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To examine relationships between history of mild traumatic brain injury (mTBI), neuropsychological measures of executive function, and lifetime history of criminal justice (CJ) involvement among combat-exposed Veterans and Service Members (V/SM).
Participants and Methods:
Participants were combat-exposed V/SM who completed a baseline assessment for the multicenter Long-term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium study (N=1,341) and had adequate engagement/symptom reporting on measures of performance and symptom validity (i.e., Medical Symptom Validity Test and Mild Brain Injury Atypical Symptoms Scale). Neuropsychological battery included the Trail Making Test (A and B), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span subtest, and the National Institute of Health (NIH) Toolbox Flanker subtest. Lifetime history of brain injury, criminal justice involvement, and demographics were collected. Participants were 87% male, 72% white, with a mean age of 40 years (SD=9.67). Eighty-one percent had at least some college education. Nineteen percent were active duty. Eighty percent of Veterans and 86% of Service Members reported a history of >1 mTBI, and of these 31% and 47% respectively experienced 3+ mTBIs.
Results:
Three groups were composed based on level of involvement with the CJ system: 1.) No history of arrests or incarcerations (3+ mTBIs: 64%), 2.) A lifetime history of arrest but no felony incarceration (3+ mTBIs: 34%), and 3.) A lifetime history of felony incarceration (3+ mTBIs: 2%). Ordinal regression analyses revealed that performance on a working memory task (Digit Span; b= 0.024, p= .041; OR= 1.024) was significantly associated with increased CJ involvement after adjusting for age, education, service status, and mTBIs. Performance on measures of processing speed (Trails A), set-shifting (Trails B), and inhibition (Flanker) were not significantly associated with CJ involvement. Number of mTBIs was significantly and positively associated with level of CJ involvement in all four models; Digit Span (p= .016), Trails A (p= .016), Trails B (p= .020), and Flanker (p= .008).
Conclusions:
Performance on most measures of executive functioning was not significantly associated with CJ involvement in this large, representative sample of V/SM who served in combat. Although performance on a working memory task was significantly associated with CJ involvement, the size of the effect was small and the association was in the opposite direction as expected. Number of mTBIs was significantly associated with level of CJ involvement, indicating that sustaining multiple mTBI may be linked to greater risk of CJ involvement. These findings suggest that social and psychological factors beyond executive dysfunction may better explain the relationship between history mTBIs and CJ involvement. Some aspects of military service and veteran status, such as interdisciplinary treatment for brain injury and physical, mental, and psychosocial health needs, may be protective against previously identified risk factors for arrest (e.g., deficits in executive functioning). Contextualizing mTBI within the larger behavioral health profile of V/SM, with emphasis placed on intervention for related co-morbidities, may reduce the impact of previous arrest on wellbeing and/or reduce the risk of future CJ involvement.
This volume of the Haskins Society Journal brings together a rich and interdisciplinary collection of articles. Topics range from the politics and military organization of northern worlds of the Anglo-Normans and Angevins in the twelfth and thirteenth centuries, to the economic activity of women in Catalonia and political unrest in thirteenth-century Tripoli. Martin Millett's chapter on thesignificance of rural life in Roman Britain for the early Middle Ages continues the Journal's commitment to archaeological approaches to medieval history, while contributions on �lfric's complex use of sources in his homilies, Byrhtferth of Ramsey's reinterpretation of the Alfredian past, and the little known History of Alfred of Beverly engage with crucial questions of sources andhistoriographical production within Anglo-Saxon and Anglo-Norman England. Pieces on the political meaning of the Empress Helena and Constantine I for Angevin political ambitions and the role of relicssuch as the Holy Lance in strategies of political legitimation in Anglo-Saxon England and Ottonian Germany in the tenth century complete the volume.
Contributors: David Bachrach, Mark Blincoe, Katherine Cross, Sarah Ifft Decker, Joyce Hill, Katherine Hodges-Kluck, Jesse Izzo, Martin Millett, John Patrick Slevin, Oliver Stoutner, Laura Wangerin.
Objectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)
Primary progressive aphasia (PPA) affects a range of language and cognitive domains that impact on conversation. Little is known about conversation breakdown in the semantic variant of PPA (svPPA, also known as semantic dementia). This study investigates conversation of people with svPPA.
Methods:
Dyadic conversations about everyday activities between seven individuals with svPPA and their partners, and seven control pairs were video recorded and transcribed. Number of words, turns, and length of turns were measured. Trouble-indicating behaviors (TIBs) and repair behaviors were categorized and identified as successful or not for each participant in each dyad.
Results:
In general, individuals with svPPA were active participants in conversation, taking an equal proportion of turns, but indicating a great deal of more trouble in conversation, shown by the significantly higher number of TIBs than evidenced by partners or control participants. TIBs were interactive (asking for confirmation with a shorter repetition of the original utterance or a repetition which included a request for specific information) and non-interactive (such as failing to take up or continue the topic or a minimal response) and unlike those previously reported for people with other PPA variants and dementia of the Alzheimer type. Communication behaviors of the partner were critical to conversational success.
Conclusions:
Examination of trouble and repair in 10-min conversations of individuals with svPPA and their important communication partners has potential to inform speech pathology interventions to enhance successful conversation, in svPPA and should be an integral part of the comprehensive care plan.
Only two spinach herbicides are currently available to producers, and with limited choices in herbicide mode of action (MOA), overuse of the current herbicides can result in dominance of uncontrolled weeds. Therefore, spinach producers need more herbicide options. Trials were conducted in processing spinach to evaluate the crop safety of dimethenamid-p (0.56 kg ai/ha), EPTC (2.94 to 3.40 kg ai/ha), or ethofumesate (0.84, 1.12 or 2.24 kg ai/ha) applied pre-emergent (PRE), and ethofumesate (0.09 or 0.18 kg ai/ha) applied early postemergent (EPOST) for potential use as alternatives to s-metolachlor (0.73 kg ai/ha) and cycloate (2.52 kg ai/ha). The control of London rocket was excellent with s-metolachlor, dimethenamid-p, and ethofumesate. Weed control with cycloate and EPTC was fair, and generally inferior to all others. Cycloate and s-metolachlor were safe to spinach, and only minor crop injury was observed with all other herbicides, except the high rate of ethofumesate PRE, which resulted in high levels of injury. Spinach outgrew all early herbicide injury with no significant yield losses. Ethofumesate applied EPOST caused no injury in year 1, although in year 2 injury was higher in all plots where it was applied twice, regardless of rate. In high-density plantings, dimethenamid-p caused significant crop injury to spinach, but only at one location on a sandy loam soil. In that trial, yields in dimethenamid-p plots were reduced an average 30% compared to the hand-weeded and s-metolachlor plots. As a result of this research, dimethenamid-p, EPTC, and ethofumesate should be considered candidates for expanded-use registrations in processing spinach production. More research is needed to determine additional rates and use patterns for improved crop safety, as well as an evaluation of soil types and spinach varieties.
The tufa deposits of the Ghaap Plateau escarpment provide a rich, yet minimally explored, geological archive of climate and environmental history coincident with hominin evolution in South Africa. This study examines the sedimentary and geochemical records of ancient and modern tufas from Buxton-Norlim Limeworks, Groot Kloof, and Gorrokop, to assess the potential of these sediments for providing reliable chronologies of high-resolution, paleoenvironmental information. Chronometric dating demonstrates that tufa formation has occurred from at least the terminal Pliocene through to the modern day. The stable isotope records show a trend toward higher, more variable δ18O and δ13C values with decreasing age from the end of the Pliocene onwards. The long-term increase in δ18O values corresponds to increasingly arid conditions, while increasing δ13C values reflect the changing proportion of C3/C4 vegetation in the local environment. Analysis of the Thabaseek Tufa, in particular, provides valuable evidence for reconstructing the depositional and chronological context of the enigmatic Taung Child (Australopithecus africanus). Collectively, the results of the present study demonstrate the potential of these deposits for developing high-precision records of climate change and ultimately, for understanding the causal processes relating climate and hominin evolution.
Empathy involves being able to understand and respond to others’ emotional experiences. Whilst deficits in empathy have been observed in frontotemporal dementia, the extent to which empathy is disrupted in dementia syndromes with predominant language impairment remains unclear. The current study investigated cognitive and affective empathy in the two non-fluent primary progressive aphasia syndromes: progressive non-fluent aphasia (PNFA) and logopenic progressive aphasia (LPA). Informants of 23 PNFA and 16 LPA patients completed the Interpersonal Reactivity Index (IRI), regarding patients’ capacity for empathy pre- and post-disease onset. Twenty-four healthy control participants completed the self-rated IRI for comparison of post-disease empathy capabilities. Within-group analyses revealed reduced cognitive empathy and increased personal distress in both patient groups. In addition, lowered affective empathy was reported in PNFA, with a similar trend observed in LPA. Interestingly, reduced affective empathy was associated with greater carer burden in LPA. Between-group analyses revealed reduced cognitive empathy in both patient groups relative to controls. The current study is the first to document empathy changes in PNFA and LPA, offering insight into the social cognitive deficits experienced in these syndromes. Future neuroimaging studies are needed to identify the underlying neural correlates and mechanisms driving empathy deficits in PNFA and LPA.
Objectives: With comparable baseline performance on executive functions (EF) and memory between Alzheimer’s disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), it is currently unclear if both diseases can be distinguished longitudinally on these measures reliably. Methods: A total of 111 participants (33 AD, 31 bvFTD, and 47 controls) were followed-up annually over a 4-year period and tested on measures of EF, memory, and orientation. Linear mixed-effect models were constructed using disease severity as a nuisance variable to examine profiles of neuropsychological performance decline. Results: At baseline, overlap in terms of cognitive impairment between bvFTD and AD on multiple EF, memory, and orientation measures was present. Longitudinally, only disinhibition (Hayling total errors) appeared sensitive to discriminating AD from bvFTD; however, only after the first annual follow-up. Subgroup analyses on smaller samples revealed comparable profiles on EF tasks at baseline and over time between bvFTD and AD who presented with impaired EF at presentation, and on memory and orientation tasks between AD and bvFTD who presented with severe amnesia. Conclusions: Our results replicate previous findings showing only moderate discriminability between AD and bvFTD at clinical presentation on EF and memory measures. More importantly, we also show that longitudinal trajectories strongly overlap for both dementias on these measures. Disinhibition emerged as the sole measure that in the long run was significantly more impaired in bvFTD. Future studies should use tests designed to target cortical regions that are specifically impaired in bvFTD, such as the ventromedial prefrontal cortex, to improve the accurate discrimination of these diseases. (JINS, 2017, 23, 34–43)
Originally published in 2007, this book reflects the enormous advances in our understanding of frontotemporal dementia and related syndromes. The impetus for these advances has come from a number of directions including genetic discoveries, fresh approaches to neuroimaging and improved neuropsychological understanding of the cognitive aspects of the condition. This book provides a much needed review of the status of our knowledge of these syndromes. The book starts with chapters reviewing the history of the condition and describes the presenting clinical, neuropsychiatric and neuropsychological features, before reviewing, in detail, the areas of greatest recent research progress. The book concludes with a chapter proposing a multidisciplinary approach to patient management. Frontotemporal Dementia Syndromes will be essential reading for neurologists, psychologists, psychiatrists and other clinicians interested in cognitive and behavioural disorders, as well as to basic scientists working in the area of neurodegeneration.
One approach to treating atrial fibrillation relies on freezing tissue of the heart wall. This surgical technology requires sub-millimeter spatial resolution when dynamically tracking the freezing of pulmonary vein; conventional techniques such as ultrasound lack the necessary precision. Here we use an electrothermal “3ω” method to track propagating freezing fronts in nearly real time. The heater line is excited with multiple frequencies simultaneously, and the freezing front detected as it passes through the various penetration depths due to the contrast between thermal conductivities on either side of the front. Comparison of water freezing experiments with video images further suggests the accuracy of the method. Analysis and experiments show how the uncertainty, time response, and measurement range depend on the frequencies and thermal conductivity contrast. Finally, the method is demonstrated on biological tissue as further proof of principle for medical applications.
Extended matching questions (EMQs) were introduced to the Part 2 MRCOG examination paper in September 2006. This book provides a detailed guide for candidates preparing for the examination, and includes:background and introduction to the question formatadvice on answering EMQsworked examples of specimen questions, including an explanation of the answer, guidance on how to tackle each question and advice on how to avoid mistakestwo mock examination papers, with answers provided.
Recognition of negative emotions is impaired in behavioral-variant frontotemporal dementia (bvFTD). Less is known about the identification of positive emotions. One limitation likely arises from the stimulus sets used in previous studies. The widely used Ekman 60 Faces Test, for example, consists of four negative emotions (anger, fear, disgust and sadness) but only one positive emotion (happiness). Here, patients with bvFTD (n = 9), AD (n = 9), and controls (n = 15) recognized a range of experimentally-validated positive and negative non-verbal vocalizations (e.g., cheers for triumph; retching for disgust) that have recently become available. The bvFTD group was impaired in the recognition of both positive and negative vocalizations. In contrast, performance in the AD cohort was comparable to that of controls. Findings in the bvFTD group point to a global emotion recognition deficit in this syndrome. These results are consistent with a growing body of research showing that deficits also extend to positive emotions. (JINS, 2013, 19, 1–5)