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Auditory verbal hallucinations (AVHs) in schizophrenia have been suggested to arise from failure of corollary discharge mechanisms to correctly predict and suppress self-initiated inner speech. However, it is unclear whether such dysfunction is related to motor preparation of inner speech during which sensorimotor predictions are formed. The contingent negative variation (CNV) is a slow-going negative event-related potential that occurs prior to executing an action. A recent meta-analysis has revealed a large effect for CNV blunting in schizophrenia. Given that inner speech, similar to overt speech, has been shown to be preceded by a CNV, the present study tested the notion that AVHs are associated with inner speech-specific motor preparation deficits.
Objectives
The present study aimed to provide a useful framework for directly testing the long-held idea that AVHs may be related to inner speech-specific CNV blunting in patients with schizophrenia. This may hold promise for a reliable biomarker of AVHs.
Methods
Hallucinating (n=52) and non-hallucinating (n=45) patients with schizophrenia, along with matched healthy controls (n=42), participated in a novel electroencephalographic (EEG) paradigm. In the Active condition, they were asked to imagine a single phoneme at a cue moment while, precisely at the same time, being presented with an auditory probe. In the Passive condition, they were asked to passively listen to the auditory probes. The amplitude of the CNV preceding the production of inner speech was examined.
Results
Healthy controls showed a larger CNV amplitude (p = .002, d = .50) in the Active compared to the Passive condition, replicating previous results of a CNV preceding inner speech. However, both patient groups did not show a difference between the two conditions (p > .05). Importantly, a repeated measure ANOVA revealed a significant interaction effect (p = .007, ηp2 = .05). Follow-up contrasts showed that healthy controls exhibited a larger CNV amplitude in the Active condition than both the hallucinating (p = .013, d = .52) and non-hallucinating patients (p < .001, d = .88). No difference was found between the two patient groups (p = .320, d = .20).
Conclusions
The results indicated that motor preparation of inner speech in schizophrenia was disrupted. While the production of inner speech resulted in a larger CNV than passive listening in healthy controls, which was indicative of the involvement of motor planning, patients exhibited markedly blunted motor preparatory activity to inner speech. This may reflect dysfunction in the formation of corollary discharges. Interestingly, the deficits did not differ between hallucinating and non-hallucinating patients. Future work is needed to elucidate the specificity of inner speech-specific motor preparation deficits with AVHs. Overall, this study provides evidence in support of atypical inner speech monitoring in schizophrenia.
The period of the crusades and the Latin settlement of the eastern Mediterranean was an important one for medieval historical writing. Indeed, it has been recently suggested that the chroniclers of the First Crusade (1095–99), faced with the need to couch events in a more overtly exegetical register, ‘pioneered a new way of writing about the recent past’. Whether or not one accepts the notion that such writers adopted a fundamentally new mode of composition, there can be little doubt that this initial expedition left a significant imprint on medieval literary cultures. For a start, the vast number of extant narratives is unusual by medieval standards. More than this, though, the enterprise is renowned for popularising the medieval monograph format, with many writers electing to compose standalone histories characterised by a narrow focus on the crusade. As the crusading movement progressed, some embedded crusade accounts into works with wider chronological and geographical scopes, but the free-standing ‘crusade’ history was an outcome of nearly all subsequent expeditions (or at least the major ‘numbered’ ones). It is perhaps a by-product of this textual tradition – among other factors, such as modern historians’ propensity to compartmentalise evidence to facilitate historical analysis and the hangover of nineteenth-century scholarly conventions – that crusading expeditions are often treated in isolation: a discrete series of holy wars related to, but somehow distinct from, the Latin Christian settlements established in the wake of the First Crusade, known collectively as the crusader states, the Latin East or, when viewed from the West, Outremer (‘the land across the sea’). One need only cast an eye over the many modern general histories of the crusades to appreciate that most devote comparatively little space to the crusader states. Instead, the history of those polities on the fringes of Latin Christendom has usually been detailed separately, so much so that even the validity of the long-standing descriptor ‘crusader states’ has been disputed.
Consequently, the historiography of the crusades and the crusader states has developed along slightly different contours. For the purposes of this volume, the most significant difference, to be discussed in greater detail below, is that whereas texts – especially historical narratives – pertaining to the crusades have been subjected to an unparalleled degree of literary scrutiny in recent years, the textual evidence for the Latin East has less frequently been examined through the same interpretative lens.
Language in healthcare settings is important in order to better serve and understand the unique needs of various groups within transgender and gender diverse communities. Failure of healthcare professionals and institutions to adapt to evolving terminology contributes to the marginalization, invalidation, and exclusion of gender diversity in the medical field. Rather than dismissing or erasing unfamiliar identities, identifiers, or terminology, healthcare professionals should reflectively listen to how the patient affirms their autonomy and agency by using patient-provided terms. This chapter discusses the importance of using gender-affirming terminology in healthcare settings, reviews basic terms and definitions from a Western perspective, and provides recommendations for inclusive practices.
The impact of a collapsing gas bubble above rigid, notched walls is considered. Such surface crevices and imperfections often function as bubble nucleation sites, and thus have a direct relation to cavitation-induced erosion and damage structures. A generic configuration is investigated numerically using a second-order accurate compressible multi-component flow solver in a two-dimensional axisymmetric coordinate system. Results show that the crevice geometry has a significant effect on the collapse dynamics, jet formation, subsequent wave dynamics and interactions. The wall-pressure distribution associated with erosion potential is a direct consequence of development and intensity of these flow phenomena.
Leafy spurge is a troublesome, exotic weed in the northern Great Plains of the United States. Leafy spurge produces showy yellow bracts during June that give this weed a conspicuous appearance. A study was conducted to determine the feasibility of using remote sensing techniques to detect leafy spurge in this phenological stage. Study sites were located in North Dakota and Montana. Plant canopy reflectance measurements showed that leafy spurge had higher visible (0.63- to 0.69-μm) reflectance than several associated plant species. The conspicuous yellow bracts of leafy spurge gave it distinct yellow-green and pink images on conventional color and color-infrared aerial photographs, respectively. Leafy spurge also could be distinguished on conventional color video imagery where it had a golden yellow image response. Quantitative data obtained from digitized video images showed that leafy spurge had statistically different digital values from those of associated vegetation and soil. Computer analyses of video images showed/that light reflected from leafy spurge populations could be quantified from associated vegetation. This technique permits area estimates of leafy spurge populations. Large format conventional color photographs of Theodore Roosevelt National Park near Medora, ND were digitized and integrated with a geographic information system to produce a map of leafy spurge populations within the park that can be useful to monitor the spread or decline of leafy spurge.
δ18O values of sulfate minerals from a 186-m core (past 200,000 years) in Death Valley varied from +9 to +23‰ (V-SMOW). Sulfates that accumulated in the past ephemeral saline lake, salt pans, and mud flats have relatively low δ18O values similar to those of present-day local inflows. Sulfates that accumulated during two perennial lake intervals, however, have higher δ18O values, reflecting changes in temperature, lake water levels, and/or sulfur redox reactions. Over the same time interval, the δ18O record for sulfate had excursions that bear similarities to those found for carbonate in the Death Valley core, marine carbonate (SPECMAP), and polar ice in the Summit ice core, Greenland. The δ18O record differed considerably from the records reported for carbonate at Owens Lake and Devils Hole, which probably relates to different water sources. Death Valley, Owens Lake, and Devils Hole are responding to the same climatic changes but manifesting them differently. In Death Valley sediments, the isotopic composition of sulfate may have potential as an indicator of paleoenvironmental changes.
This note describes our recent attempts to apply the schlieren-interferometer to the study of supersonic flow around axi-symmetric bodies at zero incidence, and in particular shows how the density field distribution for a cone has been derived.
Various optical techniques, e.g. shadowgraph, schlieren and interferometric, have been used in the study of gas flows where density changes are significant. In some instances, however, a qualitative investigation is insufficient and although it is possible to obtain quantitative data from most optical methods, the interferometer has proved, so far, to be the most valuable in this respect.
Objective: Assess the long-term safety and effectiveness of mixed amphetamine salts extended release (MAS XR) in adults with attention-deficit/hyperactivity disorder (ADHD) combined subtype.
Methods: A 24-month, open-label extension of a 4-week, multicenter, double-blind, placebo-controlled, parallel-group, forced–dose-escalation study of MAS XR in adults (≥ 18 years of age) with ADHD. The 223 enrolled subjects started treatment at 20 mgl day for 1 week, with subsequent titration up to 60 mgl day for optimal therapeutic effects. At monthly visits, efficacy was assessed based on the ADHD Rating Scale IV (ADHD-RS-N). Safety assessments included spontaneously reported adverse events, laboratory assessments, and monitoring of vital signs.
Findings: ADHD symptoms significantly improved for all subjects as measured by change from baseline in mean ADHD-RS-IV total scores (-7.2±13.04 unit points; P<.001); this was sustained for up to 24 months. The most common treatment-related adverse events were dry mouth (43% of subjects reporting at least one occurrence), infection (33%), insomnia (32%), anorexia/decreased appetite (32%), headache (30%), and nervousness (26%). Most adverse events were mild to moderate in intensity.
Conclusion: Treatment with MAS XR 20–60 mgl day for adult ADHD was generally well tolerated and was associated with sustained symptomatic improvement for up to 24 months.
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that affects many domains of life. Studies have shown that adequate treatment of ADHD can affect the course of the disorder in a fundamental manner. While nonpharmacologic treatments such as education and various psycho-social interventions are used in the management of ADHD, pharmacotherapy is the mainstay of treatment for this disorder. Psychostimulants are the only group of agents that have been approved for the ADHD indication and are considered to be first-line treatment for the disorder. Methylphenidate, amphetamines, andpemoline are the most commonly used agents in this group. The stimulants have been successfully used for many years and their efficacy has been confirmed by a large number of clinical studies. Recent pharmacological advances have been made with longer-acting stimulants, new isomers, and more advanced drug delivery systems that enable more convenient dosing schedules with drug effects lasting throughout the day. Other nonstimulant medications have been shown to have anti-ADHD activity as well, although more research is needed on the efficacy and utility of these treatments. Antihypertensive medications and antidepressants, such as tricyclics and bupropion, have been studied and may have applications in the treatment of specific subgroups of patients with comorbid conditions or for patients who do not respond to stimulant treatment.
Objective: To assess long-term cardiovascular effects of mixed amphetamine salts extended release (MAS XR) in adults with attention-deficit/hyperactivity disorder (ADHD) combined subtype.
Methods: 223 otherwise healthy adults (≥18 years of age) with ADHD combined subtype were exposed to ≤24 months of MAS XR (20–60 mg/day). Resting sitting diastolic blood pressure (DBP) and systolic blood pressur (SBP) and pulse were measured at baseline and weekly, then monthly during long-term treatment. Twelve-lead electrocardiograms were obtained at screening/baseline, weekly, then at 3-and 6-month intervals up to 24 months.
Findings: With MAS XR 20–60 mg/day, mean changes in DBP (1.3±9.2 mm Hg; P=.O42), SBP (2.3±12.5 mmHg; P=.OO6), and pulse (2.1±13.4 bpm; P=.019) were small and not clinically significant. A clinically insignificant increase in QTcB (corrected by Bazett's formula) interval (7.2 msec; P<.001) was observed at 24 months. No subject exhibited QTcB interval >480 msec (QTcF [corrected by Fridericia's formula] >454 msec). Seven subjects discontinued due to a car-diovascular adverse event (hypertension, n=5, palpitation/tachycardia, n=2); none of these events was reported as serious. Few subjects with normal baseline vital signs (using approved parameters at the time of study initiation) exhibited clinically significant abnormalities at end point; several subjects with borderline baseline values exhibited shifts to abnormal values during MAS XR therapy.
Conclusion: Cardiovascular effects of long-term MAS XR (≤60 mg/day) were minimal in otherwise healthy adults with ADHD. Nevertheless, vital signs should be monitored prior to and during treatment with any stimulant.