; for the NES Treatment Trial (NEST-T) Consortium IMPORTANCE There is a paucity of controlled treatment trials for the treatment of conversion disorder, seizures type, also known as psychogenic nonepileptic seizures (PNES). Psychogenic nonepileptic seizures, the most common conversion disorder, are as disabling as epilepsy and are not adequately addressed or treated by mental health clinicians. OBJECTIVE To evaluate different PNES treatments compared with standard medical care (treatment as usual). DESIGN, SETTING, AND PARTICIPANTS Pilot randomized clinical trial at 3 academic medical centers with mental health clinicians trained to administer psychotherapy or psychopharmacology to outpatients with PNES. Thirty-eight participants were randomized in a blocked schedule among 3 sites to 1 of 4 treatment arms and were followed up for 16 weeks between September 2008 and February 2012; 34 were included in the analysis. INTERVENTIONS Medication (flexible-dose sertraline hydrochloride) only, cognitive behavioral therapy informed psychotherapy (CBT-ip) only, CBT-ip with medication (sertraline), or treatment as usual. MAIN OUTCOMES AND MEASURES Seizure frequency was the primary outcome; psychosocial and functioning measures, including psychiatric symptoms, social interactions, quality of life, and global functioning, were secondary outcomes. Data were collected prospectively, weekly, and with baseline, week 2, midpoint (week 8), and exit (week 16) batteries. Within-group analyses for each arm were performed on primary (seizure frequency) and secondary outcomes from treatment-blinded raters using an intention-to-treat analysis. RESULTS The psychotherapy (CBT-ip) arm showed a 51.4% seizure reduction (P = .01) and significant improvement from baseline in secondary measures including depression, anxiety, quality of life, and global functioning (P < .001). The combined arm (CBT-ip with sertraline) showed 59.3% seizure reduction (P = .008) and significant improvements in some secondary measures, including global functioning (P = .007). The sertraline-only arm did not show a reduction in seizures (P = .08). The treatment as usual group showed no significant seizure reduction or improvement in secondary outcome measures (P = .19). CONCLUSIONS AND RELEVANCE This pilot randomized clinical trial for PNES revealed significant seizure reduction and improved comorbid symptoms and global functioning with CBT-ip for PNES without and with sertraline. There were no improvements in the sertraline-only or treatment-as-usual arms. This study supports the use of manualized psychotherapy for PNES and successful training of mental health clinicians in the treatment. Future studies could assess larger-scale intervention dissemination. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00835627

These findings suggest that circulating or MSC-EXOs may modulate pulmonary hypertensive effects based on their miR cargo. The ability of MSC-EXOs to reverse MCT-PH offers a promising potential target for new PAH therapies.

Internet-based sexuality research with hidden populations has become increasingly popular. Respondent anonymity may encourage participation and lower social desirability, but associated disinhibition may promote multiple submissions, especially when incentives are offered. The goal of this study was to identify the usefulness of different variables for detecting multiple submissions from repeat responders and to explore incentive effects. The data included 1,900 submissions from a three-session Internet intervention with a pretest and three post-test questionnaires. Participants were men who have sex with men and incentives were offered to rural participants for completing each questionnaire. The final number of submissions included 1,273 "unique", 132 first submissions by "repeat responders" and 495 additional submissions by the "repeat responders" (N = 1,900). Four categories of repeat responders were identified: "infrequent" (2-5 submissions), "persistent" (6-10 submissions), "very persistent" (11-30 submissions), and "hackers" (more than 30 submissions). Internet Provider (IP) addresses, user names, and passwords were the most useful for identifying "infrequent" repeat responders. "Hackers" often varied their IP address and identifying information to prevent easy identification, but investigating the data for small variations in IP, using reverse telephone look up, and patterns across usernames and passwords were helpful. Incentives appeared to play a role in stimulating multiple submissions, especially from the more sophisticated "hackers". Finally, the web is ever evolving and it will be necessary to have good programmers and staff who evolve as fast as "hackers". KeywordsInternet research; Multiple submissions; Repeat responders; Validity; Rural; MSM Internet-based research with high HIV risk and hidden populations, such as men who have sex with men (MSM), is rapidly expanding (Pequegnat et al. 2006). The increase in Internet research has led a number of authors to call for examination of methodological issues related to internal and external validity (Kraut et al. 2004;Pequegnat et al. 2006). The anonymity of the Internet provides advantages and disadvantages in terms of internal validity (Kraut et al. 2004). Respondent anonymity may reduce pressure to respond in socially desirable ways, but may lead to unintended outcomes. Catania (1999) suggests that lowered presentation bias may result in more honest responses to sensitive questions. However, anonymity in online studies may lower self-regulation, increasing the possibility of developing multiple identities (Joinson 1998). If significant numbers of participants in online studies change their identity and enroll multiple times, the integrity of data will be severely compromised (Birnbaum 2004;Mustanski 2001;Pequegnat et al. 2006; Reips 2002a, b).Early in the Internet research revolution, it was suggested that the prevalence of repeat responders (the number of people who enroll multiple times) and the frequency of multiple submissions (the numbe...

Rationale: Recent studies have focused on the role of female sex and estradiol (E2) in pulmonary arterial hypertension (PAH), but it is not known whether sex hormones are risk factors for PAH in men.Objectives: We performed a case-control study to determine whether hormone levels (E2, dehydroepiandrosterone-sulfate [DHEA-S], and testosterone) are associated with PAH in men.Methods: Plasma sex hormone levels in men with idiopathic, heritable, or connective tissue disease-associated PAH were compared with those from age-and body mass index-matched men without clinical cardiovascular disease.Measurements and Main Results: There were 23 cases with PAH (70% had idiopathic PAH, 65% were functional class III/IV) and 67 control subjects. Higher E2 and E2/testosterone levels were associated with the risk of PAH (odds ratio per 1 ln[E2:testosterone], 6.0; 95% confidence interval, 2.2-16.4; P = 0.001), whereas higher levels of DHEA-S were associated with a reduced risk (odds ratio per 1 ln[DHEA-S], 0.1; 95% confidence interval, 0.0-0.3; P = 0.001). E2 and DHEA-S levels were strong predictors of case status (C statistic for both, 0.82) but testosterone was not (C statistic, 0.53). Higher levels of E2 were associated with shorter 6-minute-walk distances (P = 0.03), whereas higher levels of DHEA-S were associated with lower right atrial pressure (P = 0.02) and pulmonary vascular resistance (P = 0.01) in men with PAH.Conclusions: Higher levels of E2 and lower levels of DHEA-S were associated with PAH in men. Sex-based differences in sex hormone processing and signaling may contribute to unique phenotypes in pulmonary vascular disease.

This study examined whether youth with learning disabilities reported more maladaptive cognitive self-regulatory characteristics known to influence learning motivation and performance. Specifically, 1,518 sixth-through twelfth-graders from two separate rural school districts with and without learning disabilities completed measures of academic self-efficacy, theories of intelligence, academic goal preferences, and attributions for exerting effort in academic contexts. We found that students with a learning disability were more likely to possess low academic self-efficacy, to believe that intelligence was fixed and nonmalleable, to prefer performance over learning goals, and to interpret the exertion of effort as meaning they possessed limited levels of ability. Theories of intelligence and academic self-efficacy were also found to influence goal preferences and ability attributions. Einally, mediational findings provided strong support for the notion that differences in goal preferences and effort attributions between youth with and without LD were largely due to the fact that youth with LD possessed greater entity views of intelligence and lower academic self-efficacy. Our findings add to existing studies that support Dweck's (1999) model and suggest that interventions for learning disabilities ought to target a broader range of cognitive self-regulatory processes.

Brain disease models of psychopathology, such as the popular "chemical imbalance" explanation of depression, have been widely disseminated in an attempt to reduce the stigma of mental illness. ironically, such models appear to increase prejudicial attitudes among the general public toward persons with mental disorders. However, little is known about how biochemical causal explanations affect the perceptions of individuals seeking mental health treatment. Ninety undergraduate students participated in a thought experiment in which they were asked to imagine feeling depressed, seeking help from a doctor who diagnosed them with major depressive disorder, and receiving, in counterbalanced order, a chemical imbalance and biopsychosocial explanation for their symptoms. ratings of each explanation's credibility and perceptions of self-stigma (e.g., blame), prognosis, and treatment expectancies were obtained. Compared to the biopsychosocial model, the chemical imbalance model was associated with significantly less self-stigma but also significantly lower credibility, a worse expected prognosis, and the perception that psychosocial interventions would be ineffective. the chemical imbalance explanation appears to reduce blame at the cost of fostering pessimism about recovery and the efficacy of nonbiological treatments. research is needed on how the chemical imbalance model affects the clinical response of patients receiving mental health treatment.

The CAPTIVE embolectomy technique may result in higher recanalization rates and better clinical outcomes.

With DBT, the recall rate decreased and the biopsy PPV and cancer detection rate did not decrease. The distribution of recalled abnormalities changed, and more patients were evaluated with US only.