Faculty Bibliography

Background: Due to their rarity, a satisfactory understanding of the full clinical and biological characteristics of PTCLs is lacking, no reliably effective treatment is available, and pts outcome remains very poor. Since pts age is a key factor in choosing initial therapy, we analysed pts aged >70 yrs comparing disease features, treatments and outcome of this subset to their younger counterparts. A parallel analysis is presented by the COMPLETE US network. Patients and methods: The T-cell project is a prospective registry collecting data on baseline characteristics, details of therapy delivered and outcome data in pts with mature, aggressive PTCLs. Pts were grouped into three age categories (<60, >60-<70, and >70 yrs): chi-squared test and t-test were used to compare the groups, log-rank test and Cox regression models were used for overall survival (OS). Results: From 2006 to 2014, 1308 pts were registered from 73 sites worldwide. Complete baseline data were available for 819 pts (<60: n = 462, >60-<70: n = 168, >70: n = 189), 754 of which had also therapy information. Median follow-up was 48 mos. There were no differences in gender or B-symptoms at presentation; however, elderly pts were more likely to suffer from disease-related symptoms (77%, P = 0.01) and to present with an ECOG performance status >1 (35%, P = 0.002). No difference in disease extent was noted, but pts >70 yrs more frequently had bone marrow involvement (28%, P = 0.01). A different distribution in histologic subtypes was observed in different age groups. Intent of therapy was curative in 96% of younger vs 87% of older pts (P < 0.0001). Anthracycline- and etoposide-containing regimens were adopted in 70% and 8% of pts >70, respectively, and consolidative stem cell transplantation (HSCT) in 10% and 1% of younger and older pts, respectively. Overall responses were higher in younger pts [74% (<60), 69% (>60-<70), 57% (>70 yrs), P < 0.0001]; 2-yr and 5-yr OS were 60% and 51% (<60), 55% and 38% (>60-<70), 40% and 24% (>70 yrs), respectively (P < 0.0001). Cox modelling suggests age (HR 1.12; 95% CI: 1.04-1.20, P = 0.004) and stage III/IV disease (HR 3.0; 95% CI: 1.46-6.22, P = 0.003) are predictors of inferior OS. HSCT emerged as a predictor of better OS (HR 0.50, 95% CI: 0.29-0.85, P = 0.01). Conclusions: The T-cell project data document that PTCLs pts >70 yrs exhibit a poorer outcome than younger, and are more likely to receive non-curative intent therapy. Optimal treatment for this subset is still a relevant unmet need, and more efforts in defining better strategies are urgent. (Table Presented)

It has been long recognized that parents exert profound influences on child development. Dating back to at least the seventeenth-century Enlightenment, the ability for parents to shape child behavior in an enduring way has been noted. Twentieth-century scholars developed theories to explain how parenting histories influence psychological development, and since that time, the number of scientific publications on parenting influences in both human and nonhuman animal fields has grown at an exponential rate, reaching numbers in the thousands by 2015. This special issue describes a symposium delivered by Megan Gunnar, Regina Sullivan, Mar Sanchez, and Nim Tottenham in the Fall of 2014 at the Society for Social Neuroscience. The goal of the symposium was to describe the emerging knowledge on neurobiological mechanisms that mediate parent-offspring interactions across three different species: rodent, monkey, and human. The talks were aimed at designing testable models of parenting effects on the development of emotional and stress regulation. Specifically, the symposium aimed at characterizing the special modulatory (buffering) effects of parental cues on fear- and stress-relevant neurobiology and behaviors of the offspring and to discuss examples of impaired buffering when the parent-infant relationship is disrupted.

Explicit but not implicit facial emotion perception has been shown to be impaired in schizophrenia. In this study, we used newly developed technology in social neuroscience to examine implicit emotion processing. It has been shown that when people look at faces, they automatically infer social traits, and these trait judgments rely heavily on facial features and subtle emotion expressions even with neutral faces. Eighty-one individuals with schizophrenia or schizoaffective disorder and 62 control subjects completed a computer task with 30 well-characterized neutral faces. They rated each face on 10 trait judgments: attractive, mean, trustworthy, intelligent, dominant, fun, sociable, aggressive, emotionally stable and weird. The degree to which trait ratings were predicted by objectively-measured subtle emotion expressions served as a measure of implicit emotion processing. Explicit emotion recognition was also examined. Trait ratings were significantly predicted by subtle facial emotional expressions in controls and patients. However, impairment in the implicit emotion perception of fear, happiness, anger and surprise was found in patients. Moreover, these deficits were associated with poorer everyday problem-solving skills and were relatively independent of explicit emotion recognition. Implicit emotion processing is impaired in patients with schizophrenia or schizoaffective disorder. Deficits in implicit and explicit emotion perception independently contribute to the patients' poor daily life skills. More research is needed to fully understand the role of implicit and explicit processes in the functional deficits of patients, in order to develop targeted and useful remediation interventions.

Mental Disorders are found in all countries and in all populations including children. According to the WHO, "Mental disorders affect hundreds of millions of people and if left untreated it creates an enormous toll of suffering, disability and economic loss."(1) For years mental health care has been overlooked as an important component in strengthening health care. Today, there is a movement to wards integrating psychiatric treatment more into healthcare and also into other systems such as schools that promote the wellbeing of children. This integration is happening throughout the world but we believe that more education and knowledge should be made available to providers that may not have been accustomed to this way of thinking or working. The focus of this presentation is to educate and explore the experiences of mental health involvement with other medical specialties as well as other child-focused systems of care such as child protective services and schools. Each presenter will discuss his or her role as a clinician in different treatment models and explain the evolution of child psychiatry in to their perspective clinics. Drs. Caraballo and Cabrera use their extensive experience to explain how child psychiatry has been incorporated into traditionally non-psychiatry focused organizations such as schools and child protective services foster care agencies. Drs. Shapiro and Booth-Watkins will discuss having a primarily psychiatric focused clinic-community mental health clinic and partial hospitalization-and how they have been incentivized to include other child focused services such as pediatrics and government agencies into their programs. Following the four presentations, Dr. Palyo will lead a discussion with the audience to participate in processing the benefits and foreseeable obstacles that arise with the trend of integrated mental health and health care. Each presenter will speak for 15 minutes with a 30-minute discussion. Workshop Services, Treatments, and Advocacy: Child and Adolescent MH Services and Multidisciplinary Teams

Objective: To assess group-differences in movement measures in published studies contrasting Attention-Deficit/Hyperactivity Disorder (ADHD) vs. controls. Background: ADHD diagnoses continue to be completely based on clinical history, which is subjective and subject to recall bias. In response, investigators have proposed incorporating objective measures such as locomotor activity which can be measured with actigraphy or with a high spatial and temporal resolution infrared camera. In May 2014, the United States Food and Drug Administration cleared an example of the latter, the Qb-Test, as a device to be used in supporting the diagnosis of ADHD. A review of the literature did not reveal any prior meta-analyses of such data. Methods: We performed a systematic review and meta-analysis of published studies on motion measures contrasting individuals diagnosed with ADHD and healthy controls. Two authors reviewed a total of 89 abstracts culled from an initial search of 356. After applying inclusion and exclusion criteria, 13 papers were included in our analyses of actigraphy and five papers in analyses of motion tracking systems. Results: The combined sample sizes were 406 patients with ADHD versus 359 controls with actigraphy data and 164 patients with ADHD versus 156 controls with motion tracking system data. Meta-analyses revealed medium effect sizes for actigraphy (standardized mean difference [SMD]: 0.64, 95 % CI: 0.43, 0.85) and large effects for motion tracking systems (SMD: 0.92, 95 % CI: 0.65, 1.20) in differentiating individuals with ADHD from controls. Conclusions: When measured objectively, locomotor hyperactivity robustly differentiates groups of patients with ADHD from healthy controls. Inclusion of objective locomotion measures is likely to be useful in circumstances in which ancillary information is not available, such as when evaluating adults with possible ADHD. However, even the relatively large effect sizes reported to date are unlikely to yield clinically actionable information for individual patients on their own. How to best incorporate such objective data in the diagnostic process remains unclear

One useful approach for fitting linear models with scalar outcomes and functional predictors involves transforming the functional data to wavelet domain and converting the data-fitting problem to a variable selection problem. Applying the LASSO procedure in this situation has been shown to be efficient and powerful. In this article, we explore two potential directions for improvements to this method: techniques for prescreening and methods for weighting the LASSO-type penalty. We consider several strategies for each of these directions which have never been investigated, either numerically or theoretically, in a functional linear regression context. We compare the finite-sample performance of the proposed methods through both simulations and real-data applications with both 1D signals and 2D image predictors. We also discuss asymptotic aspects. We show that applying these procedures can lead to improved estimation and prediction as well as better stability. Supplementary materials for this article are available online.