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The current study examined whether self-reported memory problems among cognitively intact older adults changed concurrently with, preceded, or followed depressive symptoms over time.
Data were collected annually via in-person comprehensive medical and neuropsychological examinations as part of the Einstein Aging Study.
Community-dwelling older adults in an urban, multi-ethnic area of New York City were interviewed.
The current study included a total of 1,162 older adults (Mage = 77.65, SD = 5.03, 63.39% female; 74.12% White). Data were utilized from up to 11 annual waves per participant.
Multilevel modeling tested concurrent and lagged associations between three types of memory self-report (frequency of memory problems, perceived one-year decline, and perceived ten-year decline) and depressive symptoms.
Results showed that self-reported frequency of memory problems covaried with depressive symptoms only in participants who were older at baseline. Changes in perceived one-year and ten-year memory decline were related to changes in depressive symptoms across all ages. Depressive symptoms increased the likelihood of perceived ten-year memory decline the next year; however, perceived ten-year memory decline did not predict future depressive symptoms. Additionally, no significant temporal relationship was observed between depressive symptoms and self-reported frequency of memory problems or perceived one-year memory decline.
Our findings highlight the importance of testing the unique associations of different types of self-reported memory problems with depressive symptoms.
Cardiopulmonary exercise testing has been used to measure functional capacity in children who have undergone a heart transplant. Cardiopulmonary exercise testing results have not been compared between children transplanted for a primary diagnosis of CHD and those with a primary diagnosis of cardiomyopathy despite differences in outcomes. This study is aimed to compare cardiopulmonary exercise testing performance between these two groups.
Patients who underwent heart transplant with subsequent cardiopulmonary exercise testing at least 6 months after transplant at our institution were identified. They were then divided into two groups based on primary cardiac diagnosis: CHD or cardiomyopathy. Patient characteristics, echocardiograms, cardiac catheterisations, outcomes, and cardiopulmonary exercise test results were compared between the two groups.
From the total of 35 patients, 15 (43%) had CHD and 20 (57%) had cardiomyopathy. Age at transplant, kidney disease, lung disease, previous rejection, coronary vasculopathy, catheterisation, and echocardiographic data were similar between the groups. Mean time from transplant to cardiopulmonary exercise testing, exercise duration, and maximum oxygen consumption were similar in both groups. There was a difference in heart rate response with CHD heart rate response of 63 beats per minute compared to cardiomyopathy group of 78 (p = 0.028). Patients with CHD had more chronotropic incompetence than those with cardiomyopathy (p = 0.036).
Primary diagnosis of CHD is associated with abnormal heart rate response and more chronotropic incompetence compared to those transplanted for cardiomyopathy.
This paper explores law school portraits of women in law as a way to challenge the over-representation of men in law. Portraiture is a long-standing means by which professions celebrate worthy individuals and reproduce institutional values. In relation to law and the legal professions, portraits are predominantly of men and link law with masculine attributes, contributing to the visual and actual marginalisation of women in law's past and present. The paper begins by setting out why portraits of women exhibited in UK law schools are an important way to challenge gender inequalities in law. It then provides a snapshot of the gender dimensions of university and law school portraiture in the UK, before analysing the Inspirational Women of the Law exhibition at Newcastle Law School as a method of disrupting the dominant gendered visual order in law, and bringing into focus women in legal history.
The Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire.
Analysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.
An integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.
Patient-reported outcomes and preferences rely on reports of the status of a patient’s health condition that comes directly from the patient, without interpretation or qualification by clinicians or investigators. Patient-reported outcomes and preferences have become an accepted approach in drug development. As part of this effort, we assessed the relative importance to patients with schizophrenia of trying a new antipsychotic that might improve symptoms in the context of common antipsychotic side effects, especially weight gain. Information from surveys such as this one can provide pilot guidance about what might be acceptable versus unacceptable trade-offs when considering new therapies for schizophrenia.
We prospectively administered a cross-sectional survey to 250 patients with clinical diagnoses of schizophrenia or schizoaffective disorder, aged ≥18 years, from five US outpatient community clinics, regarding the importance of efficacy and side effects on treatment decisions involving medications. Sixty-four percent (n=160) of the patients were male; mean age was 43 years (range: 18–72 years); mean weight was 91 kg (range: 49–182 kg); and mean body mass index was 30.3 kg/m2 (range: 15.3–63.3 kg/m2).
Patients rated both efficacy and side effects as important attributes of medication for schizophrenia treatment, with 88.5% identifying the ability to think more clearly as an important property of their medication. Patients identified efficacy and side effects as important drivers to take their prescribed medicine (endorsed as very or most important by 94.3% and 84.0% of patients, respectively). Patients identified weight gain, physical restlessness and somnolence as significant side effects of current treatments for schizophrenia (very/most important by 61.5%, 60.4%, and 58.9%, respectively). When asked about willingness to change antipsychotics, anticipated weight gain had a strong negative influence on willingness to try a new antipsychotic, with 44.9% of patients declining to try a medication that would lead to a weight gain of 3–5 kg, and 70.8% of patients declining for an anticipated weight gain of 5–9kg.
Patients living with schizophrenia or schizoaffective disorder are influenced by many factors when considering whether to take their prescribed medication, including efficacy and side effects. It is important for clinicians to assess patient-specific concerns and develop a comprehensive treatment plan to maximize adherence to prescribed therapies.
Funding Acknowledgements: This study was funded by Alkermes, Inc.
In the United Kingdom (UK), 23,000 people annually are diagnosed with facial palsy (acute onset facial paralysis). For nearly one third this will result in a permanent disability, including in some the inability to smile. In addition to initial pharmacological therapy, guidelines recommend tailored facial exercise (TFE) therapy repeated every day. However, not all patients are currently able to access such specialist physical therapy. ‘Smart specs’ (using miniaturized sensors in the frames to measure facial movement) are currently being developed. Linked to a smartphone, these could allow people to practice TFEs discreetly, provide immediate feedback, and supply data on outcomes to the patient and their clinician.
Modelling of introduction of Facial Remote Activity Monitoring Eyewear (FRAME) into treatment pathways for patients with facial palsy. This included: (i) review on effectiveness of TFE therapy; (ii) national surveys (medical staff, facial therapy specialists and patients) to gather data on access to TFE therapy; (iii) Delphi Exercise to identify consensus on key outcome measures; and, (iv) economic modelling to estimate cost-effectiveness and determine a range of acceptable costs for the technology. In parallel, research to examine target markets to inform product development, and production of integral commercialization plan.
Searches short-listed ten studies to add to the three included in the 2011 Cochrane review. Surveys indicate approximately thirteen percent of eligible UK patients access personalized TFE therapy. Estimated annual expenditure on hospital treatments for facial palsy patients is currently >GBP 80 million (>USD 106 million) compared with <GBP 0.5 million (<USD 0.66 million) on TFE therapy. Patients with permanent defects can suffer a loss of up to two quality-adjusted life years (QALYs).
Findings from this study, particularly in relation to costs and benefits, will inform the design of a subsequent randomized controlled trial. A novel wearable technology could make a major difference to people's lives, as well as generating potential efficiencies for healthcare.
Archival records need context in order to maintain their value. Indeed, value is rarely inherent. It needs to be excavated, lifted out, exposed and made explicit; and it needs to be shared widely to take its place in broader contexts in order to grow and create value in the collective. Conceptualisations of value in the archive are constantly changing and dynamic, and context and re-contextualisation – core to the work of archivists – underpins this.
Context is perhaps best understood as a series of questions, such as: What happened before? What happened after? What was happening at the same time? Who was involved? Where did things happen? When did things happen? Which, when all combined, might help to answer the question: Why did things happen? (McCarthy et al., forthcoming). Record systems and archival systems don't always make this collation of context possible, but continuum model thinking, incorporated by design into systems, with its emphasis on multiple purposes and values, potentially does. But not all records which have – or have the potential to bear – value as archives are waiting patiently in archival repositories for their value to be appreciated. With changing conceptions of value – and growing audiences for archival knowledge – unmanaged archival material, fragmentary in nature and sitting at and outside the boundary of the archive, is proving highly valuable.
This chapter is written by archivists and historians from the University of Melbourne's eScholarship Research Centre (ESRC, the Centre) to reflect on the value that we add or diminish by our archival interventions and the means by which (and reasons why) we work at the boundary of the archive. Critically, these reasons include the desire to situate the materials of the archive ‘in a contextual information framework that helps make them understandable to those without the deep lived experience of the field’ (McCarthy et al., forthcoming). The work of the ESRC, a post-custodial archival service based in a research environment and operating in the digital space, offers unique insights into the value of archives for the general public, as well as for specific communities. Situated originally within the University of Melbourne faculty structure, the group of archivists who had worked together as the Australian Science Archives Project moved into the library and academic services area on the transformation of the group into a research centre.
While it may, at first, appear absurd to associate Stockholm syndrome with situations other than those involving kidnapping or hostage relationships, it is quite tenable to do so. In fact, research has shown that a variety of different psychological issues and forms of captivity are best explained as instances of Stockholm syndrome. Originally, Stockholm syndrome was typified as a disorder resulting from situations involving negative face-to-face contact between captors and captives. The resulting environment is one of extreme fright or terror to victims, rendering them helpless and, over time, totally subservient to their perpetrators. Typification helps to shed light on the connection between abusive athletic coaches and consequential victimisation of young athletes, which can lead to Stockholm syndrome. This correlation supports the view that Stockholm syndrome relates to victimisation of young athletes in a paradoxical, but very real way. This concept paper addresses the potential for domain expansion of Stockholm syndrome into the area of youth athletics. It develops the theory that once youth begin to rationalise the actions of abusive athletic coaches, they begin to sympathise and defend the actions of the abusive coach leading to a pattern of events which can be labelled as indications of Stockholm syndrome.
It is recognised internationally that children in out-of-home care (‘children in care’ or ‘children looked after’) generally have lower educational attainments than other pupils. This article provides two forms of evidence that challenge the view that care status in itself can explain this ‘attainment gap’. A systematic review of 28 studies was conducted to assess the evidence on whether being in care is detrimental to young people's educational outcomes. This is complemented by an analysis of administrative data from England, which compares the educational outcomes of children in care at age 16 to those of children in the general population and to other children supported by social services. Taken together, the findings suggest that while research demonstrates an important attainment gap between children in care and children in the general population, this difference is reduced and in many cases disappears when other important factors are taken into consideration to reduce selection bias. We find little evidence that being in care is detrimental to the educational outcomes of children looked after, but suggest that given the heterogeneity of the population, special attention should be paid to different groups of children and their particular needs while in care.
While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline.
In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7–16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome.
Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31.
Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.
Erect veldtgrass (Ehrharta erecta Lam.) is an invasive grass actively spreading in California that is capable of invading multiple habitats. Our objective is to contribute to a better understanding of the ecology, impacts, and potential for control of E. erecta in order to guide management practices. In a mixed-evergreen forest in Santa Cruz County, we measured impacts of E. erecta on native plant species richness and abundance in an observational comparison across 11 sites. Strikingly, we measured nearly four times greater total vegetation cover in plots invaded by E. erecta. However, native plants were not significantly less abundant in invaded plots than in reference plots, and native cover was not significantly predicted by E. erecta cover within invaded plots. We did, however, find evidence of change in community composition in response to E. erecta abundance. Our findings demonstrate that native species can persist in the presence of E. erecta, although the long-term impacts on populations of the perennial plants that dominate this forest understory are still unknown.
We also compared the effectiveness of mechanical (hand pulling with volunteers) and chemical (glyphosate) management methods. Twenty-two months following management treatments, we found substantial reductions in E. erecta using both mechanical and herbicide treatments, but herbicide application also produced greater reductions in native species cover and species richness. Transplanting native yerba buena [Clinopodium douglasii (Benth.) Kuntze] into management plots following treatment did not slow regrowth of E. erecta. It did, however, increase total native plant percent cover in herbicide and pull treatments, although largely by increasing C. douglasii cover. Effective management is possible using either manual or chemical removal methods; the optimal method may depend on the availability of manual labor and the sensitivity of the habitat to non-target effects on native plants.
The mental health assessment is a fundamental aspect of clinical practice and central to this is the use of questions.
To investigate the frequency and type of questions utilised within a child mental health assessment.
The data consisted of 28 naturally occurring assessments from a UK child and adolescent mental health service. Data were analysed using quantitative and qualitative content analysis to determine frequencies and question type.
Results indicated a total of 9086 questions in 41 h across the 28 clinical encounters. This equated to a mean of 3.7 questions per minute. Four types of questions were identified; yes–no interrogatives, wh-prefaced questions, declarative questions and tag questions.
The current format of questioning may impede the opportunity for families to fully express their particular concerns and this has implications for service delivery and training.
Between 1868 and 1950, when meat production facilities were expelled from the city of Buenos Aires, Argentina became one of the largest producers of meat in the world. Beginning in 1945, bringing the city into the countryside and the countryside into the city, agriculture was instrumentalized as an urban function. Revealing the convergence of two usually separated movements – hygenics and eugenics – the meat industry in the province of Buenos Aires created a scientifically supported arena for the biopolitical appropriation of human and non-human resources, bearing out a unified ideology of medicalization, aestheticization, urbanization and productivity.