Does the Relationship between Age and Brain Structure Differ in Youth with Conduct Disorder?

Conduct disorder (CD) is characterised by persistent antisocial and aggressive behaviour and typically emerges in childhood or adolescence. Although several authors have proposed that CD is a neurodevelopmental disorder, very little evidence is available about brain development in this condition. Structural brain alterations have been observed in CD, and some indirect evidence for delayed brain maturation has been reported. However, no detailed analysis of age-related changes in brain structure in youth with CD has been conducted. Using cross-sectional MRI data, this study aimed to explore differences in brain maturation in youth with CD versus healthy controls to provide further understanding of the neurodevelopmental processes underlying CD. 291 CD cases (153 males) and 379 healthy controls (160 males) aged 9–18 years (Mage = 14.4) were selected from the European multisite FemNAT-CD study. Structural MRI scans were analysed using surface-based morphometry followed by application of the ENIGMA quality control protocols. An atlas-based approach was used to investigate group differences and test for group-by-age and group-by-age-by-sex interactions in cortical thickness, surface area and subcortical volumes. Relative to healthy controls, the CD group showed lower surface area across frontal, temporal and parietal regions as well as lower total surface area. No significant group-by-age or group-by-age-by-sex interactions were observed on any brain structure measure. These findings suggest that CD is associated with lower surface area across multiple cortical regions, but do not support the idea that CD is associated with delayed brain maturation, at least within the age bracket considered here.</p

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Interpretable machine learning for dementia: A systematic review

Introduction: Machine learning research into automated dementia diagnosis is becoming increasingly popular but so far has had limited clinical impact. A key challenge is building robust and generalizable models that generate decisions that can be reliably explained. Some models are designed to be inherently “interpretable,” whereas post hoc “explainability” methods can be used for other models. Methods: Here we sought to summarize the state-of-the-art of interpretable machine learning for dementia. Results: We identified 92 studies using PubMed, Web of Science, and Scopus. Studies demonstrate promising classification performance but vary in their validation procedures and reporting standards and rely heavily on popular data sets. Discussion: Future work should incorporate clinicians to validate explanation methods and make conclusive inferences about dementia-related disease pathology. Critically analyzing model explanations also requires an understanding of the interpretability methods itself. Patient-specific explanations are also required to demonstrate the benefit of interpretable machine learning in clinical practice

Cortical structure and subcortical volume in adults with psychopathy: A multi-site mega-analysis from the ENIGMA Antisocial Behavior working group

Psychopathy is a personality disorder characterised by distinctive interpersonal and affective abnormalities combined with recurring disruptive and antisocial behaviours (Hare &amp; Neumann, 2009). It is associated with violence, criminal versatility, and increased rates of recidivism (Hare &amp; Neumann, 2008; Hare &amp; Neumann, 2009; Salekin et al., 1997). Previous structural MRI studies have identified several volumetric and surface-based cortical and subcortical brain differences in individuals with psychopathy compared to control groups (Johanson et al., 2020; Howner et al., 2012; Ly et al., 2012; Yang et al., 2009a; Yang et al., 2009b; Yang et al., 2011). Furthermore, studies examining associations between structural brain alterations and psychopathy Factor 1 (indexing interpersonal and affective traits such as egocentricity, deception, low empathy and manipulation) and Factor 2 (indexing impulsive and antisocial traits such as social deviance, criminality and impulsivity) have noted that while there are certain structural differences associated with both factors, the two factors of psychopathy might be also associated with distinct structural correlates (Contreras-Rodríguez et al., 2015; Cope et al., 2012; De Brito et al., 2021b; Howner et al., 2012; Leutgeb et al., 2015; Miglin et al., 2022; Miskovich et al., 2018; Yang et al., 2009). Finally, a small body of work also reveals that among individuals with a diagnosis of antisocial personality disorder (ASPD), individuals who additionally present with psychopathy (ASPD+P), might show unique abnormalities compared to those without psychopathy (ASPD-P) (De Brito et al., 2021; Gregory et al., 2012, 2015; Johanson et al., 2020). While neuroimaging investigations have sought to characterise the neural differences that underlie psychopathy, there still appears to be some variability in findings across studies and diverging patterns of associations between psychopathy factors and cortical structure (e.g., De Brito et al., 2021a, 2021b; Poeppl et al., 2019). Ambiguity in the current literature may be due to methodological factors such as heterogenous image acquisition techniques, analytical approaches, sample characteristics (e.g., community vs clinical/forensic), and participant characteristics. Furthermore, most published research in the psychopathy literature has focused on male adults from forensic or clinical populations. Given that such individuals are often difficult to access and recruit, previous studies have suffered from small sample sizes and have been unable to consider sex as a variable within the research design or test for sex-by-diagnosis interactions. Overall, we argue that a consistent picture of the brain morphometric differences associated with psychopathy is lacking. Therefore, a comprehensive, large-scale analysis in relation to psychopathy could provide a more accurate account of the neuroanatomical correlates of the disorder. Utilising existing individual-level brain imaging data (such as that assembled by the ENIGMA consortium), some of which may not have been previously published as surface-based morphometry studies, provides an opportunity to overcome the weaknesses of existing research and provides greater population generalisability owing to the large sample size and increase in statistical power. Furthermore, this approach offers the opportunity to consider individual differences in more detail. It allows for the investigation of psychopathy as a dimension and consideration of how the different psychopathy factors may be related to brain structure across the full range of disorder severity. This study will use datasets provided to the ENIGMA-Antisocial behavior working group to examine the cortical and subcortical correlates of psychopathy and take a mega-analytical approach which allows for a more flexible and comprehensive analysis of the data (Boedhoe et al., 2019). Main Research Questions: 1: Do adults with psychopathy show consistent and reliable differences in cortical thickness, surface area and/or subcortical volume compared to control groups without psychopathy? 2: In comparison to a healthy control group, can we identify structural differences that are unique to antisocial personality disorder with psychopathy, and which are common to both antisocial personality disorder with/without psychopathy? 3: How are the two factors of psychopathy associated with cortical thickness, surface area and subcortical volume? 4: Do these structural differences occur across the full spectrum of disorder severity (i.e., across community and/as well as forensic/clinical samples)? 5: Is the relationship between psychopathy and cortical thickness, surface area or subcortical volume different in male versus female participants

Investigating Dimensional Relationships Between Conduct Problems and Brain Structure: An ENIGMA Mega-Analysis

Pre-registration of a secondary analysis plan for a study by the ENIGMA-Antisocial Behavior working group focused on the relationship between conduct problems and brain structure

Regards sur l'intime en Irlande

À la frontière entre l’être et le monde, entre une société qui édicte des lois écrites ou implicites et un individu qui les interprète en fonction du temps et du contexte de leur mise en œuvre, l’intime repose sur des codes partagés dont l’interprétation est chaque fois singulière. L’opposition entre espace public et privé ne suffit pas à définir la sphère de l’intime, puisque selon l’âge, le sexe, l’éducation, et plus globalement la culture à laquelle on appartient, les limites tracées varient amplement selon des codes souvent perçus comme des évidences pour les membres d’une communauté donnée. Personnel dans ce qu’il y a de plus profond pour l’être, l’intime s’apparente à un domaine individuel que chacun ouvre à l’autre par degrés. Dans Regards sur l’intime en Irlande, les analyses portent sur la tension entre les masques constitutifs de l’intimité et l’exposition de l’intime, sa négation ou son questionnement dans diverses composantes de la vie irlandaise. Il s’agit non seulement d’interroger l’intime en Irlande, mais aussi d’évaluer comment les intimités irlandaises se sont exprimées, tant dans le domaine des arts que dans la sphère sociale où s’est posée de façon parfois très aiguë la question des frontières de l’intime