Objective: Childhood irritability is a common, impairing problem with changing agerelated manifestations that predict long-term adverse outcomes. However, more work is needed on its overall and age-specific neural correlates. Since irritable youth exhibit exaggerated responses to frustrating stimuli, we used a frustrating functional magnetic resonance imaging (fMRI) paradigm to examine associations between irritability and neural activation and tested the moderating effect of age. Method: We studied a transdiagnostic sample of 195 youths with varying levels of irritability (52 disruptive mood dysregulation disorder, 42 anxiety disorder, 40 attention deficit/hyperactivity disorder, and 61 healthy volunteers). Irritability was measured by parent- and child-reports on the Affective Reactivity Index. The fMRI paradigm was a cued-attention task differentiating neural activity in response to frustration (rigged feedback) from activity during attention orienting in the trial following frustration. Results: Whole-brain activation analyses revealed associations with irritability during attention orienting following frustration. Irritability was positively associated with frontalstriatal activation, specifically in dorsolateral prefrontal cortex, inferior frontal gyrus, and caudate (rs=.31-.40, ps<.05). Age moderated the association between irritability and activation in some frontal and posterior regions (anterior cingulate cortex [ACC], medial frontal gyrus, cuneus, precuneus, superior parietal lobule; F1,189=19.04–28.51, ps<.001, ηp2=.09-.13). Specifically, higher irritability was more strongly related to increased activation in younger relative to older youths. Conclusions: Following frustration, levels of irritability correlate with activity in neural systems mediating attention orienting, top-down regulation of emotions, and motor execution. While most associations were independent of age, dysfunction in ACC and posterior regions was more pronounced in young children with irritability.

These data extend prior work conducted in youths with irritability or anxiety alone and suggest that research may miss important findings if the pathophysiology of irritability and anxiety are studied in isolation. Decreased amygdala-medial prefrontal cortex connectivity may mediate emotion dysregulation when very anxious and irritable youth process threat-related faces. Activation in the ventral visual circuitry suggests a mechanism through which signals of social approach (ie, happy and angry expressions) may capture attention in irritable youth.

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Background Over the last decade, medical student residency applicants have shown a substantial increase in the number of interviews attended, which is associated with a significant increase in travel. The carbon footprint associated with residency interviews has not been well documented prior to this investigation, and is a critical issue related to climate health. Objective The purpose of this study is to document the carbon footprint associated with travel to residency interviews of the applicants from a single institution. Methods Graduating medical students from the University of Michigan Medical School were surveyed in 2020 to gather information regarding travel related to residency interviews. A validated carbon emissions calculator was used to determine the associated carbon footprint. Results Response rate was 103 of 174 (59%). Average interviews per student across all specialties was 14.39 interviews per student. The overall class average for total carbon footprint per student was calculated as 3.07 metric tons CO2, making the class average carbon footprint per interview 0.21 metric tons CO2. If we extrapolate the results of our study to all residents, the resulting CO2 emissions approach 51 665 metric tons CO2 per year, which is equivalent to the amount of CO2 produced by 11 162 passenger cars in 1 year. Conclusions Medical education leaders could help reduce the carbon footprint by encouraging a reduction in number of in-person interviews attended by applicants.