Faculty Bibliography

A 2016 survey of pediatric neuropsychologists found that 92% of clinicians reported use of "at least one" performance validity test (PVT) in each assessment. The present investigation sought to verify documented PVT use among clinicians by review of actual reports. A convenience sample of pediatric neuropsychological reports of children ages 6-17 were reviewed over an 24-month period (January 2015-January 2017); reports were those seen as part of our routine practice, including reports on children we were reevaluating, cases that we consulted on, or cases evaluated elsewhere presenting to our centers that required record review for clinical decision making (e.g., presurgical epilepsy evaluations). A total of 131 reports, from 102 unique neuropsychologists were reviewed. PVT usage was documented in only six reports, from six unique clinicians, representing only 4.58% of the reports (or 5.88% of clinicians), far below expectations recent survey results. Though sampling differences and documentation factors may account for some of this disparity, a "social desirability bias" on surveys is likely a major factor in explaining these discordant findings.

Previous studies suggest that reducing the numbers of adult-born neurons in the dentate gyrus (DG) of the mouse increases susceptibility to severe continuous seizures (status epilepticus; SE) evoked by systemic injection of the convulsant kainic acid (KA). However, it was not clear if the results would be the same for other ways to induce seizures, or if SE-induced damage would be affected. Therefore, we used pilocarpine, which induces seizures by a different mechanism than KA. Also, we quantified hippocampal damage after SE. In addition, we used both loss-of-function and gain-of-function methods in adult mice. We hypothesized that after loss-of-function, mice would be more susceptible to pilocarpine-induced SE and SE-associated hippocampal damage, and after gain-of-function, mice would be more protected from SE and hippocampal damage after SE. For loss-of-function, adult neurogenesis was suppressed by pharmacogenetic deletion of dividing radial glial precursors. For gain-of-function, adult neurogenesis was increased by conditional deletion of pro-apoptotic gene Bax in Nestin-expressing progenitors. Fluoro-Jade C (FJ-C) was used to quantify neuronal injury and video-electroencephalography (video-EEG) was used to quantify SE. Pilocarpine-induced SE was longer in mice with reduced adult neurogenesis, SE had more power and neuronal damage was greater. Conversely, mice with increased adult-born neurons had shorter SE, SE had less power, and there was less neuronal damage. The results suggest that adult-born neurons exert protective effects against SE and SE-induced neuronal injury.

Despite its popularity in the neuropsychological evaluation of children, the utility of the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) has not yet been investigated in children with epilepsy. Eighty clinically referred children and adolescents with epilepsy were administered the WISC-V as part of a comprehensive assessment and scores were compared to matched controls from the WISC-V standardization sample. T tests compared WISC-V indices and subtests between patients and controls and Chi-square analyses compared the rates of low scores. Correlational analyses assessed the relationships between epilepsy severity variables (e.g., age of onset, duration of epilepsy, number of antiepileptic drugs, seizure frequency). All WISC-V composites and subtests were significantly lower in patients versus controls and the rate of low scores was higher in patients than controls for all composites and subtests with the exception of Figure Weights. The Working Memory Index and Processing Speed Index were most sensitive to impairment, while the Verbal Comprehension Index and Fluid Reasoning Index were least sensitive. Of the epilepsy severity variables, age of seizure onset and number of antiepileptic drugs were strong predictors of deficits, whereas seizure frequency was the weakest predictor. Importantly, no significant differences were seen in children with right hemisphere epilepsy versus left on the five WISC-V composites, though a trend was seen towards a lower Visual-Spatial Index in those with right-sided focal seizures.

Purpose: In 2016 there were roughly 77,000 PrEP users in the United States, while over 1.2 million Americans were identified as "high-risk" for HIV infection. The reasons for this discrepancy are vast; however, potential reasons that have been identified are stigma, ineffective or poorly targeted marketing, access, and cost, amongst other factors. This pilot project seeks to understand the ways in which people and companies talk about PrEP on social media to glean deeper insights on methods to increase PrEP use. The increased use of social media gives researchers, clinicians, policymakers, and health organizations the opportunity to have access to real time data and potentially influence awareness of PrEP. This inductive exploratory study uses natural language processing (NLP) and content analysis to examine the ways in which people are using social media to talk about PrEP. Method(s): An R script was utilized to crawl Twitter the Twitter API based on keywords related to PrEP and HIV, plus all lemmatized variations related to the word pair. Data cleaning was then performed to remove tweets that were not in English, tweets that had been retweeted, as well as removing any identifying information. The resulting data frame was then used both qualitatively and quantitatively for analysis. Qualitative analysis involved a comprehensive reading of tweets, development of a category dictionary, and identification of themes that would help to train an algorithm to automatically process and count tweets based on its category. The quantitative process involved further cleaning and removing of stop-words to develop a Ngram frequency cloud as well as development of a process to automatically categorize the different types of tweets based on the type of tweet (advertisement, question about PrEP, comment on cost or availability, criticism of manufacturer, etc.). Result(s): This processes resulted in identification of 587 unique HIV related PrEP tweets. Qualitative insights from this reduced dataset indicated that there are preventative concerns related to access and cost which may be preventing high-risk individuals from getting PrEP. Algorithmic sorting and categorization processes also identified concerns about targeted marketing, specifically the lack of campaigns focusing on transgender, female, and minority communities. Our bootstrap method of training and testing resulted in a process that had an 80% likelihood of identifying, analyzing, and classifying HIV related PrEP tweets. Once classified, 40% of tweets were advertising and messaging, the rest were concerns about cost (31%), requests for info/ways to pay for PrEP (20%), as well as other non-classified comments. Conclusion(s): There are a number of different conversations about HIV/PrEP awareness happening on Twitter. However, access and cost were consistently the most common themes being discussed. Currently, a 30-day supply of PrEP costs between 0-$1600, in the US, which may be creating a substantial barrier to further reducing HIV rates. Additionally, Improving online marketing strategies of PrEP could increase awareness and use by offering targeted information as well as identification of local resources to those interested or in need. Sources of Support: NYU CAMS Undergradaute Internship

Purpose: Instagram has grown over the years to become one of the most popular social media platforms, and three quarters of teens who use social media use Instagram. In recent years, "Finstas", or "fake" Instagrams have grown in popularity among US teenagers. Finsta accounts are subsidiary Instagram accounts with highly selected audiences where owners can post material that is not associated with their main account. Public Twitter posts (tweets) can provide insight into communication about these clandestine accounts not available through Instagram due to the inherent private nature of these accounts. This exploratory study uses natural language processing (NLP) techniques on tweets about Finsta accounts to gain insight into this phenomenon. Method(s): An R-script was developed to pull data from the Twitter API to capture tweets longitudinally that were in English, from North America, and specifically mention some form of the stem and lemmatized word "Finsta." As there are no current studies on Finsta accounts, a comprehensive thematic analysis was then performed on the corpus of tweets to develop qualitative insights on this phenomenon. A quantitative process involved further cleaning and removing of stop-words to develop a Ngram frequency chart of the lemmatized words in the corpus of tweets to better understand the ways in which people were communicating about Finsta accounts. Result(s): 10,000 tweets containing the word "Finsta" were pulled from the Twitter API. After a comprehensive cleaning process, 5,159 tweets were then analyzed qualitatively to identify themes as a preliminary inquiry into this relatively new phenomenon. Themes identified within the corpus were: a desire for privacy compared to their main account, a place to share information that may be politically incorrect or would get users in trouble if shared on accounts with wider viewership, and a place to showcase real life. Ngram frequency words highlight similar words common to social media, "follow," "like," and "post" being amongst the most popular; however, within this corpus there are high frequencies of the words, "private," "sad," "nudes," "spam," "rant," "exposed," "emotional," and "outlet," tied to contextual themes indicating that Finstas may be an outlet for emotional catharsis in a "safe space." A Finsta user may have twenty followers (as opposed to 1000 on their main account) that include their closest friends. They may post blurry pictures without filters, with long captions detailing their negative emotional state. This sensitive content is posted with the underlying assumption that their friends will keep this information private. Conclusion(s): Preliminary analyses indicate that Finstas are a new way for teens to connect with peers in a controlled space online, where they can truly express themselves. Additionally, there is also a great deal of gossip, exhibitionism, risk-taking, and other attention-seeking behaviors typical of adolescence that manifest in ways not seen on users' primary accounts. Finsta accounts fulfill a vital role in the lives of adolescents looking for ways to authentically connect, share, and create community that is not offered through traditional uses of social media. Sources of Support: NYU CAMS Undergraduate Internship

Purpose: There are an ever increasing number of social media platforms available for people to connect and build online communities. Pro-eating disorder communities, notably anorexia nervosa (AN), have developed a steady presence on Twitter. While these communities can be beneficial for individuals who are not yet ready or able to seek professional help, multiple studies have revealed the detrimental side effects these communities can have on users, such as normalization of maladaptive behaviors, encouragement of behaviors and sharing new ways to perpetuate behaviors. To date, few studies have investigated the ways in which available social media data from self-identified anorexic individuals could be used to better inform screening, treatment, and follow-up with these individuals. This study evaluated the ways in which natural language processing (NLP) and machine learning algorithms, coupled with qualitative methods, could collect, categorize, and inform clinician insights about pro-eating disorder communities. Method(s): Twitter crawling algorithms were developed and deployed through the Twitter API to find tweets based on key words such as: "ana" "proana" "thinspo" and "meanspo." This initial corpus of tweets containing the identified keywords was then qualitatively assessed to further refine the algorithmic process of identifying appropriate tweets and removing irrelevant tweets. This process resulted in a cleaned corpus of 970 unique tweets over a ten-day period. This cleaned dataset was then utilized for NLP to identify common words, phrases, and topics. Concurrently, data was hand coded in a thematic analysis process to identify deeper themes within the dataset. These themes could inform qualitative lines of inquiry as well as machine learning systems. Qualitative insights were utilized to improve sentiment analysis as well as classification of unstructured data though a semi-supervised machine learning process. Result(s): Analysis revealed that emotional restraint was not present and judgement of one's self on external standards was present within these Twitter communities. Additionally, users' frequently requested "meanspo," an extension of thinspo that serves as an inspiration for thinness by using aggressive and abrasive rhetoric to encourage users to aspire for thinness. Additionally, posts asking for an "ana buddy," a partner to help users hold each other accountable to their AN behaviors, were extremely common. Additional information about caloric restrictions, weekly weight loss goals, and a large number of individuals tweeting from residential treatment for ED about lying about wanting to get better as a means to be released, as well as genuine statements about wanting to change. Conclusion(s): AN is a complicated disease with multiple causes, side effects and comorbid illnesses. This pilot study offers a promising 'first-step' approach towards understanding the mindset, experiences, and potential gaps within current ED treatment approaches from a patient perspective. NLP and ML processes are now developed to scan, collect, and analyze this data in an ongoing way to develop new AI processes with the ultimate goal of identifying individuals with a higher likelihood of wanting to enter treatment. Overall, the present study highlights the benefits of using new available data streams to develop patient-informed comprehensive care models. Sources of Support: NYU CAMS Undergaduate Internship

Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.

BACKGROUND:Quantitative MRI can detect early changes in cartilage biochemical components, but its routine clinical implementation is challenging. PURPOSE/OBJECTIVE:along radial sections of the hip for accurate and reproducible multiparametric quantitative cartilage assessment in a clinically feasible scan time. STUDY TYPE/METHODS:Reproducibility, technical validation. SUBJECTS/PHANTOM/UNASSIGNED:A seven-compartment phantom and three healthy volunteers. FIELD STRENGTH/SEQUENCE/UNASSIGNED:at 3 T was developed. Automatic positioning and semiautomatic cartilage segmentation were implemented to improve consistency and simplify workflow. ASSESSMENT/RESULTS:Intra- and interscanner variability of our technique was assessed over multiple scans on three different MR scanners. STATISTICAL TESTS/UNASSIGNED:over six radial slices was calculated. Restricted maximum likelihood estimation of variance components was used to estimate intrasubject variances reflecting variation between results from the two scans using the same scanner (intrascanner variance) and variation among results from the three scanners (interscanner variance). RESULTS:. DATA CONCLUSION/UNASSIGNED:Our method, which includes slice positioning, model-based parameter estimation, and cartilage segmentation, is highly reproducible. It could enable employing quantitative hip cartilage evaluation for longitudinal and multicenter studies. LEVEL OF EVIDENCE/METHODS:1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018.

OBJECTIVE:To assess knowledge of both promoting and preventive dietary factors on nephrolithiasis in a diverse patient population. Precipitating factors of kidney stone disease include diet, lifestyle, socioeconomic status, and race/ethnicity. However, patient awareness of these influences is poorly described. MATERIALS AND METHODS/METHODS:A 24-question survey, assessing intake-related risk factors for stone disease, was administered prospectively to 1018 patients. Responses were summarized with frequency and percent. Statistical comparisons were made using a propensity scoring method in order to account for potential confounding variables. Propensity scores were stratified into quintiles. Further analysis with multiple imputation was performed to account for any missing data in the survey. The results of the propensity-adjusted log-binomial regression model are presented as prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS:Respondents demonstrated limited knowledge of nutrient factors that influence stone development. However, most study participants (70.3%) reported a willingness to make lifestyle changes aimed at lowering their risk for stone disease. Respondents reporting previous nephrolithiasis education were less likely to report that diet had no effect on kidney stone formation (PR = 0.795, 95% CI 0.65, 0.96, p = 0.01) The type of physician who counseled the respondent had no association with patient knowledge for stone disease (PR = 0.83, 95% CI 0.63, 1.10, p = 0.2). CONCLUSIONS:Knowledge of diet-related risk factors for nephrolithiasis is limited among this population. Respondents who received prior education appeared to maintain the knowledge of dietary risk for nephrolithiasis. Participants also expressed a willingness to make requisite dietary changes if that information is provided. Given that most stone formers experience a recurrence, these findings highlight the need for more comprehensive patient education strategies on the modifiable risk factors for nephrolithiasis.

Gender variance and dysphoria are present across all classes, ethnicities, and experiences, including among those with severe and chronic mental illness. In these, our most vulnerable populations, adequate assessment and treatment of gender dysphoria often is overlooked despite evidence that appropriate treatment of gender dysphoria leads to improvement in psychological functioning (Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005). The World Professional Association for Transgender Health recommend in their Standards of Care that somatic and surgical treatments for gender dysphoria should be made available to those with medical or mental illness with the caveat that "[the illness] must be reasonably well-controlled (2011)." In this article, we will utilize case-based material to elucidate the challenges of treating gender dysphoria in the context of complex mental illness such as bipolar disorder, schizophrenia, and sexual trauma, and the pitfalls of defining "well-controlled" for the sake of treatment.