Victoria Wesevich

Real-time motion analytics during brain MRI improve data quality and reduce costs

Abstract Head motion systematically distorts clinical and research MRI data. Motion artifacts have biased findings from many structural and functional brain MRI studies. An effective way to remove motion artifacts is to exclude MRI data frames affected by head motion. However, such post‐hoc frame censoring can lead to data loss rates of 50% or more in our pediatric patient cohorts. Hence, many scanner operators collect additional ‘buffer data’, an expensive practice that, by itself, does not guarantee sufficient high‐quality MRI data for a given participant. Therefore, we developed an easy‐to‐setup, easy‐to‐use Framewise Integrated Real‐time MRI Monitoring (FIRMM) software suite that provides scanner operators with head motion analytics in real‐time, allowing them to scan each subject until the desired amount of low‐movement data has been collected. Our analyses show that using FIRMM to identify the ideal scan time for each person can reduce total brain MRI scan times and associated costs by 50% or more. Graphical abstract Figure. No Caption available.

Pupillary Contagion in Infancy Evidence for Spontaneous Transfer of Arousal

Pupillary contagion—responding to pupil size observed in other people with changes in one’s own pupil—has been found in adults and suggests that arousal and other internal states could be transferred across individuals using a subtle physiological cue. Examining this phenomenon developmentally gives insight into its origins and underlying mechanisms, such as whether it is an automatic adaptation already present in infancy. In the current study, 6- and 9-month-olds viewed schematic depictions of eyes with smaller and larger pupils—pairs of concentric circles with smaller and larger black centers—while their own pupil sizes were recorded. Control stimuli were comparable squares. For both age groups, infants’ pupil size was greater when they viewed large-center circles than when they viewed small-center circles, and no differences were found for large-center compared with small-center squares. The findings suggest that infants are sensitive and responsive to subtle cues to other people’s internal states, a mechanism that would be beneficial for early social development.

Behavioral interventions for reducing head motion during MRI scans in children

&NA; A major limitation to structural and functional MRI (fMRI) scans is their susceptibility to head motion artifacts. Even submillimeter movements can systematically distort functional connectivity, morphometric, and diffusion imaging results. In patient care, sedation is often used to minimize head motion, but it incurs increased costs and risks. In research settings, sedation is typically not an ethical option. Therefore, safe methods that reduce head motion are critical for improving MRI quality, especially in high movement individuals such as children and neuropsychiatric patients. We investigated the effects of (1) viewing movies and (2) receiving real‐time visual feedback about head movement in 24 children (5–15 years old). Children completed fMRI scans during which they viewed a fixation cross (i.e., rest) or a cartoon movie clip, and during some of the scans they also received real‐time visual feedback about head motion. Head motion was significantly reduced during movie watching compared to rest and when receiving feedback compared to receiving no feedback. However, these results depended on age, such that the effects were largely driven by the younger children. Children older than 10 years showed no significant benefit. We also found that viewing movies significantly altered the functional connectivity of fMRI data, suggesting that fMRI scans during movies cannot be equated to standard resting‐state fMRI scans. The implications of these results are twofold: (1) given the reduction in head motion with behavioral interventions, these methods should be tried first for all clinical and structural MRIs in lieu of sedation; and (2) for fMRI research scans, these methods can reduce head motion in certain groups, but investigators must keep in mind the effects on functional MRI data. HighlightsIn young children, movie watching during MRI scans reduces head motion.Real‐time head motion feedback also reduces motion during MRI scans in young children.Motion effects were specific to younger (5‐10 years) not older children (11‐15 years).Movies, but not feedback, significantly alter functional connectivity MRI data.

Callous–unemotional traits affect adolescents' perception of collaboration

Background How is the perception of collaboration influenced by individual characteristics, in particular high levels of callous–unemotional (CU) traits? CU traits are associated with low empathy and endorsement of negative social goals such as dominance and forced respect. Thus, it is possible that they could relate to difficulties in interpreting that others are collaborating based on a shared goal. Methods In the current study, a community sample of 15‐ to 16‐year olds participated in an eye tracking task measuring whether they expect that others engaged in an action sequence are collaborating, depending on the emotion they display toward each other. Positive emotion would indicate that they share a goal, while negative emotion would indicate that they hold individual goals. Results When the actors showed positive emotion toward each other, expectations of collaboration varied with CU traits. The higher adolescents were on CU traits, the less likely they were to expect collaboration. When the actors showed negative emotion toward each other, CU traits did not influence expectations of collaboration. Conclusions The findings suggest that CU traits are associated with difficulty in perceiving positive social interactions, which could further contribute to the behavioral and emotional problems common to those with high CU traits.

The Role of Patient Advocacy and the Declining Rate of Clitoroplasty in 46,XX Patients With Congenital Adrenal Hyperplasia:

Prior to the 1990s, most 46,XX infants with clitoromegaly secondary to congenital adrenal hyperplasia were treated with feminizing genitoplasty to make their cosmetic appearance congruent with their genotypic sex. A 2006 consensus statement for the management of intersex disorders accepted input from patient advocates and did not support purely cosmetic surgery for clitoromegaly. This study examined the extent to which the desired change was implemented in practice. Retrospective chart review was performed at a single Midwestern tertiary care medical center for patients born between 1979 and 2013. Of 45 virilized patients, 40 had clitoromegaly and 39 had urogenital sinus or posterior labial fusion. Twenty-seven (67.5%) patients underwent clitoroplasty and 33 (84.6%) underwent perineoplasty, including vaginoplasty, urethroplasty, imperforate vagina repair, and/or posterior labial fusion repair. There was a linear decline in the rate of clitoroplasty over time for the patient cohort. This study demonstrates the power of patient advocacy to improve medical practice.

Implementation and Outcomes of Universal Delayed Umbilical Cord Clamping at Term

Objective To evaluate the implementation of an institutional protocol for universal delayed umbilical cord clamping (DCC) at term on maternal, neonatal, and umbilical cord blood gas outcomes. Study Design This is a retrospective cohort study of singleton term gestations from April through July 2017. On June 1, 2017, a protocol was implemented for DCC in all deliveries. Outcomes were compared between patients delivered prior to and those delivered after implementation. The primary outcome was postpartum hemorrhage (PPH). Secondary outcomes were additional adverse maternal, neonatal, and umbilical cord blood gas outcomes. Multivariable logistic regression was used to adjust for potential confounders. Results Of 682 patients, 341 were delivered preprotocol and 341 were delivered postprotocol. After implementation, there was 91.8% adherence to the protocol. Overall, there was no significant difference in PPH between patients delivered preprotocol and those delivered postprotocol (8.2 vs. 13.2%; adjusted relative risk [aRR]: 1.26, 95% confidence interval [CI]: 0.98‐1.51). There was a significant decrease in the ability to obtain paired arterial and venous umbilical cord blood gases from preprotocol to postprotocol (83 vs. 63.6%; aRR: 0.62 [95% CI: 0.50‐0.76]). There were no significant differences in abnormal umbilical cord blood gases or neonatal outcomes. Conclusion We did not find an increased risk of adverse outcomes associated with the widespread use of DCC.