bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid neuromorphic circuits exploiting non-conventional properties of RRAM for massively parallel local plasticity mechanisms
Authors: Dalgaty Thomas , Payvand Melika , Moro Filippo , Ly Denys R. B. , Pebay-Peyroula Florian , Casas Jerome , Indiveri Giacomo , Vianello Elisa
Published: August 2019

Recurrent neural networks are currently subject to intensive research efforts to solve temporal computing problems. Neuromorphic processors (NPs), composed of networked neuron and synapse circuit models, natively compute in time and offer an ultralow power solution particularly suited to emerging temporal edge-computing applications (wearable medical devices, for example). The most significant roadblock to addressing useful problems with neuromorphic hardware is the difficulty in maintaining healthy network dynamics in recurrent neural networks. In animal nervous systems, this is achieved via a multitude of adaptive homeostatic mechanisms which act over multiple time scales to counteract network instability induced via drift, component failure, or learning processes such as spike-timing dependent plasticity. One such mechanism is neuronal intrinsic plasticity (IP) where a neuron adapts its parameters which govern its excitability to fire around a target rate. The approach employed in state of the art NPs, based on a central volatile memory remotely setting model parameters, critically constrains parameter variety and bandwidth rendering realization of these essential mechanisms impossible. This paper demonstrates how reconfigurable nonvolatile resistive memories can be incorporated into neuron and synapse circuits allowing memory to be truly colocalized with the computational units in the computing fabric and facilitating the realization of massively parallel local plasticity mechanisms in neuromorphic hardware. Exploiting nonconventional programming operations of HfO2 based RRAM (stochastic SET and the RESET random variable), we propose a technologically plausible IP algorithm and demonstrate its use in the case of a recurrent neural network topology whereby the system self-organizes to sustain stable and healthy network dynamics around a target firing rate.
Estrogen conjugated fluorescent silica nanoparticles as optical probes for breast cancer cells imaging
Authors: Chen Ying , Yang Lingzhi , Liu Jing , Chen Zilin
Published: August 2019

Fluorescent nanoparticles are promising tools for living cancer cell imaging and cancer targeting. In this study, estrogen conjugated dye-doped fluorescent nanoparticles (estrogen conjugated FNPs) were synthesized and characterized. The functionalized nanoparticles with low toxicity have shown high selectivity and sensitivity toward target cells. Based on the specific recognition between the estrogen and the estrogen receptor, estrogen conjugated FNPs have been employed as optical probes for specific targeting of estrogen receptor-positive cancer cells with fluorescence microscopy imaging technology. The results demonstrate that the estrogen conjugated FNPs can effectively recognize breast cancer cells with good sensitivity and exceptional photostability, which would offer a novel approach for the diagnosis of breast cancer cells, as well as a new method in detecting estrogen receptors.
A review of Austrocallerya and Pongamia (Leguminosae subfamily Papilionoideae) in Australia, and the description of a new monotypic genus, Ibatiria
Authors: Cooper Wendy E. , Crayn Darren M. , Zich Frank A. , Miller Rebecca E. , Harrison Melissa , Nauheimer Lars
Published: August 2019

A review of Austrocallerya J.Compton & Schrire and Pongamia Adans. (Leguminosae subfamily Papilionoideae) in Australia, and the description of a new monotypic genus, Ibatiria W.E.Cooper, is presented with the support of fresh, dried, spirit-preserved specimens, molecular phylogenetic analysis of plastid and nuclear data, and illustrations. Three Austrocallerya species are confirmed, described and distinguished for Australia. Two varieties of Pongamia pinnata (L.) Pierre are recognised; P. pinnata var. minor (Benth.) Domin is reinstated and is distinguished from var. pinnata by habitat, leaflet number and width, floral bract length and bracteole length. The new genus, Ibatiria, includes a single species, Ibatiria furfuracea W.E.Cooper, from Queensland’s Wet Tropics Bioregion. A second-step lectotype is designated for Pterocarpus australis Endl., and lectotypes are designated for Wisteria megasperma F.Muell. and Pongamia glabra var. minor Benth.
Structural insight into multistage inhibition of CRISPR-Cas12a by AcrVA4
Authors: Peng Ruchao , Li Zhiteng , Xu Ying , He Shaoshuai , Peng Qi , Wu Lian-ao , Wu Ying , Qi Jianxun , Wang Peiyi , Shi Yi , Gao George F.
Published: August 2019

Prokaryotes possess CRISPR-Cas systems to exclude parasitic predators, such as phages and mobile genetic elements (MGEs). These predators, in turn, encode anti-CRISPR (Acr) proteins to evade the CRISPR-Cas immunity. Recently, AcrVA4, an Acr protein inhibiting the CRISPR-Cas12a system, was shown to diminish
Lachnospiraceae bacterium
Cas12a (LbCas12a)-mediated genome editing in human cells, but the underlying mechanisms remain elusive. Here we report the cryo-EM structures of AcrVA4 bound to CRISPR RNA (crRNA)-loaded LbCas12a and found AcrVA4 could inhibit LbCas12a at several stages of the CRISPR-Cas working pathway, different from other characterized type I/II Acr inhibitors which target only 1 stage. First, it locks the conformation of the LbCas12a-crRNA complex to prevent target DNA-crRNA hybridization. Second, it interacts with the LbCas12a-crRNA-dsDNA complex to release the bound DNA before cleavage. Third, AcrVA4 binds the postcleavage LbCas12a complex to possibly block enzyme recycling. These findings highlight the multifunctionality of AcrVA4 and provide clues for developing regulatory genome-editing tools.
Evaluation of a clinical dose accumulation algorithm using deformable gel dosimetry
Authors: Matrosic Charles K , Holmes Shannon , Bednarz Bryan , Culberson Wesley
Published: August 2019

Deformable 3D dosimetry represents a robust method of verifying the accuracy of clinical deformable dose accumulation algorithms used to monitor interfraction anatomical changes during radiotherapy treatments. For this study, a deformable abdominal phantom was developed incorporating a deformable nPAG gel dosimeter for the dose verification of Adaptivo™, a commercial software program with a deformable dose accumulation algorithm. A comparison was made for three single fraction irradiations of gel dosimeters, each with a different deformation state. Additionally, a comparison was made for the cumulative dose over a three-fraction treatment of a single gel dosimeter with individual fraction deformations matching those of the single fraction measurements. The single fraction irradiations resulted in target contour dose volume histograms (DVH) created by Adaptivo™ that were in close agreement with those determined by gel dosimeter measurements for doses similar to and higher than the planned target dose, with two of the three cases matching to within 5%. Discrepancies are attributed to a deformed contour compression during analysis in the cases where the phantom was deformed. The three-fraction treatment resulted in very close agreement between the DVHs determined through the gel dosimeter measurements and Adaptivo™ calculations across the full range of doses, with an average absolute discrepancy of 2.0% and a maximum absolute discrepancy of 6.3%.
Feasibility of radiosurgery dosimetry using NIPAM 3D dosimeters and x-ray CT
Authors: Adamson Justus , Carroll Jaclyn , Trager Michael , Yoon Paul , Kodra Jacob , Yin Fang-Fang , Maynard Evan , Hilts Michelle , Oldham Mark , Jirasik Andrew
Published: August 2019

We investigated the feasibility of using N-isopropylacrylamide (NIPAM) dosimeters with x-ray CT to verify radiosurgery dose. Dosimeters were prepared at one facility and shipped to a second facility for irradiation. A simulation CT was acquired and plans prepared for a 4 field box, and a 4 arc VMAT radiosurgery plan to 6 targets with 1cm diameter. Each dosimeter was aligned via CBCT and irradiated, followed by 5 diagnostic CTs acquired after >24 hours, which were averaged for analysis. Absolute dose calibration was applied and dose evaluated for both plans. Hounsfield Units were proportional to dose above 10-12Gy. For the 4-field box, mean difference between measured and predicted dose >10Gy was -0.13Gy ±1.69Gy and gamma index was <1 for 72% and 65% of voxels using a 5% / 1mm and 3% / 2mm criteria, respectively (threshold = 15Gy, global dose criteria). For the multifocal SRS case, mean dose within each target was within -0.14Gy± 0.55Gy of the expected value, and gamma index was < 1 for 94.0% and 99.5% of voxels, respectively (threshold = 15Gy). NIPAM based 3D dosimetry with x-ray CT is well suited for validating radiosurgery spatial alignment, as well as dose distributions when dose is above 10-12Gy.
Evaluation of a lung-equivalent gel dosimeter for MR image-guided radiation therapy
Authors: McDonald BA , Lee HJ , Ibbott GS
Published: August 2019

With recent advances in magnetic resonance image-guided radiation therapy (MR-IGRT), Fricke gel dosimetry has demonstrated value for its ability to measure three-dimensional dose distributions in the presence of a strong magnetic field. This strong magnetic field causes hot and cold spots in dose distributions at the interfaces of lung and normal tissue due to a phenomenon known as the electron return effect (ERE). In this paper, we report the development of lung-equivalent gel dosimeters to better measure dose to lung tissue caused by the ERE. Small polystyrene beads of variable sizes were mixed into Fricke xylenol orange gelatin (FXG) and ferrous oxide xylenol orange (FOX) gels. Lung-equivalence was confirmed by measuring the average CT number of each gel. The effects of gel type, bead size, and voxel size on uniformity and signal intensity were investigated. The smallest beads ( < 1 mm) exhibited the best uniformity, with values comparable to conventional gel with 2 mm voxels. Signal intensity followed an inverse relationship with uniformity, but FXG low-density dosimeters generated enough signal to produce acceptable quality images. The spin-lattice relaxation rate (R1 = 1/T1) increased with dose, which enabled us to measure dose to both soft tissue and lung due to the ERE using a phantom simulating the soft tissue-lung interface.
Pre-clinical and small field dosimetry
Authors: Wuu Cheng-Shie , Wang Yi-Fang , Xu Andy Y. , Adamovics John
Published: August 2019

Preclinical in vivo studies have drastically improved over the past decade with the development of cone beam computed tomography (CBCT) image-guided small animal irradiation systems. Such systems produce 220 or 225 kV x-rays with square and circular field sizes ranging from 0.5 to 10 mm. The dosimetry of such equipment involving kilovoltage small-field dosimetry has not received as much attention as the megavoltage small-field dosimetry. The dosimetry of megavoltage small fields can be challenging due to lateral charged particle disequilibrium, detector volume averaging effect, and high dose gradients. Clinically there has been a rapid increase in the use of small fields in modern radiotherapy techniques such as stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SBRT). This study presents dosimetric properties of image-guided small animal irradiation systems. Both EBT Gafchromic films and 3-D PRESAGE measured beam data were presented and compared with the calculated dose distribution from a commissioned planning system. For megavoltage small-field dosimetry, EBT3 films and PRESAGE dosimeters were used to measure the dose distributions for MLC-delimited 6 x 6 to 20 x 20 mm2 square fields, and for selected IMRT and VMAT plans with small field sizes or segments of 1-4 cm. A single-beam optical CT scanner was used as the readout mechanism of the radiation-induced 3-D information in the PRESAGE phantoms. Measured data sets were compared with calculated results from Eclipse Acuros XB. The results for kilovoltage small animal irradiator showed that PDD data measured from EBT films and PRESAGE dosimeters are in agreement within 3%; profiles and 2-D dose distributions measured from PRESAGE present a larger penumbra compared with those from EBT films. Discrepancies between measured beam data and treatment planning data were identified. For megavoltage small fields, the measured data percent depth dose, beam profiles, and dose distributions were found to agree within experimental uncertainties for EBT films and PRESAGE dosimeters. Beam profiles for MLC-delimited field sizes less than 10 mm reveal some discrepancies in the penumbra region between measured data and calculated results. Dose distributions from EBT film and PRESAGE measurements demonstrate that 3-D dosimetry measurement for small-field IMRT and VMAT QA may be necessary to ensure a complete verification of dose delivery and accuracy.
Optimization for stability of the deformable FlexyDos3D radiation dosimeter and curing effects
Authors: Wheatley M J , Balatinac A S , Booth J T , De Deene Y
Published: August 2019

Previous formulations of the FlexyDos3D dosimeter have shown significant changes in the dose-response over time. In this study, various formulations of the dosimeter were created and tested to see if this stability could be improved. A dosimeter that was stable over a three-day period was found. Rapid manufacture of this dosimeter for patient-specific validation of radiotherapy treatments is desirable. The use of 3D printing manufacturing techniques for thermosetting polymers require high temperatures to cure the polymer within a reasonable time. The effect of different curing temperatures and times were investigated for the FlexyDos3D radiation dosimeter for its effect on stability. No significant difference in the dose-response was found for dosimeters cured for different curing times beyond an hour. A significant dose-response offset was found between dosimeters cured at different temperatures, but the dose-response sensitivity was the same.
Development of fast Monte Carlo code for high dose rate brachytherapy
Authors: Hu Ankang , Qiu Rui , Wu Zhen , Li Chunyan , Zhang Hui , Li Junli
Published: August 2019

Brachytherapy plays an important role in the treatment of various cancers. The TG-43 formalism is widely used in dose calculation for brachytherapy, but it is not accurate as it assumes the patient as homogeneously constituted of water. Monte Carlo simulation can obtain accurate result, but computing time using traditional code is too long to be accepted in clinical application. This work developed a fast Monte Carlo code THUBrachy for high dose rate brachytherapy dose calculation. THUBrachy can simulate photon with energy up to 3MeV for heterogeneous materials and obtain dose, fluence and dose distribution. It applies several accelerators such as Graphics Processing Unit (GPU), Intel Xeon Phi to perform dose calculation with good accuracy and high speed. THUBrachy adopts several parallel programming models to transplant the code onto different hardware accelerators. Voxel geometry based on CT images is used to describe the tissues of patient. A linear track-length estimator is used for dose calculation. In the preliminary accuracy test, a cuboid water model and a heterogeneous-material model were selected as the phantoms. Dose and fluence distributions were calculated by both THUBrachy and FLUKA which is a well-benchmarked Monte Carlo code. A total of 5×108 photons were simulated to make the uncertainty in all area less than 5%. The maxium difference of the results in low dose area is less than 3% and in high dose area is less than 1%, indicating a good agreement. In the performance test, a phantom consisted by 24 types of human tissue materials was chosen to estimate the performance in practical application. Dose distributions with an uncertainty of 2% or less for the target volume were obtained in less than 1 min by simulating 5×107 photons with a GTX 1080Ti, while FLUKA taking several hours to simulate the same number of particles. There is great potential for clinical application in brachytherapy dose planning using this fast Monte Carlo code.
How important is the dose rate sensitivity of 2D and 3D radiation dosimeters?
Authors: De Deene Yves
Published: August 2019

Several kinds of chemical 3D radiation dosimeters have been fabricated to acquire the dose distribution in clinical radiotherapy. A legitimate concern with every new dosimeter is its dose rate dependent response because, the dose rate in each point of the phantom during a clinical treatment is unknown. Unfortunately, many 3D dosimeters have shown some degree of dose rate dependence. In practice, radiation dosimeters are mostly calibrated using a calibration curve that is obtained by irradiating calibration vials with different doses but using a fixed dose rate. Therefore, when applying a dose calibration to an experimentally obtained dose distribution, a deviation between the measured dose distribution and the actual dose distribution can be expected. In this computational study, the effect of a dose rate dependent dosimeter response on a theoretical dose distribution has been investigated. In order to compare the effect of dose rate, a gamma evaluation is performed between the predefined dose distribution and the dose distribution that is affected by a dose rate dependent radiation response. It is found that a dose rate difference of -10%, results in a gamma pass rate of 100% in the 3D dose distribution.
Multi-scale dosimetry with multi-scale Chinese reference phantoms
Authors: Qiu Rui , Wu Zhen , Li Chunyan , Ren Li , Wang Wenjing , Ma Ruiyao , Hu An kang , Zhu Hongyu , Li Junli
Published: August 2019

Recent studies on the development and applications of Chinese reference phantoms are reported in this paper. The Chinese adult reference male (CRAM) and female (CRAF) phantoms had been developed in previous work. A Chinese male phantom library was constructed with 7 different heights ranging from 155 cm to 185 cm and 12 phantoms with different total body masses in each height. Chinese paediatric reference phantoms were constructed for 3 months, 1 year, 5 years, 10 years, and 15 years male and female respectively. Detailed organ models were developed, including a set of microscopic skeletal models, a set of detailed breast models, a detailed human respiratory tract model and a detailed eye model. The phantoms were applied in radiation protection, including dose estimation from external exposure and internal exposure, in normal situations and in accidental situations, and detailed dose distributions in radiation-sensitive organs. The phantoms were also applied in medical imaging field such as dose estimation in mammography, CT and X-ray radiology, and could be potentially used in the secondary cancer estimation induced by radiation therapy.
A benchtop UV irradiator for 3D dosimetry laboratories with dose considerations in a spinning NMR test tube
Authors: De Deene Yves
Published: August 2019

Many different chemical radiation dosimeters have been fabricated over the last 20 years. In the search for new dosimeters, next to being sensitive to clinical radiation doses, several other physicochemical characteristics need to be satisfied, such as stability of the dose response, spatial integrity, temperature independence, dose rate independence and tissue equivalence. The development of new dosimeters is often hindered by a limited access to radiation facilities to irradiate hundreds of test tubes or cuvettes to study these physicochemical properties. To facilitate this basic experimental research, we propose the use of an inexpensive UVC irradiator. While care is required in extrapolating the results obtained with UV radiation to high energetic X-rays, for several studies, a UV irradiator is a handy tool for first line investigation of new dosimeters. In this study, we calculated the dose distribution in a cylindrical test tube when being rotated during UV exposure. A quantitative analysis allows the optimization of the set-up to obtain dose rates in the sample in similar order of magnitude that are delivered at a clinical Linac. Regardless the usefulness of a UVC irradiator in the laboratory for preliminary testing, it should not be a complete replacement for measurements with high energetic X-rays.
Survivalism and Other Class Fantasies
Authors: Shonkwiler Alison
Published: August 2019

The subjective demands of crisis capitalism are addressed by three books on the literature and culture of the late twentieth and early twenty-first centuries. These texts shed light on the possibilities and limits of materialist critique in holding various forms of ruthless, abstracted, and injurious capitalism to account. Measuring the uneven development of neoliberal subjectivities across different groups and conditions invites readers to theorize the class dimensions embedded in aesthetic narratives. An analysis of the “microeconomic mode” of contemporary subjectivity, which redefines the traditional liberal political subject to a narrowly survivalist subject of “life-interest,” offers a way of understanding how populations become increasingly sortable into more- and less-disposable groups. A study of deindustrialization literature, focused on the working-class experience, considers the cultural persistence of the blue-collar figure in a service and knowledge economy. A study of finance fictions argues that contemporary capitalism fits a new, psychotic paradigm and requires theorizing a new financial ontology of the present.
Dual nationality revisited: a modern approach to dual nationals in non-ICSID arbitrations
Authors: Michalopoulos Stavros , Hicks Edward
Published: August 2019

The authors revisit the vexed question of the standing of investors to bring a claim against one of their states of origin. Contrary to Article 25 of the Convention on the Settlement of Investment Disputes between States and Nationals of Other States (ICSID Convention), which forbids natural persons in possession of the nationality of the host state to initiate proceedings against it, the majority of other arbitration rules do not provide for such a prohibition. Consequently, unlike the realm of diplomatic protection, where the question seems settled, there is little guidance in the treaty-based field of investment arbitration on the probable scenario of a dual national suing one of its states of nationality in a non-ICSID arbitration context. Some tribunals have resorted to traditional principles to deny investment protection to dual nationals, whereas recent awards have been considerably more lenient. This article will demonstrate that, given the fundamental differences between investment treaty arbitration and diplomatic protection, the application by analogy of doctrinal formulations of the former to the latter is not warranted. Instead, a holistic interpretation in accordance with Article 31 of the Vienna Convention on the Law of Treaties should be the primary point of focus of international tribunals, taking into account the object and purpose of the treaty and comparable treaty practice.
A-03 Ethnic/Racial Differences in Longitudinal Neurocognitive Change among People Living with HIV
Authors: Watson C , Kamalyan L , Hussain M , Tang B , Collier A , Clifford D , Gelman B , Sacktor N , Morgello S , McCutchan J A , Ellis R , Grant I , Heaton R , Marquine M
Published: August 2019

HIV disproportionately affects Black and Latino people in the United States, but data on longitudinal neurocognitive patterns for these groups are scarce. This study evaluated the incidence and predictors of neurocognitive decline by ethnicity/race in a cohort of Black, Latino, and White people living with HIV (PLWH). Participants included 499 PLWH (43.5% White, 42.7% Black, 13.8% Latino; mean age at baseline = 43.5) from the six-site CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study. Participants completed comprehensive neurocognitive and neuromedical evaluations over 3-7 study visits for an average of 2.8 years (SD = 1.1). Interpertation of neurocognitive change was based on published methods using regression-based norms that correct for baseline performance and practice effects. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and predictors of neurocognitive decline. In follow-up, 108 participants (21.6%) declined, 311 (62.3%) remained stable, and 80 (16.0%) improved. In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latinos compared to Whites (HR = 2.19, 95%CI = 1.32-3.63, p = .002) and Blacks (HR = 1.87, 95%CI = 1.14-3.04, p = .01). Including significant covariates (baseline nadir CD4, hepatitis C Virus, and VACS Index: a composite marker of physical health among PLWH)did not significantly decrease the elevated risk for decline among Latinos. We found that Latino PLWH appear to have higher risk of neurocognitive decline compared to White and Black PLWH. Traditional markers of HIV disease and physical health at baseline did not explain this elevated risk of neurocognitive decline. Future research examining economic, socio-environmental, and culturally-relevant biomedical factors may help to explain this observed ethnic/racial disparity in longitudinal neurocognitive function in HIV.
A-06 The Culturally Expressive and Responsive (CER) Supervision Model in Neuropsychology
Authors: Strutt A , MacDonald B , Stinson J
Published: August 2019

Objective

The competency-based movement within neuropsychology training programs has done much to create uniform standards of training and identify the “readiness” of trainees to progress to the next level. However, there is little research regarding best practices for development of a supervisory style. The successful progression from trainee to independent practitioner requires a training model that evolves, allowing for independence and collegiality, which includes knowledge expansion, changes in professional relationships and successful institutional navigation. Culture mediates interactions in the patient-doctor relationship, case conceptualization, and also within and between institutional frameworks; therefore, a supervision model should include a multicultural perspective at its core. Data Selection: An otherwise unrestricted multi-database search for “Neuropsychology Supervision” within the title of peer-reviewed journals yielded six results with publication years spanning 1999-2017. Only three specifically address models of supervision and only one is US-based (Stucky et al., 2010). Given then demographic shift estimated for 2050 (Passel & Cohn, 2008), there is a call to action to increase culturally competent neuropsychological services, including training and strengthening the student pipeline (Mindt Rivera et al., 2010). Data Synthesis: The proposed Model for Neuropsychology Supervision (Stucky et al., 2010) recommends supervision to be individually tailored, with both process-based and developmental approaches.

Conclusions

There is a strong need for clear supervision models designed specifically for neuropsychology that integrate culture at all levels of training. Authors propose the Culturally Expressive and Responsive (CER) Supervision Model in Neuropsychology. This is a framework for both trainees and professionals that provides a developmental approach integrating culture and the competency-based standards.
A-07 The Potential Impact of Nuclear History of Micronesia in Neuropsychological Functioning
Authors: Duke L , Gallahue C , Lin J , Shah D , Wu J , Wu V
Published: August 2019

Objective

As a result of 67 nuclear tests in the Marshall Islands between 1946 and 1958, inhabitants of Micronesia exposed to radiation exhibited chronic health issues and birth defects that persist to this day. This patient’s presentation may be an example of the continued residual impact of nuclear testing in Micronesia and demonstrates the importance of historical and biological factors when considering differential diagnoses.

Method

Patient is a six-year-old Micronesian male referred for assessment of psychological functioning. He was developmentally delayed since birth, exhibited unusual facial features, and previously diagnosed with Autism Spectrum Disorder (ASD). Presenting problems included speech delays, limited attention span, difficulty coping with challenges, narrow interests, impulsivity, difficulties interacting with peers, and toileting issues (i.e., defecating on the floor). Mother immigrated to Hawaii from Micronesia in 2006 and primarily speaks Chuukese. While pregnant, mother was on medications for diabetes, hospitalized with high blood pressure, and chewed tobacco daily. Patient experienced some difficulties during the neonatal period.

Results

Average nonverbal intelligence; moderately low receptive single word vocabulary; possible somatization, tendency to withdraw, and atypical behavior; problems with functional communication and daily living activities; and learning-related problems at school. Probability of autism within the Possibly/Very Likely range. Age-inappropriate projective drawings, with indications of potential genetic or developmental dysfunction.

Conclusions

Patient was diagnosed with ASD, with accompanying language impairment. Due to family history of radiation exposure in Micronesia and prenatal concerns, a rule out of other neurodevelopmental disorders and various genetic conditions were considered.
A-08 Aggressive Presentation of Attention Deficit Hyperactivity Disorder: A SPECT Study
Authors: Ailes E , Datoc A , Gilmore M , Golden C , Amen D , Willeumier K , Taylor D
Published: August 2019

Objective

Explore the effects of aggression in adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) on regional cerebral blood flow (rCBF).

Method

Participants were extracted from an archival de-identified SPECT database (n = 889,Mage = 36.73, 60.4% male, 71.6% Caucasian). Two groups were formed based on self-reported aggressive symptoms: low (below 25th percentile; n = 396) and high aggression (above 75th percentile; n = 435).

Results

Age was used as a covariate. One-way ANCOVA’s were conducted controlling for age (alpha = .01). Significant differences were found between groups in the left (F[1,829] = 5.755, ) and right (F[1,829] = 6.114) limbic regions, left basal ganglia (F[1,829] = 4.006, p = .046), left occipital (F[1,829] = 3.951,p = .047), and right parietal regions (F[1,829] = 4.341,p = .038). Discussion: Results revealed that individuals with ADHD and high aggression failed to have significantly different levels of rCBF in areas of the brain responsible for emotion regulation compared to those with low aggression. This study is the first to explore differences in rCBF in a sample of individuals with ADHD. It was hypothesized that higher activation in the limbic and basal ganglia areas was the process of experiencing highly emotional/distressing feelings and the process of acting upon these emotional experiences. However, SPECT failed to present as a reliable resource for identifying individuals with ADHD that have aggressive and impulsive tendencies in this study. Thus, it is suggested that clinicians use caution when using SPECT as a resource in identifying populations likely to engage in aggressive and highly dangerous acts (i.e., suicide/homicide). Further research is needed in using SPECT to identify ADHD populations which may be likely to engaged in aggressive and highly dangerous acts.
B-17 Examining Driving Abilities in Autistic Young Adults
Authors: Nemeth D , Chustz K
Published: August 2019

Objectives

A single white 27 year-old male with autism was referred for an evaluation of his neurocognitive skills for driver’s training competency. Typically, the following criteria are required for special needs individuals to be issued a driver’s license: 1) Must pass neuropsychologist evaluation, 2) Must be cleared by occupational therapist, and 3) must be approved by primary care physician; Schultheis presented a symposium on this topic at the International Neuropsychology Society meeting in Portland, Oregon in 2007. As driving is one of the primary methods of achieving independence in our society, most teens and young adults, regardless of diagnosis, strive to obtain a license.

Methods

This case presentation will profile the results of this individual’s neurocognitive driving skills. This neuropsychological evaluation included the Cognitive Behavioral Driver’s Inventory (CBDI).

Results

Significant results included: Average to low average intellectual skills, high average to average memory and attentional skills, weakness in math, multi-tasking perceptual motor difficulties, visual spatial/constructional difficulties, normal affective functioning, and positive personality profile. This individual had a “clearly failing” CBDI score of 91, with weaknesses in the following areas: Visual scrutiny and attention to detail, Visual motor coordination and fine motor speed, attention and concentration, rapid decision-making, distractibility, and mental flexibility, and consistency of performance. Although previously diagnosed with ADD, results of objective testing (TOVA) did not support this diagnosis.

Conclusions

Outpatient occupational therapy program to include visual spatial and rapid decision-making skills was recommended. Upon completion of this program, a re-administration of the CBDI is recommended.
B-20 Neuropsychological Profile in an Individual with Mitochondrial Encephalopathy, Lactic acidosis, and Stroke-like episodes (MELAS): A Case Study
Authors: Figueroa P , Barbeito C , Ireland S
Published: August 2019

Objective

Mitochondrial Encephalopathy, Lactic acidosis, and Stroke-like episodes (MELAS) is a rare and debilitating mitochondrial disease that affects bodily systems at the neurological level. The purpose of this study is to contribute to the paucity of research regarding the neuropsychological presentation and functional impact of MELAS.

Method

Mr. James is a 23-year-old male of Thai descent who initially presented with 2-3 days of headaches followed by generalized seizures and altered mental status. Over the course of one year, Mr. James experienced recurrent seizures with postictal confusion, and transient aura-like episodes. Patient was diagnosed with MELAS based off a combination of clinical findings, including magnetic resonance imaging (MRI) spectroscopy (SPECT) and molecular genetic testing. Extensive evaluation revealed persistent bilateral multifocal cortical/subcortical lesions, diffuse edema like signal and expansion involving the bifrontal, bitemporal, and bilateral subinsular cortices. Neuropsychological sequalae included physical, cognitive, and emotional changes from baseline.

Results

Mr. James was given a comprehensive neuropsychological battery in order to identify marked changes from his pre-morbid levels of neuropsychological functioning. Consistent with the literature, his profile revealed hallmark expressive and receptive language difficulties and markedly reduced bilateral fine motor functioning. In addition, problems with higher order executive skills (i.e., cognitive flexibility, problem-solving, and hypothesis testing) were elucidated, correlating with individual findings on neuroimaging.

Conclusions

Neuropsychological evaluation of Mr. James contributes to the dearth of research surrounding MELAS. These findings also highlight the importance of neuropsychological testing as part of the comprehensive evaluation for diagnostic clarification, and provide recommendations of the functional impact for others affected with this disease.
B-21 Neuropsychological Profiles and Co-morbid Diagnosis of Patients with HIV Seen in an Outpatient Psychology Clinic
Authors: Cassill C , Rosenstein L
Published: August 2019

There is a high rate of medical and psychiatric comorbidities in the HIV population (Kilbourne et al, 2001), many of which complicate the clinical picture, especially with respect to cognitive functioning (Milanini & Valcour, 2017). It is important to be aware of the impact multiple disorders can have on formulating impressions and treatment planning. We reviewed the records of 35 consecutive patients with HIV seen in our neuropsychology clinic in a county hospital. The 30 men and 5 women had a mean age of 49 (SD = 13.7), with mean education of 13.5 years (SD = 2.0). Average age of HIV diagnosis was 33 (SD = 9.3). Patients had an average of eight major comorbid medical and psychiatric diagnoses, including ADHD (45%), mood disorders (62%), developmental disorders (11%), substance abuse or dependence (45%), sleep apnea (11%), TBI (31%), stroke (14%), cardiovascular disease (51%), and hepatitis (20%). Neuropsychological data were available for 33 patients. Performance on CVLT Trial 5 and Delayed Recall, Rey-Ostereith Copy, WAIS-IV Information and Digit Span, as well as Trail Making A and B were used to measure memory and executive functioning. 21% of the sample obtained one score that was >2 SD below the normative means, and 45% obtained 2 or more scores >2 SD below the mean.In this clinical sample referred for evaluation of cognitive functioning, there was a high rate of comorbid diagnoses. This review highlights the point that comorbid diagnoses are a common presentation and must be considered when discussing etiology of cognitive impairment and treatment planning.
B-22 Non-Convulsive Seizure and Post-Ictal Psychosis Presenting as Foreign Language in a Monolingual Patient: A Case Report
Authors: Nabulsi Y , Cahill J , Kotlarz P
Published: August 2019

Objective

This paper seeks to advance the discussion of foreign language automatisms and clinical consequences of Non-Convulsive Status Epilepticus (NCSE) such as post-ictal psychosis. We present the first case of a monolingual English speaker communicating solely in Spanish, a non-native language during an epileptic episode.

Method

A 70-year old man with no history of seizures, epilepsy, or psychiatric illness presented to his primary care provider with episodes of confusion and "speaking Spanish." Prolonged video EEG performed after admission demonstrated a disorganized background with a mixture of generalized theta and delta activity with frequent focal and generalized ictal and epileptiform activity occurring predominantly out of the right hemisphere.

Results

Laboratory evaluation punctures were unrevealing. MRI of the brain with and without contrast were both normal. Keppra and Depakote were continued during the admission. His psychosis and cognitive impairment improved slowly over several days though he did not return back to his neurological baseline. He returned to speaking only English after several days of treatment. He continued to have frontal lobe dysfunction with psychotic features. A diagnosis of rapidly progressive dementia of unclear etiology was given.

Conclusion

Though foreign language automatisms are a rare consequence of NCSE, the combination of psychotic symptoms and confusion presented in this case creates an interesting connection between psychosis, dementia syndromes, and epilepsy, all involving aberrant activity or deficits in similar brain regions. The generation of foreign language automatisms may indicate a form of psychotic symptomology manifesting as a language anomaly as opposed to visual hallucinations, delusions, or formal thought disorder.
B-27 Primary Progressive Multiple Sclerosis in an Older Man
Authors: Schieszler-Ockrassa C , Bylsma F
Published: August 2019

Objective

Multiple sclerosis (MS) is an autoimmune demyelinating disease more common in women than men, usually diagnosed between 20-30 years of age. Approximately 50% of individuals with MS develop cognitive dysfunction, with men and progressive MS subtype cases at higher risk (Beatty & Aupperle, 2002). Mr. Doe’s case is unique because he was diagnosed with primary progressive MS at age 56 and demonstrated only mild cognitive dysfunction.

Method

Mr. Doe presented to his neurologist with complaints of extreme fatigue, slowed processing, and sensory and motor disturbances. He was seen for neuropsychological evaluation one year after diagnosis and was reassessed one year later. He reported worsening mood including passive suicidal ideation since diagnosis. He reported difficulties with work duties (attorney) and household demands due to gradual motor and sensory disturbances, slowed processing speed, fatigue, and mood disturbance.

Results

Mr. Doe’s initial neuropsychological assessment revealed variability in auditory working memory, weakness in sustained visual attention, and mild deficits in upper extremity fine motor dexterity. Memory, executive functioning, language, and processing speed were all intact unless a motor component was involved (mild decline after one year). His cognitive performances remained generally stable after one year, but depression, anxiety, and hopelessness levels were all significantly worse.

Conclusions

Although Mr. Doe’s impairments are extremely mild and somewhat unexpected given the primary progressive MS diagnosis, his gender, and age, the affected domains are consistent with the diagnosis. This case demonstrates the importance of understanding base rates for conditions we assess, but also not ruling out lower base rate conditions.
B-30 Sturge-Weber Syndrome in Adulthood: A Case Study of Superior Cognitive Reserve
Authors: Abramson D , Fredrick A , Bell Z , Fink J
Published: August 2019

Objective

Sturge-Weber Syndrome (SWS) is a neurological disorder usually diagnosed in childhood and characterized by facial port-wine stains, seizures, and intracranial vascular malformations. SWS is associated with a variety of neuropsychological presentations in children, but the adult cognitive profile of this disease is not well established. Specifically, little is known about how cerebral abnormalities found using Magnetic Resonance Imaging (MRI) correlate with cognitive difficulties in adulthood or if certain prognostic factors can predict cognitive outcome.

Methods

The present case involved a 53-year-old, left-handed, Caucasian female with 20 years of education with SWS, possible seizures, multiple concussions, posttraumatic stress disorder (PTSD; multiple reported traumas) and bipolar disorder, referred for a neuropsychological evaluation for progressive problems with memory, word-finding, and coordination over the last 14 years. A neuropsychological evaluation was administered and structural neuroimaging was reviewed.

Results

MRI studies revealed left hemispheric atrophy with enlargement of the left ventricle, cortical calcification in the left temporo-occipital region, cerebrovascular disease particularly in the frontal lobes, and vascular malformations. Despite severe neuroanatomical abnormalities associated with SWS, as well as comorbid psychiatric disorders, a neuropsychological evaluation revealed a relatively intact cognitive profile, with only scattered minor inefficiencies in attention/processing speed, executive functioning, and motor functioning.

Conclusions

This case provided an example of good prognosis of SWS in adulthood, despite significant brain abnormalities, potential seizure activity, multiple concussions, and psychiatric comorbidity. Further research is needed to conceptualize the neuropsychological impact of SWS in adulthood, specifically whether aspects of superior cognitive reserve (e.g., higher education) are associated with better prognosis.
B-34 Correspondence of Latent Neurophysiological and Neurocognitive Profiles to Psychosis Biotypes
Authors: Rhoads T , Gotra M , Kaseda E , Hill S
Published: August 2019

Objective

The Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) Consortium has developed a novel classification system for psychotic-spectrum disorders that emphasizes objective and neurobiologically valid measures. However, these ‘biotypes’ were created based on a lengthy battery of tests including electroencephalography (EEG), which is time-consuming to administer and not widely available in most clinical settings. The aim of the present study was to evaluate the degree to which classifications obtained using only cognitive and eye tracking paradigms correspond with the biotypes, which would allow for a more efficient approach to diagnosis of psychotic-spectrum disorders that could feasibly be implemented in a clinical setting.

Method

This study utilized latent profile analysis to identify distinct profiles in 683 patients diagnosed with schizophrenia, schizoaffective, or bipolar with psychosis and compared the solution to previously assigned biotypes.

Results

A 3-profile solution provided the best fit for the data (p = .02) and the profiles were characterized by varying degrees of cognitive and sensorimotor impairment. The most impaired profile accurately classified 58.1% of the probands in the most impaired biotype; the least impaired profile classified 63.4% of the least impaired biotype. The intermediate profile did not discriminate between biotypes.

Conclusions

Using composite scores to represent general cognition, eye tracking, and inhibitory control led to better classification of individuals at neurocognitive extremes, but not intermediate levels. These results suggest that the EEG findings are essential to better classify psychosis probands with intermediate impairment and contribute unique variance that may be clinically significant in classifying a subset of psychotic patients in treatment settings.
B-36 Effects of Electroconvulsive Therapy on Cognitive Performance and Depressive Symptoms: A Naturalistic Study
Authors: Goegan S , Hasey G , Ballantyne E , MacKillop E , King J , Gojmerac C , Losier B , Bieling P , McKinnon M , McNeely H
Published: August 2019

Objective

1) Examine the short- and long-term effects of electroconvulsive therapy (ECT)—conducted in a naturalistic treatment setting—on objective and subjective cognitive functioning. 2) Examine the long-term effects of naturalistic ECT on depressive symptoms.

Method

Participants (N = 108) were outpatients (aged 18-65) diagnosed with a Major Depressive Episode who received ECT at St. Joseph’s Healthcare Hamilton, Ontario. Parameters of ECT varied clinically. Participants completed a cognitive and psychological test battery at baseline (n = 108), mid-treatment (n = 82), 2–6-weeks post-ECT (n = 52), 6-months post-ECT (n = 24), and 12-months post-ECT (n = 14) that included Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Squire Subjective Memory Questionnaire (SSMQ), Beck Depression Inventory-II (BDI-II), and WHO Disability Assessment Schedule (WHODAS-2).

Results

Overall cognitive performance (total RBANS scaled scores) did not improve from baseline to 2-6 weeks post-ECT (p = 0.156), significantly improved from baseline to 6-months post-ECT (t(22) = -2.34, p = .026, CI: = -8.93– -0.63), but were not maintained at 12-months post-ECT (p = 0.20). SSMQ scores significantly worsened from baseline to mid-ECT (t(75) = -5.04, p < .001, CI: -17.53– -7.60), but returned to baseline levels by 2–6-weeks post-ECT. Depressive symptoms (BDI-II) significantly improved by the 4th ECT session and gains were maintained across all timepoints (p < 0.004). WHODAS-2 scores significantly improved from baseline and were maintained across follow-up (t < 0.05).

Conclusion

ECT was effective at improving depressive symptoms in a naturalistic setting with diverse patient presentations. Preliminary findings show minimal, if any, gains in cognitive performance–although, functioning did not appear to worsen following ECT. RBANS may not be sufficiently sensitive. Developing recommendations for conducting and evaluating ECT in naturalistic settings marks an essential next step.