Life Questionnaire), psychological symptoms (Patient Health Questionnaire), and work/school productivity. Racial/ethnic differences were evaluated using descriptive statistics and analysis of variance/chi-square analyses. RESULTS: Three-hundred twelve subjects (Black = 30.8%, Hispanic = 17.6%, Asian/other = 17.3%, White = 34.3%) completed the survey (mean age = 35.3 ± 5.9 years). Acne negatively impacted quality of life for all subjects. Black subjects reported significantly less negative impact on self-perception versus Asian/other (Black = 12.6 ± 9.9, Asian/other = 8.4 ± 8.6; p = .05). Social functioning was less negatively impacted in White and Black subjects versus Asian/other (White = 12.7 ± 7.5, Asian/other = 8.4 ± 7.8, p < .05; Black = 12.1 ± 9.2, Asian/other = 8.4 ± 7.8, p = .06). Over one third (total sample = 40.7%, Black = 31.3%, Hispanic = 36.4%, Asian/other = 50.0%, White = 46.7%) reported moderate/severe anxiety/depression symptoms. Acne also impacted ability to concentrate on work/school. CONCLUSION: Racial/ethnic differences were observed in acne-related quality of life and psychological symptoms in female adults; acne negatively impacted self-perceptions and social/emotional functioning.

Acne treatment patterns, expectations, and satisfaction among adult females of different races/ethnicities.

BACKGROUND: Limited data are available on acne treatment patterns, expectations, and satisfaction in the adult female subpopulation, particularly among different racial and ethnic groups. OBJECTIVE: Describe acne treatment patterns and expectations in adult females of different racial/ethnic groups and analyze and explore their potential effects on medication compliance and treatment satisfaction. METHODS: A cross-sectional, Web-based survey was administered to US females (25-45 years) with facial acne (≥25 visible lesions). Data collected included sociodemographics, self-reported clinical characteristics, acne treatment use, and treatment expectations and satisfaction. RESULTS: Three hundred twelve subjects completed the survey (mean age, 35.3±5.9 years), comprising black (30.8%), Hispanic (17.6%), Asian/other (17.3%), and white (34.3%). More than half of the subjects in each racial group recently used an acne treatment or procedure (black, 63.5%; Hispanic, 54.5%; Asian/other, 66.7%; white, 66.4%). Treatment use was predominantly over-the-counter (OTC) (47.4%) versus prescription medications (16.6%). OTC use was highest in white subjects (black, 42.7%; Hispanic, 34.5%; Asian/other, 44.4%; white, 59.8%; P<0.05). The most frequently used OTC treatments in all racial/ethnic groups were salicylic acid (SA) (34.3%) and benzoyl peroxide (BP) (32.1%). Overall, compliance with acne medications was highest in white versus black (57.0±32.4 vs 42.7±33.5 days, P>0.05), Hispanic (57.0±32.4 vs 43.2±32.9 days, P>0.05), and Asian/other (57.0±32.4 vs 46.9±37.2 days, P>0.05) subjects. Most subjects expected OTC (73.7%) and prescription (74.7%) treatments to work quickly. Fewer than half of the subjects were satisfied with OTC treatment (BP, 47.0%; SA, 43.0%), often due to skin dryness (BP, 26.3%; SA, 44.3%) and flakiness (BP, 12.3%; SA, 31.1%). No statistically significant differences were observed among racial/ethnic groups in their level of satisfaction with OTC or prescription acne treatments. CONCLUSION: Racial/ethnic differences were observed in acne treatment patterns in adult females, while treatment expectations were similar. Results indicate that treatment patterns and expectations may impact treatment satisfaction and medication compliance.

Object processing in the infant: lessons from neuroscience.

Object identification is a fundamental cognitive capacity that forms the basis for complex thought and behavior. The adult cortex is organized into functionally distinct visual object-processing pathways that mediate this ability. Insights into the origin of these pathways have begun to emerge through the use of neuroimaging techniques with infant populations. The outcome of this work supports the view that, from the early days of life, object-processing pathways are organized in a way that resembles that of the adult. At the same time, theoretically important changes in patterns of cortical activation are observed during the first year. These findings lead to a new understanding of the cognitive and neural architecture in infants that supports their emerging object-processing capacities.