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Although cognitive remediation (CR) improves cognition and functioning, the key features that promote or inhibit its effectiveness, especially between cognitive domains, remain unknown. Discovering these key features will help to develop CR for more impact.
Aim
To identify interrelations between cognition, symptoms, and functioning, using a novel network analysis approach and how CR affects these recovery outcomes.
Methods
A secondary analysis of randomized controlled trial data (N = 165) of CR in early psychosis. Regularized partial correlation networks were estimated, including symptoms, cognition, and functioning, for pre-, post-treatment, and change over time. Pre- and post-CR networks were compared on global strength, structure, edge invariance, and centrality invariance.
Results
Cognition, negative, and positive symptoms were separable constructs, with symptoms showing independent relationships with cognition. Negative symptoms were central to the CR networks and most strongly associated with change in functioning. Verbal and visual learning improvement showed independent relationships to improved social functioning and negative symptoms. Only visual learning improvement was positively associated with personal goal achievement. Pre- and post-CR networks did not differ in structure (M = 0.20, p = 0.45) but differed in global strength, reflecting greater overall connectivity in the post-CR network (S = 0.91, p = 0.03).
Conclusions
Negative symptoms influenced network changes following therapy, and their reduction was linked to improvement in verbal and visual learning following CR. Independent relationships between visual and verbal learning and functioning suggest that they may be key intervention targets to enhance social and occupational functioning.
Identifying feeding interactions in the fossil record remains a key challenge for paleoecologists. We report the rare occurrence of a conical, perforative bite mark in a cervical vertebra of an azhdarchid pterosaur, which we identified as a juvenile individual of Cryodrakon boreas Hone, Habib, and Therrien, 2019 from the Campanian Dinosaur Park Formation in Alberta, Canada. Based on comparative analysis of the dentition and ecomorphology of potential trace makers in the Dinosaur Park Formation, as well as the morphology of the trace, the most likely candidate is a crocodilian, although whether it was made as a result of scavenging or predatory behavior is unknown. Feeding interactions involving pterosaurs are rare globally, whereas crocodilian bite marks are not uncommon in Cretaceous terrestrial ecosystems. Given the opportunistic feeding style and known range of food items for both extant and extinct crocodilians, pterosaurs can be counted as a rare, but not surprising, component of at least some Cretaceous crocodilian diets.
Mental health problems are elevated in autistic individuals but there is limited evidence on the developmental course of problems across childhood. We compare the level and growth of anxious-depressed, behavioral and attention problems in an autistic and typically developing (TD) cohort.
Methods
Latent growth curve models were applied to repeated parent-report Child Behavior Checklist data from age 2–10 years in an inception cohort of autistic children (Pathways, N = 397; 84% boys) and a general population TD cohort (Wirral Child Health and Development Study; WCHADS; N = 884, 49% boys). Percentile plots were generated to quantify the differences between autistic and TD children.
Results
Autistic children showed elevated levels of mental health problems, but this was substantially reduced by accounting for IQ and sex differences between the autistic and TD samples. There was small differences in growth patterns; anxious-depressed problems were particularly elevated at preschool and attention problems at late childhood. Higher family income predicted lower base-level on all three dimensions, but steeper increase of anxious-depressed problems. Higher IQ predicted lower level of attention problems and faster decline over childhood. Female sex predicted higher level of anxious-depressed and faster decline in behavioral problems. Social-affect autism symptom severity predicted elevated level of attention problems. Autistic girls' problems were particularly elevated relative to their same-sex non-autistic peers.
Conclusions
Autistic children, and especially girls, show elevated mental health problems compared to TD children and there are some differences in predictors. Assessment of mental health should be integrated into clinical practice for autistic children.
Incremental prediction of aggression from callous–unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.
Evidence from previous small trials has suggested the effectiveness of early social communication interventions for autism.
Objectives
The Preschool Autism Communication Trial (PACT) investigated the efficacy of such an intervention in the largest psychosocial autism trial to date.
Aims
To provide a stringent test of a pre-school communication intervention for autism.
Methods
152 children with core autism aged 2 years - 4 years 11 months in a 3 site 2 arm single (assessor) blinded randomised controlled trial of the parent-mediated communication-focused intervention added to treatment as usual (TAU) against TAU alone. Primary outcome; severity of autism symptoms (modified social communication algorithm from Autism Diagnostic Observation Schedule-Generic, ADOS-G). Secondary outcomes; blinded measures of parent-child interaction, child language, and adaptation in school.
Results
At 13 month endpoint the treatment resulted in strong improvement in parental synchronous response to child (adjusted between-group effect size 1.22 (95% CI 0.85, 1.59) and child initiations with parent (ES 0.41 (0.08, 0.74) but small effect on autism symptomatology (ADOS-G, ES -0.24 (95% CI -0.59, 0.11) ns). Parents (not blind to allocation) reported strong treatment effects on child language and social adaptation but effects on blinded research assessed language and school adaptation were small.
Conclusions
Addition of the PACT intervention showed clear benefit in improving parent-child dyadic social communication but no substantive benefit over TAU in modifying objectively rated autism symptoms. This attenuation on generalisation from ‘proximal’ intervention effects to wider symptom change in other contexts remains a significant challenge for autism treatment and measurement methodology.
Interactions between an oblique shock wave generated by a sharp fin placed on a cylindrical surface and the incoming boundary layer are investigated to unravel the mean features of the resulting shock/boundary layer interaction (SBLI) unit. This fin-on-cylinder SBLI unit has several unique features caused by the three-dimensional (3-D) relief offered by the cylindrical surface that noticeably alter the shock structure. Complementary experimental and computational studies are made to delineate both the surface and off-body flow features of the fin-on-cylinder SBLI unit and to obtain a detailed understanding of the mechanisms that dictate the mean flow and wall pressure features of the SBLI unit. Results show that the fin-on-cylinder SBLI exhibits substantial deviation from quasi-conical symmetry that is observed in planar fin SBLI. Furthermore, the separated flow growth rate appears to decrease with downstream distance and the separation size is consistently smaller than the planar fin SBLI with the same inflow and fin configurations. The causes for the observed diminution of the separated flow and its downstream growth rate were investigated in the light of changes caused by the cylinder curvature on the inviscid as well as separation shock. It was found that the inviscid shock gets progressively weakened in the region close to the triple point with downstream distance due to the 3-D relief effect from cylinder curvature. This weakening of the inviscid shock feeds into the separation shock, which is also independently impacted by the 3-D relief, to result in the observed modifications in the fin-on-cylinder SBLI unit.
Recent findings highlight that there are prenatal risks for affective disorders that are mediated by glucocorticoid mechanisms, and may be specific to females. There is also evidence of sex differences in prenatal programming mechanisms and developmental psychopathology, whereby effects are in opposite directions in males and females. As birth weight is a risk for affective disorders, we sought to investigate whether maternal prenatal cortisol may have sex-specific effects on fetal growth. Participants were 241 mothers selected from the Wirral Child Health and Development Study (WCHADS) cohort (n=1233) using a psychosocial risk stratifier, so that responses could be weighted back to the general population. Mothers provided saliva samples, which were assayed for cortisol, at home over 2 days at 32 weeks gestation (on waking, 30-min post-waking and during the evening). Measures of infant birth weight (corrected for gestational age) were taken from hospital records. General population estimates of associations between variables were obtained using inverse probability weights. Maternal log of the area under the curve cortisol predicted infant birth weight in a sex-dependent manner (interaction term P=0.029). There was a positive and statistically significant association between prenatal cortisol in males, and a negative association in females that was not statistically significant. A sex interaction in the same direction was evident when using the waking (P=0.015), and 30-min post-waking (P=0.013) cortisol, but not the evening measure. There was no interaction between prenatal cortisol and sex to predict gestational age. Our findings add to an emerging literature that suggests that there may be sex-specific mechanisms that underpin fetal programming.
CVD accounted for 27 % of all deaths in the UK in 2014, and was responsible for 1·7 million hospital admissions in 2013/2014. This condition becomes increasingly prevalent with age, affecting 34·1 and 29·8 % of males and females over 75 years of age respectively in 2011. The dysregulation of cholesterol metabolism with age, often observed as a rise in LDL-cholesterol, has been associated with the pathogenesis of CVD. To compound this problem, it is estimated by 2050, 22 % of the world's population will be over 60 years of age, in culmination with a growing resistance and intolerance to pre-existing cholesterol regulating drugs such as statins. Therefore, it is apparent research into additional therapies for hypercholesterolaemia and CVD prevention is a growing necessity. However, it is also imperative to recognise this complex biological system cannot be studied using a reductionist approach; rather its biological uniqueness necessitates a more integrated methodology, such as that offered by systems biology. In this review, we firstly discuss cholesterol metabolism and how it is affected by diet and the ageing process. Next, we describe therapeutic strategies for hypercholesterolaemia, and finally how the systems biology paradigm can be utilised to investigate how ageing interacts with complex systems such as cholesterol metabolism. We conclude by emphasising the need for nutritionists to work in parallel with the systems biology community, to develop novel approaches to studying cholesterol metabolism and its interaction with ageing.
The polarisation observations of the central region (containing the jet) of the galaxy M87 were obtained in May 1980, with the polarimeter (Visvanathan 1972) attached to the f/15 cassegrain focus of the AAT. The IPCS was used in direct mode to record the images of the field. Figure 1 shows a single, raw image of M87 in the light of B (the image shown is 90 arcsec square). The knots referred to in the text are marked. One complete observation consists of 12 images of the object field, corresponding to the 12 selected position angles of the polaroid filter, rotated from 0° to 330° in 30° increments. The Taurus software (Taylor and Atherton 1980) was used to increment the data to the relevant memory location. The data were stored on tape after a sufficient number of complete rotations of the polaroid were completed.
Mothers' self-reported stroking of their infants over the first weeks of life modifies the association between prenatal depression and physiological and emotional reactivity at 7 months, consistent with animal studies of the effects of tactile stimulation. We now investigate whether the effects of maternal stroking persist to 2.5 years. Given animal and human evidence for sex differences in the effects of prenatal stress we compare associations in boys and girls.
Method
From a general population sample of 1233 first-time mothers recruited at 20 weeks gestation we drew a random sample of 316 for assessment at 32 weeks, stratified by reported inter-partner psychological abuse, a risk indicator for child development. Of these mothers, 243 reported at 5 and 9 weeks how often they stroked their infants, and completed the Child Behavior Checklist (CBCL) at 2.5 years post-delivery.
Results
There was a significant interaction between prenatal anxiety and maternal stroking in the prediction of CBCL internalizing (p = 0.001) and anxious/depressed scores (p < 0.001). The effects were stronger in females than males, and the three-way interaction prenatal anxiety × maternal stroking × sex of infant was significant for internalizing symptoms (p = 0.003). The interactions arose from an association between prenatal anxiety and internalizing symptoms only in the presence of low maternal stroking.
Conclusions
The findings are consistent with stable epigenetic effects, many sex specific, reported in animal studies. While epigenetic mechanisms may be underlying the associations, it remains to be established whether stroking affects gene expression in humans.
The current banking crisis has reminded us of how risks materialising in one part of the financial system can have a widespread impact, affecting other financial markets and institutions and the broader economy. This paper, prepared on behalf of the Actuarial Profession, examines how such events have an impact on the entire financial system and explores whether such disturbances may arise within the insurance and pensions sectors as well as within banking. The paper seeks to provide an overview of a number of banking and other financial crises which have occurred in the past, illustrated by four case studies. It discusses what constitutes a systemic event and what distinguishes it from a large aggregate system wide shock. Finally, it discusses how policy-makers can respond to the risk of such systemic financial failures.
To describe an unusual case of lateral neck swelling in a patient with a permanent cardiac pacemaker.
Case report:
We describe a patient who presented with a painful, lateral neck swelling due to an internal jugular vein thrombus. This thrombus originated from around pacemaker wires in the subclavian vein. This case is unusual, as the vast majority of thromboses in patients with cardiac pacemakers are found in the subclavian vein alone. We also review the literature on the relationship between cardiac pacemakers and internal jugular vein thrombosis, and on the management of the latter.
Conclusion:
Our patient illustrates a rare cause of a painful, lateral neck swelling: an internal jugular vein thrombus secondary to a cardiac pacemaker. Clinicians should be wary of such pathology in similar patients, in order to ensure early treatment and avoidance of complications.
Data from a representative community sample were used to explore predictors of lifetime suicidality and to examine associations between distal adolescent and more proximal adult risks.
Method
Data are from a midlife follow-up of the Isle of Wight study, an epidemiological sample of adolescents assessed in 1968. Ratings of psychiatric symptoms and disorder, relationships and family functioning and adversity were made in adolescence; adult assessments included lifetime psychiatric history and suicidality, neuroticism and retrospective reports of childhood sexual abuse and harsh parenting.
Results
A wide range of measures of childhood psychopathology, adverse experiences and interpersonal difficulties were associated with adult suicidality; associations were particularly strong for adolescent irritability, worry and depression. In multivariate analyses, substantial proportions of these effects could be explained by their association with adult psychopathology and neuroticism, but additional effects remained for adolescent irritability and worry.
Conclusions
Factors of importance for long-term suicidality risk are evident in adolescence. These include family and experiential adversities as well as psychopathology. In particular, markers of adolescent worry and irritability appeared both potent risks and ones with additional effects beyond associations with adult disorder and adult neuroticism.
The Adult Personality Functioning Assessment (APFA) provides ratings of interpersonal and social role performance in six domains over substantial periods of time. Ratings based on subject and informant accounts using the APFA were compared. There was good agreement for estimates of levels of dysfunction, and moderate agreement for type of dysfunction. An anticipated under-reporting of difficulties by subjects was not found. The extent of personality dysfunction was predictive of whether a close informant was available; however, closeness of informant was not consistently associated with subject–informant agreement.
Winter wheat cultivars Apollo, Hornet, Longbow and Norman were each sown at 50, 100, 200, 400, 800 and 1600 seeds/m2 in a field experiment conducted in Northern Ireland over the 1989/90 crop year. No growth regulators were applied and the wheat received 178 kgN/ha top-dressing in the spring. Hourly rainfall, windspeed and wind direction data were recorded and lodging was visually assessed from the end of May to harvest. Lodging first occurred in the 1600 seed-rate plots as the ears were emerging in early June and then progressively increased in the 800, 400 and 200 plots during June, July and August. Lodging did not occur suddenly but took several hours, with the stems first lying at an angle before lodging completely. Stem buckling or breakage did not appear to be the principal form of structural failure. The longest strawed cultivar, Longbow, lodged most severely. The shorter-strawed Norman also lodged badly in contrast with Hornet which had a similar straw length. Apollo, which was taller than Norman and Hornet and produced more ears per square metre than the other cultivars, lodged least but tended to lean at c. 30° from the vertical. Lodging occurred during or within 24 h of periods of rainfall which, in many cases, coincided with windspeeds at crop height averaging > 25 km/h and occasionally > 50 km/h. Lodging also occurred following rainfall when the windspeed did not exceed 16 km/h. The grain yield was negatively correlated with the average lodging from ear emergence to harvest, there being a 1 t/ha decline in yield for each 10% increase in average area lodged. The 50 and 100 seed-rate plots yielded 10 t/ha and had little or no lodging. The decline in yield with increased lodging and seed rate was attributed to the effect of lodging rather than to seed rate and was associated with a fall in the number of grains/ear and 1000-grain weight from 56 and 53·5 g at the lowest seed rate to 15 and 42·7 g at the highest, respectively. A comparison of the plants from lodged and unlodged plots of the 1600 and 800 seed rates, and subsequently of the 800 and 400 seed rates, indicated that at the higher seed rate, lodged plots had less fresh weight per unit area, basal internodes with smaller diameters, fewer support roots per stem, and a lower root dry weight per stem.
The effects of anabolic steroids on the quality of voice have been well documented; however, no study has established significant structural changes in the larynx as a direct result of anabolic steroid use. We report a unique case of a 47-year-old male smoker and professional body builder who presented with progressive stridor and hoarseness following abuse of anabolic steroids over a period of two years. Conservative management failed to resolve his symptoms and a planned tracheostomy was performed to secure his airway. Subsequently he was treated with multiple laser resections and eventually decannulated. No case of severe laryngitis in association with anabolic steroid usage has been reported previously in the literature.
We present a case report of a patient who developed a sinonasal myopericytoma treated by surgical excision through a lateral rhinotomy. Some aggressive features on pre-operative computed tomography scanning and the complexity of recent changes in the histological nomenclature for these tumours led to consideration of adjuvant therapy. The close histological relationship between myopericytoma, myofibromatosis, solitary myofibroma and infantile haemangiopericytoma is discussed. This group of lesions constitute a single morphological spectrum with differentiation towards perivascular myoid cells (pericytes). Currently myopericytoma is the most appropriate and accepted term embracing all these entities. A review of the literature has been reassuring in identifying these tumours as benign but with a reasonably high rate of local recurrence (17 per cent). The treatment of choice is surgical excision with further excisions for local recurrence.
Recent stellar spectral libraries have sought higher resolution and the accurate determination of specific optical spectral indeces as stellar population indicators. But the value of accurate flux comparisons over wide wavelength regions should still be emphasized, particularly as more and better spectro-photometric data for composite populations becomes available.
We present the second case of primary synchronous bilateral tonsillar squamous cell carcinoma reported in the English literature and evaluate the role of fluoro-deoxyglucose positron emission tomography scanning in the search for the occult primary tumour in a patient presenting with metastatic nodal disease in the head and neck.
The dielectric properties of goethite and, in particular, the changes during the topotactic conversion of goethite to hematite were studied from room temperature to about 800 °C in the frequency range of 400 to 3000 MHz using the cavity perturbation technique. The complex permittivity, that is, both the real and the imaginary or absorptive parts (έ and ἕ), were measured under various heating regimens. In addition, thermogravimetric analysis (TGA) was performed to characterize the transformation of goethite to hematite. The Debye relaxation formalism was applied to the processes occurring both during and after the main dehydroxylation reaction to calculate the relaxation times. The Arrhenius equation for thermally activated relaxation times was used to determine the activation energies. Both the real and the absorptive parts of the permittivity exhibited a significant peak during the main part of the goethite to hematite decomposition reaction. Above the transformation, there was another, less dramatic, thermally activated increase in the permittivity values. The increase in the permittivities during the goethite to hematite transformation was attributed to the formation of quasi-free migrating radicals, for example, hydroxyl ions, oxygen ions, or hydrogen atoms, during the dehydroxylation of goethite. The derivative thermogravimetric analysis (DTGA) curve was found to be directly related to the transient values of the real and the imaginary permittivities. Higher heating rates resulted in an accelerated rate of dehydroxylation and therefore higher values of the transient permittivities. In the temperature range of 400 °C to 500 °C (i.e., just above the dehydroxylation peak), the real permittivity exhibited a varying frequency dependence, which suggested that changes were occurring in the newly formed, highly defected hematite structure, which is referred to as hydrohematite. During the reaction there were multiple relaxation processes and thus the Debye relationship could not be applied. However, at temperatures above about 500 °C, the structure stabilized, the Debye relationship was more closely followed, and the relaxation times could be determined as a function of temperature. The activation energy for the relaxation process above 500 °C was determined to be 0.47 kJ/mol.