48 results
Effect of Neutrophil to Lymphocyte ratio on antidepressant treatment response: moderating effect of sex and mediating effect of Hippocampal volumes.
- M. Paolini, Y. Harrington, J. Ernst, R. Zanardi, S. Poletti, F. Benedetti
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S246
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Introduction
In recent years much focus has been put on the role of immune/inflammatory alterations in affecting Major Depression (MDD) development and antidepressant efficacy. Neutrophil-to-lymphocyte ratio (NLR) is an inexpensive inflammatory marker shown to be elevated in depressed patients, with large population studies reporting this effect only in women. However, its relation to treatment response is much less clear. Reduced hippocampal volumes (HV) are among the few consistent brain structural predictors of poor treatment response, and they have been shown to be influenced by inflammatory status.
ObjectivesTo investigate the effect of NLR on treatment response in MDD patients, testing a possible moderating role of sex. To investigate the effect of NLR on HV and test a possible mediating role of the latter in the relation between NLR and treatment response.
MethodsOur study was performed on a sample of 120 MDD inpatients suffering from a non psychotic depressive episode (F=78; M=42). Depression severity was assessed via the Hamilton Depression Rating Scale (HDRS), both at admission and discharge; as a measure of treatment response, delta HDRS was calculated subtracting the two scores. NLR was calculated for each subject. Patients underwent 3T MRI acquisition and bilateral HV were estimated.
ResultsWe found a significant moderating effect of sex on the relationship between NLR and Delta HDRS (p < 0.001): a negative relation was found in women (p < 0.001) and a positive one in men (p = 0.042). NLR was found to negatively affect left HV in the whole sample (p = 0.027) and in women (p = 0.038). A positive effect on Delta HDRS was found for both left (p = 0.038) and right (p = 0.027) HV. Finally, we found a significant indirect effect of NLR values on Delta HDRS through left HV in women (95% BCa CI [- 0.948, -0.017]); the direct effect of NLR on Delta HDRS also remained significant (p = 0.002).
ConclusionsSex was found to moderate the relation between NLR and treatment response. The detrimental effect in women is in line with previous reports linking inflammation to hampered antidepressant effect; the positive one in men is more surprising: however, the only studies to date on the effect of NLR on antidepressant efficacy report a positive effect in patients with psychotic depression. In women we found NLR to affect treatment response partially through its effect on left HV, providing a possible, albeit incomplete, mechanistic explanation of the effect of inflammatory status on antidepressant efficacy.
Disclosure of InterestNone Declared
Non-pharmacological treatment of psychiatric disorders in a nationwide population
- S. Elkrog, M. Ernst, L. Rasmussen, R. Wesselhoeft
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S333
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Introduction
Non-pharmacological treatment like psychotherapy is associated with less side effects than pharmacological treatment and is often considered first-line treatment towards psychiatric disorders. The extent and variation of psychotherapy treatment offered in Danish psychiatric clinics over time has not previously been studied.
ObjectivesTo examine the nationwide use of psychotherapy treatment during 2001-2020 in individuals assigned with a psychiatric disorder diagnosis at Danish psychiatric clinics.
MethodsAll Danish individuals aged ≥ 3 years, who were registered with 1) a psychiatric disorder diagnosis (F10-F99) or 2) had a first psychotherapy treatment during the study period 1 January 2001 to 31 December 2020, were identified in the Danish National Patient Registry.
ResultsA total of 120,916 (27 %) study participants received psychotherapy treatment during the study period, most commonly individual psychotherapy (65 %) followed by group therapy (25 %). Adults (≥18 years) were more likely to receive therapy (34 %) than children and adolescents aged 3-17 years (15 %). The proportion of treated patients was highest among women (67 %) compared with men (33 %). The median age at first psychotherapy was 25 years (ranging from 19 to 33). 59 % of patients receiving psychotherapy had filled a psychotropic prescription within one year prior to therapy onset, particularly antidepressants (44 %) and antipsychotics (22 %).
ConclusionsThe use of psychotherapy for treatment of psychiatric disorders is limited among Danish patients, although national clinical guidelines recommend it as first-line treatment of common conditions such as depressive, anxiety and obsessive-compulsive disorders.
DisclosureNo significant relationships.
Depressive symptoms predict the incidence of common chronic diseases in women and men in a representative community sample
- Daniëlle Otten, Mareike Ernst, Antonia M. Werner, Ana N. Tibubos, Iris Reiner, Elmar Brähler, Jörg Wiltink, Matthias Michal, Markus Nagler, Philipp S. Wild, Thomas Münzel, Jochem König, Karl J. Lackner, Norbert Peiffer, Manfred E. Beutel
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- Journal:
- Psychological Medicine / Volume 53 / Issue 9 / July 2023
- Published online by Cambridge University Press:
- 21 April 2022, pp. 4172-4180
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Background
Depression, the most frequent and harmful mental disorder, has been associated with specific somatic diseases as the leading cause of death. The purposes of this prospective study were to predict incident chronic diseases based on baseline depressive symptoms and to test sex-dependent effects.
MethodsIn a representative German community sample of over 12 000 participants, baseline depressive symptoms (assessed using the Patient Health Questionnaire-9) were tested as a predictor of new onset of cardiovascular disease (CVD), chronic obstructive lung disease, diabetes, cancer, and migraine at 5-year follow-up. To study disease incidence, we created subsamples for each chronic disease by excluding participants who already had the respective disease at baseline. Potential confounders were included in logistic regression models and sex-specific analyses were performed.
ResultsControlling for demographic characteristics and loneliness, in men and women, baseline depressive symptoms were predictive of CVD, chronic obstructive lung disease, diabetes, and migraine, but not of cancer. When we additionally adjusted for metabolic and lifestyle risk factors, there was an 8% increase of chronic obstructive lung disease and migraine per point of depressive symptoms. There was a trend for CVD (4%; p = 0.053). Sex-sensitive analyses revealed trends for the relevance of depressive symptoms for CVD in men (p = 0.065), and for diabetes in women (p = 0.077).
ConclusionsThese findings underscore the need to implement screening for depression in the treatment of major somatic illnesses. At the same time, depressed patients should be screened for metabolic and lifestyle risk factors and for somatic diseases and offered lifestyle interventions.
The WHO-5 well-being scale and its correlation to depressive and manic symptoms among outpatients with bipolar disorder or unipolar depression
- S. Straszek, A.-E. Christensen, R. Licht, S. Østergaard, R. Ernst Nielsen
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S76
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Introduction
There is a lack of longitudinal studies of patients with bipolar disorder (BD) or unipolar depression (UD) in terms of psychological well-being as measured by the WHO-5 and the correlation to symptom scores. It is of interest to investigate whether the WHO-5 is useful in monitoring patients with mood disorders over time, as a tool in measurement-based care, and as a supplement to other psychometric measures.
ObjectivesIn this study we investigate the correlation at baseline between the depressive symptom scores according to the 6-item Hamilton Depression Score (HDS-6) and the WHO-5 scores in outpatients treated for BD or UD. Furthermore, in patients with BD we investigate correlations between manic symptom scores according to the modified Bech-Rafaelsen Mania Scale (MAS-M) and the WHO-5 scores. Lastly, in patients with BD or UD, we investigate the correlations between endpoint-baseline change in WHO-5 and change in MAS-M and HDS-6.
MethodsA longitudinal study of 200 outpatients diagnosed and treated for either BD or UD. Patients will be measured at baseline and at least four weeks later. Baseline data are presented as frequencies, means and standard deviations or medians with interquartile ranges as appropriate. All correlations are presented as scatter plots and a Spearman correlation analysis
ResultsThe study is ongoing, but the results will be available for presentation at the EPA in 2021.
ConclusionsThe WHO-5 may represent a relevant outcome measure in the treatment of BD and UD.
DisclosureNo significant relationships.
Cardiological health in patients with schizophrenia. A prospective cohort study
- R. Ernst Nielsen, M. Rodrigo-Domingo, L. Jørgensen, C. Tranekær Hostrup, S. Eggert Jensen
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- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S160
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Introduction
Patients with schizophrenia have a four-fold increased all-cause and a doubled cardiovascular mortality rate as compared to the general population.
ObjectivesThe study overall investigates the point-prevalence and prospective changes in cardiovascular risk factors in patients with schizophrenia, with baseline demographics of participants presented here.
MethodsA prospective study of patients diagnosed with schizophrenia divided into two subpopulations consisting of newly diagnosed (≤2 years from baseline in study (group A)) or chronic (diagnosed ≥10 years from baseline in study (group B)).
ResultsA total of 199 patients (57 diagnosed ≤2 years preceding baseline and 142 diagnosed ≥10 years ago) were included. Group A had been diagnosed for an average of 1.13±0.58 years and 21.19±7.62 years in group B. The majority (n=135 (67.8%)) were diagnosed with paranoid schizophrenia. At baseline PANSS total (median[Q1;Q3]) for group A was 61.0[51.0;76.0] and 60.0[48.0;76.0] for group B, with PANNS Positive being 17.0[13.0;20.0] and 15.0[12;19], PANSS Negative being 16.0[11.0;20.0] and 14.5[10.0;20.0], and PANSS General being 28.0[22.0;35.0] and30.0 [25.0;37.0], respectively. No difference in Clinical Global Impression was observed between groups ((median[Q1;Q3): 4.0[3.0;4.0] in both groups). Lastly, global assessment of function was similar between groups ((median[Q1;Q3): group A symptom: 38.5[37.0;46.0] and group B 41.0[37.0;52.0], and with function being 48.0[44.5;53.5] in group A and 45.5[41.0;53.0] in group B).
ConclusionsProspective studies investigating prevalence of and prospective changes in cardiovascular risk in patients with schizophrenia are essential to understand the increased all-cause and cardiovascular specific mortality. Demographic descriptions of participants are essential to estimate generalizability in different treatment settings.
DisclosureNo significant relationships.
Investigation of early signs of peripheral artery disease in patients with schizophrenia using toe-brachial index
- L. Jørgensen, C. Tranekær Hostrup, S. Eggert Jensen, R. Ernst Nielsen
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- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S815
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Introduction
Patients with schizophrenia have a reduced life expectancy compared to the general population, and cardiovascular diseases contribute to this. Peripheral arterial disease (PAD) is associated with excess all-cause mortality and specifically with cardiovascular morbidity and mortality. The risk factors for PAD, such as diabetes, smoking, hypertension, dyslipidaemia and obesity, are more common among patients with schizophrenia which could contribute to a possibly higher prevalence of PAD among patients with schizophrenia.
ObjectivesTo investigate PAD utilizing toe brachial index (TBI) in a population of patients diagnosed with schizophrenia with the purpose of establishing prevalence rates amongst newly diagnosed as well as more chronic patients.
MethodsA cross-sectional study of patients with schizophrenia (ICD10-diagnosis F20 or F25) with a study population of 57 patients diagnosed with schizophrenia within the last 2 years, psychiatric healthy controls matched by age, sex and smoking status and 142 patients with a schizophrenia diagnosis more than 10 years ago. The primary outcome is TBI in patients with schizophrenia stratified to the two subpopulations. The TBI will be calculated from the arm and toe systolic pressures. The toe pressures were measured using photoplethysmography (SysToe®, Atys Medical).
ResultsNo results are available yet. The cohort will be described by age, sex, smoking status, body fat percentage and physical comorbidities. The TBI of the two subpopulations will be compared with psychiatrically healthy controls using paired t-tests if data is normally distributed. If transformation is unsuitable, Wilcoxon test will be carried out instead.
ConclusionsNo results are available yet. Results will be presented at the EPA’s congress 2021.
DisclosureNo significant relationships.
Virtual reality-based exposure with applied biofeedback for social anxiety disorder
- M. Ernst, M. Lichtenstein, L. Clemmensen, T. Andersen, S. Bouchard
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S184
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Introduction
Social Anxiety Disorder (SAD) is considered the most prevalent anxiety disorder with the highest disease burden amongst anxiety disorders. Despite available effective treatment with Cognitive Behavioral Therapy, a majority of individuals with SAD do not seek treatment and many drop out when confronted with elements of exposure. Several studies highlight the many advantages virtual reality exposure holds over in vivo exposure. In this study, we investigate the added effect of real-time biofeedback during virtual reality exposure.
ObjectivesThe current study is part of a large scale study called VR8. The current study aims to develop and evaluate the feasibility of a VR-biofeedback-intervention for adults with mild to severe social anxiety disorder, before continuing randomized controlled trials.
MethodsData from semi-structured interviews and surveys will be compared to biodata collected during VR exposure. Participants include a minimum of (n=10) patients and (n=10) clinicians from the Mental Health Services in the Region of Southern Denmark. Surveys include questionnaires used for assessment of anxiety symptoms, usability of technology, and presence in the virtual environment. Collected biodata includes heart rate variability and electrodermal activity. Behavioral markers include eye-gaze. The findings will be analyzed and discussed in a mixed methods design.
ResultsThe study is ongoing. Preliminary results will be available at presentation.
ConclusionsSuccessful development and implementation of a biofeedback-informed virtual reality exposure intervention may provide increased reach for patients and individuals who would have otherwise not sought- or dropped out of regular treatment, as well as inform the clinician on how to proceed during virtual exposure.
Conflict of interestProf. Stephané Bouchard is consultant to and own equity in Cliniques et Développement In Virtuo, which develops virtual environments, and conflicts of interests are managed according to UQO’s conflict of interests policy; however, Cliniques et Développeme
Prioritizing Communication About Radiation Risk Reduction in the United States: Results from a Multi-criteria Decision Analysis
- Rennie W. Ferguson, Daniel J. Barnett, Ryan David Kennedy, Tara Kirk Sell, Jessica S. Wieder, Ernst W. Spannhake
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 15 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 23 June 2020, pp. 718-726
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Objectives:
The lack of radiation knowledge among the general public continues to be a challenge for building communities prepared for radiological emergencies. This study applied a multi-criteria decision analysis (MCDA) to the results of an expert survey to identify priority risk reduction messages and challenges to increasing community radiological emergency preparedness.
Methods:Professionals with expertise in radiological emergency preparedness, state/local health and emergency management officials, and journalists/journalism academics were surveyed following a purposive sampling methodology. An MCDA was used to weight criteria of importance in a radiological emergency, and the weighted criteria were applied to topics such as sheltering-in-place, decontamination, and use of potassium iodide. Results were reviewed by respondent group and in aggregate.
Results:Sheltering-in-place and evacuation plans were identified as the most important risk reduction measures to communicate to the public. Possible communication challenges during a radiological emergency included access to accurate information; low levels of public trust; public knowledge about radiation; and communications infrastructure failures.
Conclusions:Future assessments for community readiness for a radiological emergency should include questions about sheltering-in-place and evacuation plans to inform risk communication.
EPA-1297 - Lateralization of Cerebral Hemodynamics in Schizophrenia During the Trail Making Test: A Functional Transcranial Doppler Sonography Study
- S. Egger, J. Ernst, S. Grimm, H. Boeker, S. Vetter, E. Seifritz, D. Schuepbach
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Schizophrenia is a major mental disorder, with complex symptoms involving psychosis, apathy and cognitive impairment. The Trail Making Test (TMT) is a useful tool to assess cognitive functioning. Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries is a noninvasive technique that allows monitoring of cerebral hemodynamics with a high temporal resolution during cognitive tasks.
Objectives:We assessed cerebral hemodynamics and lateralization in the middle cerebral arteries (MCA) using fTCD while patients with chronic schizophrenia and healthy subjects performed the TMT Part A and B, as well as a control task.
Methods:fTCD was used to asses bilateral mean cerebral blood flow velocity (MFV) changes in the middle (MCA) and anterior (ACA) cerebral arteries. Fifteen patients with chronic Schizophrenia and 20 healthy control subjects with similar sociodemographic characteristics performed the TMT during fTCD measurements of the MCA and ACA.
Results:Schizophrenia patients demonstrated an overall poorer performance, with a significant different lateralization pattern for both forms of TMT than healthy subjects. There was a significant slowing both forms of TMT, schizophrenia was associated with initially left sided lateralization. Healthy subjects showed a bilateral pattern.
Conclusions:These novel results show performance and brain perfusion abnormalities in schizophrenia, supporting the idea that cognitive performance has a pathological functional correlate predominantly in the lateral hemispheres of the brain. It adds to the notion that fTCD is a valuable tool to correlate psychological paradigms with brain perfusion.
EPA-0705 – Correlates of Behavior and Cerebral Hemodynamics During Complex Functioning in Young Adulthood
- D. Schuepbach, A. Weibel, S. Duschek, S. Grimm, J. Ernst, M.Y. Baars, H. Boeker, E. Seifritz
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Background:
Functional transcranial Doppler sonography (fTCD) of basal cerebral arteries is a non-invasive technique that allows monitoring of cerebral hemodynamics during cognitive performance with a high temporal resolution. There is ample evidence that age impacts on performance and cerebral hemodynamics. This study investigated those associations between a sample of young adult healthy subjects performing the Trail Making Test (TMT), a means of selective attention and complex cognitive functioning.
Methods:We examined cerebral hemodynamic parameters in the middle cerebral arteries (MCA) using fTCD while healthy subjects (mean age 31.5 years) simultaneously performed the TMT.
Results:There was a significant slowing with older age (age 30 years or older) for both selective attention and complex cognitive functioning, and older age was associated with significantly lower mean cerebral blood flow velocity (MFV) in males during complex functioning. Young age (younger than 30 years) was associated with initially bilateral and then significantly left sided lateralization, and older age with a bilateral pattern.
Conclusions:These novel results suggest that, in a relatively young age continuum sample, older age results in slowing and decreased brain perfusion, though in a diverse manner. Younger age is associated with alternating pattern of lateralization implying a diverse cognitive style with age as covariate. It adds to the notion that fTCD is a substantial tool to significantly link age related modulation of performance with dedicated parameters of brain perfusion.
A novel methodology to evaluate the molecular validity of preclinical psychosis models compared to schizophrenia brain pathology
- D. Cox, M. Gottschalk, H. Wesseling, A. Ernst, J. Cooper, S. Bahn
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. s807
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Rodent models of schizophrenia (SCZ) are indispensable when screening for novel treatments, but quantifying their translational relevance with the underlying human pathophysiology has proved difficult. A novel systems methodology (shown in Figure 1) was developed integrating and comparing proteomic data of anterior prefrontal cortex tissue from SCZ post-mortem brains and matched controls with data obtained from four established glutamatergic rodent models, with the aim of evaluating which of these models represent SCZ most closely. Liquid chromatography coupled tandem mass spectrometry (LC-MSE) proteomic profiling was applied comparing healthy and “disease state” in human post-mortem samples and rodent brain tissue samples. Protein-protein interaction networks were constructed from significant abundance changes and enrichment analyses enabled the identification of pathophysiological characteristics of the disorder, which were represented across all four rodent models. Subsequently, these functional domains were used for cross-species comparisons. Five functional domains such as “development and differentiation” represented across all four rodent models, were identified. It was quantified that the chronic phencyclidine (cPCP) model represented SCZ brain changes most closely for four of these functional domains, by using machine-learning techniques. This is the first study aiming to quantify which rodent model recapitulates the neuropathological features of SCZ most closely. The methodology and findings presented here support recent efforts to overcome translational hurdles of preclinical psychiatric research by associating behavioural endophenotypes with distinct biological processes.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
6 - The Geologic History of Mercury
- Edited by Sean C. Solomon, Larry R. Nittler, Carnegie Institution of Washington, Washington DC, Brian J. Anderson
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- Mercury
- Published online:
- 10 December 2018
- Print publication:
- 20 December 2018, pp 144-175
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Summary
We assess Mercury’s geologic history, focusing on the distribution and origin of terrain types and an overview of Mercury’s evolution from the pre-Tolstojan through the Kuiperian Period. We review evidence for the nature of Mercury’s early crust, including the possibility that a substantial portion formed by the global eruption of lavas generated by partial melting during and after overturn of the crystalline products of magma ocean cooling, whereas a much smaller fraction of the crust may have been derived from crystal flotation in such a magma ocean. The early history of Mercury may thus have been similar to that of the other terrestrial planets, with much of the crust formed through volcanism, in contrast to the flotation-dominated crust of the Moon. Small portions of Mercury’s early crust may still be exposed in a heavily modified and brecciated form; the majority of the surface is dominated by intercrater plains (Pre-Tolstojan and Tolstojan in age) and smooth plains (Tolstojan and Calorian) that formed through a combination of volcanism and impact events. As effusive volcanism waned in the Calorian, explosive volcanism continued at least through the Mansurian Period; the Kuiperian Period was dominated by impact events and the formation of hollows.
In vivo experiences with magnetic resonance imaging scans in Vibrant Soundbridge type 503 implantees
- I Todt, P Mittmann, A Ernst, S Mutze, G Rademacher
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- Journal:
- The Journal of Laryngology & Otology / Volume 132 / Issue 5 / May 2018
- Published online by Cambridge University Press:
- 23 April 2018, pp. 401-403
- Print publication:
- May 2018
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Objective:
To observe the effects of magnetic resonance imaging scans in Vibrant Soundbridge 503 implantees at 1.5T in vivo.
Methods:In a prospective case study of five Vibrant Soundbridge 503 implantees, 1.5T magnetic resonance imaging scans were performed with and without a headband. The degree of pain was evaluated using a visual analogue scale. Scan-related pure tone audiogram and audio processor fitting changes were assessed.
Results:In all patients, magnetic resonance imaging scans were performed without any degree of pain or change in pure tone audiogram or audio processor fitting, even without a headband.
Conclusion:In this series, 1.5T magnetic resonance imaging scans were performed with the Vibrant Soundbridge 503 without complications. Limitations persist in terms of magnetic artefacts.
Reduced optimism and a heightened neural response to everyday worries are specific to generalized anxiety disorder, and not seen in social anxiety
- K. S. Blair, M. Otero, C. Teng, M. Geraci, M. Ernst, R. J. R. Blair, D. S. Pine, C. Grillon
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- Journal:
- Psychological Medicine / Volume 47 / Issue 10 / July 2017
- Published online by Cambridge University Press:
- 14 March 2017, pp. 1806-1815
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Background
Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are co-morbid and associated with similar neural disruptions during emotion regulation. In contrast, the lack of optimism examined here may be specific to GAD and could prove an important biomarker for that disorder.
MethodUnmedicated individuals with GAD (n = 18) and age-, intelligence quotient- and gender-matched SAD (n = 18) and healthy (n = 18) comparison individuals were scanned while contemplating likelihoods of high- and low-impact negative (e.g. heart attack; heartburn) or positive (e.g. winning lottery; hug) events occurring to themselves in the future.
ResultsAs expected, healthy subjects showed significant optimistic bias (OB); they considered themselves significantly less likely to experience future negative but significantly more likely to experience future positive events relative to others (p < 0.001). This was also seen in SAD, albeit at trend level for positive events (p < 0.001 and p < 0.10, respectively). However, GAD patients showed no OB for positive events (t17 = 0.82, n.s.) and showed significantly reduced neural modulation relative to the two other groups of regions including the medial prefrontal cortex (mPFC) and caudate to these events (p < 0.001 for all). The GAD group further differed from the other groups by showing increased neural responses to low-impact events in regions including the rostral mPFC (p < 0.05 for both).
ConclusionsThe neural dysfunction identified here may represent a unique feature associated with reduced optimism and increased worry about everyday events in GAD. Consistent with this possibility, patients with SAD did not show such dysfunction. Future studies should consider if this dysfunction represents a biomarker for GAD.
Clinical anxiety promotes excessive response inhibition
- C. Grillon, O. J. Robinson, K. O'Connell, A. Davis, G. Alvarez, D. S. Pine, M. Ernst
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- Journal:
- Psychological Medicine / Volume 47 / Issue 3 / February 2017
- Published online by Cambridge University Press:
- 25 October 2016, pp. 484-494
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Background
Laboratory tasks to delineate anxiety disorder features are used to refine classification and inform our understanding of etiological mechanisms. The present study examines laboratory measures of response inhibition, specifically the inhibition of a pre-potent motor response, in clinical anxiety. Data on associations between anxiety and response inhibition remain inconsistent, perhaps because of dissociable effects of clinical anxiety and experimentally manipulated state anxiety. Few studies directly assess the independent and interacting effects of these two anxiety types (state v. disorder) on response inhibition. The current study accomplished this goal, by manipulating state anxiety in healthy and clinically anxious individuals while they complete a response inhibition task.
MethodThe study employs the threat-of-shock paradigm, one of the best-established manipulations for robustly increasing state anxiety. Participants included 82 adults (41 healthy; 41 patients with an anxiety disorder). A go/nogo task with highly frequent go trials was administered during alternating periods of safety and shock threat. Signal detection theory was used to quantify response bias and signal-detection sensitivity.
ResultsThere were independent effects of anxiety and clinical anxiety on response inhibition. In both groups, heightened anxiety facilitated response inhibition, leading to reduced nogo commission errors. Compared with the healthy group, clinical anxiety was associated with excessive response inhibition and increased go omission errors in both the safe and threat conditions.
ConclusionsResponse inhibition and its impact on go omission errors appear to be a promising behavioral marker of clinical anxiety. These results have implications for a dimensional view of clinical anxiety.
Learning from other people's fear: amygdala-based social reference learning in social anxiety disorder
- K. S. Blair, M. Otero, C. Teng, M. Geraci, E. Lewis, N. Hollon, R. J. R. Blair, Monique Ernst, C. Grillon, D. S. Pine
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- Journal:
- Psychological Medicine / Volume 46 / Issue 14 / October 2016
- Published online by Cambridge University Press:
- 01 August 2016, pp. 2943-2953
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Background
Social anxiety disorder involves fear of social objects or situations. Social referencing may play an important role in the acquisition of this fear and could be a key determinant in future biomarkers and treatment pathways. However, the neural underpinnings mediating such learning in social anxiety are unknown. Using event-related functional magnetic resonance imaging, we examined social reference learning in social anxiety disorder. Specifically, would patients with the disorder show increased amygdala activity during social reference learning, and further, following social reference learning, show particularly increased response to objects associated with other people's negative reactions?
MethodA total of 32 unmedicated patients with social anxiety disorder and 22 age-, intelligence quotient- and gender-matched healthy individuals responded to objects that had become associated with others’ fearful, angry, happy or neutral reactions.
ResultsDuring the social reference learning phase, a significant group × social context interaction revealed that, relative to the comparison group, the social anxiety group showed a significantly greater response in the amygdala, as well as rostral, dorsomedial and lateral frontal and parietal cortices during the social, relative to non-social, referencing trials. In addition, during the object test phase, relative to the comparison group, the social anxiety group showed increased bilateral amygdala activation to objects associated with others’ fearful reactions, and a trend towards decreased amygdala activation to objects associated with others’ happy and neutral reactions.
ConclusionsThese results suggest perturbed observational learning in social anxiety disorder. In addition, they further implicate the amygdala and dorsomedial prefrontal cortex in the disorder, and underscore their importance in future biomarker developments.
Aberrant intrinsic functional connectivity within and between corticostriatal and temporal–parietal networks in adults and youth with bipolar disorder
- J. Stoddard, S. J. Gotts, M. A. Brotman, S. Lever, D. Hsu, C. Zarate, Jr., M. Ernst, D. S. Pine, E. Leibenluft
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- Journal:
- Psychological Medicine / Volume 46 / Issue 7 / May 2016
- Published online by Cambridge University Press:
- 29 February 2016, pp. 1509-1522
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Background
Major questions remain regarding the dysfunctional neural circuitry underlying the pathophysiology of bipolar disorder (BD) in both youths and adults. In both age groups, studies implicate abnormal intrinsic functional connectivity among prefrontal, limbic and striatal areas.
MethodWe collected resting-state functional magnetic resonance imaging (fMRI) data from youths and adults (ages 10–50 years) with BD (n = 39) and healthy volunteers (HV; n = 78). We identified brain regions with aberrant intrinsic functional connectivity in BD by first comparing voxel-wise mean global connectivity and then conducting correlation analyses. We used k-means clustering and multidimensional scaling to organize all detected regions into networks.
ResultsAcross the brain, we detected areas of dysconnectivity in both youths and adults with BD relative to HV. There were no significant age-group × diagnosis interactions. When organized by interregional connectivity, the areas of dysconnectivity in patients with BD comprised two networks: one of temporal and parietal areas involved in late stages of visual processing, and one of corticostriatal areas involved in attention, cognitive control and response generation.
ConclusionsThese data suggest that two networks show abnormal intrinsic functional connectivity in BD. Regions in these networks have been implicated previously in BD. We observed similar dysconnectivity in youths and adults with BD. These findings provide guidance for refining models of network-based dysfunction in BD.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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A multifaceted intervention package to improve the diagnosis and management of delirium
- J. Fleet, S. Chen, F.C. Martin, T. Ernst
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- Journal:
- International Psychogeriatrics / Volume 27 / Issue 2 / February 2015
- Published online by Cambridge University Press:
- 02 October 2014, pp. 337-342
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Background:
Delirium is a major cause of morbidity and mortality amongst hospital patients. Previous studies have shown that it is often poorly recognized and managed. We wanted to assess the impact of a multifaceted intervention on delirium management.
Methods:A pre/post-intervention design was used. The local hospital delirium guideline was adapted into A7 sized cards and A3/A2 posters. Cards were distributed to junior doctors and teaching sessions were held. Computer screen savers were displayed and delirium promotion days held. The pre/post-intervention data were used to audit the following: delirium knowledge through questionnaires, documented use of the confusion assessment method (CAM) and identification and management of eight common precipitating factors. Re-audit was four months post baseline with interventions within this period. χ2 tests were used for statistical analysis.
Results:A convenience sample of randomly selected doctors in postgraduate training posts completed 100 questionnaires and 25 clinical notes were selected via retrospective identification of delirium. Results from questionnaires demonstrated significant improvements in: recognizing CAM as the diagnostic tool for delirium (24% vs. 71%, p < 0.01); identifying haloperidol as first line in pharmacological management (55% vs. 98%, p <0.01) and its correct dose (40% vs. 67%, p <0.01). In clinical practice, there was significant improvement in documentation of CAM for inpatient delirium assessments (0% vs. 77%, p <0.01). Trainees found the delirium card “very helpful” (82%) and carried it with them at all times (70%).
Conclusion:This multifaceted intervention increased CAM use in delirium recognition and improved the knowledge of pharmacological management. The delirium card was highly popular.
Targeting Hospitals for Antimicrobial Stewardship
- Tamar Lasky, Jay S. Greenspan, Frank R. Ernst
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue 5 / May 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. 595-596
- Print publication:
- May 2014
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