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Edward Zigler pioneered and insisted upon the integration of science, practice, and policy development to support vulnerable children and families, reduce poverty, and improve US wellbeing, writ large. His far-reaching scholarship in turn critically shaped developmental science and US policy in multiple areas. This review reflects upon Zigler's influence on US child care, Head Start, Early Head Start, and prekindergarten programs. It describes the integration of one major area of developmental science, the field of attachment theory, research, and intervention, with US child care and early childhood education programs and policy. The integration of attachment into these systems not only epitomizes Zigler's overarching canon but also has improved services and advanced attachment theory and research. Throughout the review, I suggest next steps for leveraging attachment theory, research, and intervention to improve US child care and early childhood education systems in ways that both reflect and carry forward the legacy of Edward Zigler.
What shapes attitudes towards procedural rules that constrain executive power? This letter argues that procedural values are contextual: A function of who is in power. Supporters of those in power prefer fewer procedural constraints, while opposition supporters prefer greater. This study reports the results of a unique test using data from the 2016 Cooperative Congressional Election Survey. Respondents were asked, in both pre- and post-election waves, if they thought it should be ‘easier or harder for the president to keep documents secret from the public’. The panel design makes it possible to track individual changes following the shift in political context. The results show evidence of a partisan ‘flip’ in attitudes following the election, with Republicans becoming less likely – and Democrats more likely – to prefer additional constraints on presidential secrecy. However, this partisan ‘flip’ is present only among higher political knowledge respondents.
Explore the neurocognitive and temperament profile of borderline personality disorder (BPD) and schizotypal personality disorder (SPD) to better understand their underlying neurobiology for improved treatment.
17 BPD, 16 SPD, and 15 healthy controls (HCs) were given a comprehensive neuropsychological battery (CANTAB), the Iowa Gambling Task, a time perception task, and questionnaires of impulsivity, temperament, emotion, and frontal behavior (measures orbitofrontal cortex (OFC) dysfunction).
BPD and SPD patients performed significantly worse on the delayed match to sample (DMS) task compared to HCs, but had preserved function on decision-making, planning, time perception and attention tasks. SPD patients performed significantly worse on spatial working memory (SWM) tasks, and had higher religious commitment scores than HC and BPD groups, which correlated with their SWM deficits. BPD patients had significantly more frontal behaviors and emotions than both groups, which correlated with their emotionality, impulsivity, BPD symptoms, and temperament traits.
Both BPD and SPD groups had a deficit on the DMS task, sensitive to medial temporal lobe (MTL) dysfunction, but only SPD patients had SWM deficits, indicative of dorsolateral frontal cortex (DLFC) dysfunction, which correlated with their high religious commitment in line with their odd beliefs and magical thinking. Only BPD patients had frontal behavior deficits, related to OFC dysfunction, which positively correlated with their emotionality, impulsivity, and temperament traits. While both disorders may have a deficit in MTL function, DLFC dysfunction may contribute to SPD symptoms, and OFC dysfunction to BPD symptoms, suggesting treatment should target unique prefrontal cortex regions respectively.
Anhedonia may be considered as a transnosological feature of depression and schizophrenia. The aim of the present study was to assess hedonic responses to sucrose solutions and sweet taste perception threshold in patients with major depression and in schizophrenic patients in comparison with healthy subjects (matched for age and gender with depressive patients), and to compare these responses to evaluations by the Physical and Social Anhedonia scale of Chapman and the Pleasure Scale of Fawcett, generally used to quantify anhedonia. Hedonic responses to sucrose solutions were similar in patients with major depression (n = 20), schizophrenia (n = 20), and healthy controls (n = 20). Sweet taste perception threshold was significantly higher in depressive patients than in controls. Hedonic response to sucrose was inversely correlated with physical Anhedonia Scores and sweet taste perception threshold with Pleasure Scale scores. Measures of hedonia/anhedonia were not related with the intensity of depression or anxiety as measured by the Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Scale, respectively. In 11 depressed patients hospitalised for 17 to 33 days, neither hedonic ratings to sucrose solutions, sweet taste perception threshold, Physical, Social Anhedonia scores nor Pleasure Scale scores were modified in spite of substantial decrease in MADRS or Hamilton Anxiety scores. Hedonic responses to sucrose solutions and sweet taste perception threshold may be used as complementary evaluation to quantify anhedonia.
In order to identify clinical and demographic variables that predict response to antidepressants and to analyse prediction of outcome as a function of definition of outcome we analysed pooled data of two independent, multicentre, double blind parallel group studies. Study I compared the efficacy of mianserin with that of fluoxetine in 65, and study II compared mianserin with fluvoxamine in 60 patients with depression. Improvement was defined as at least 20% decrease in MADRS by day 14. Patients were considered as responders if they had greater than 50% decrease and non-responders if they had ≤ 50% decrease from baseline in the MADRS at day 56. Complete remission was defined as MADRS score ≤ 6 at day 56. Patients' characteristics did not differ between mianserin and SSRI groups. Early improvement predicted response in 92% and complete remission in 55% of the patients improved at day 14. Multivariate forward stepwise logistic regression analysis showed that response to treatments at day 56 was significantly (P = 0.0003) associated with early improvement, age (responders had higher age than non-responders) and weight (responders weighted more than non-responders). Complete remission was only predicted by early improvement. Treatments could not be differentiated when data were analysed according to responder/nonresponder status or complete remission/no complete remission. However, when the same data were analysed by analysis of variance a significant treatment effect (P = 0.02, mianserin > SSRIs) and a quadratic type treatment by time interaction (P = 0.023) were found. The robustness of the analysis was further improved by inclusion of covariates (age, weight). Early clinical improvement seems to be the best predictor of 2 month response to antidepressants (mianserin, SSRIs). Younger age and lower weight may predict non-response. Quantitative analysis differentiates treatments better than analysis of responder status. As obtenation of complete remission is a realistic objective with current antidepressants, studies longer than 2 months are needed to assess effectiveness of these drugs in the obtenation of complete remission.
Brain models of drug addiction are being tackled in humans, using PET and MRI.
1. Whereas tobacco and cannabis do not interact directly with dopamine sites, positron emission tomography detected lower availability in sites regulating the catecholamines homeostasis, notably in dopamine transporter sites in striatal and in extrastriatal regions. This further supports repeated and long term substance use progress towards an adaptative diminished basal dopamine level that would contribute to the switch to an addicted brain.
2. Alcohol: abnormalities in brain macro- and micro- structure were searched in detoxified alcohol-dependents with preserved psychosocial functioning:
- Brain function (fMRI): fronto-cerebellar overactivation detected during an auditory language task in alcohol-dependents may reflect the compensatory effort required for patients to maintain the same level of performance as controls.
- Brain macrostructure (MRI). Widespread lower white matter volumes, and lower grey matter volumes in the frontal lobe, insula, hippocampus, thalami and cerebellum, were detected. Poorer neuropsychological performance correlated with smaller grey matter volumes in these regions and with lower white matter volume in the brainstem.
- Brain microstructure (DTI): tractography of white matter fiber bundles revealed that brainstem bundles alteration may contribute to cognitive flexibility impairment. Regression analyses showed memory scores were related to brain microstructure in parahippocampal areas, frontal cortex, and left temporal cortex. This suggest diffusion imaging (DTI) is a useful probe to early alcohol-induced brain alterations.
While indices of dopamine down-regulation are consistency detected in several drug addictions, even “socially-adapted” alcohol dependence may induce change in brain structure.
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Appetite and weight changes are commonly occurring symptoms of depressive illness. The occurrence of these symptoms may not only be related to depressive mood but may also be related to body weight.
To examine the relationship between symptoms of depression and body weight.
Symptoms of depression were assessed by the Montgomery-Asberg depression rating scale (MADRS) in 1694 patients seeking medical help and fulfilling DSM-IV criteria for a major depressive episode. The level of anxiety was evaluated by Covi’s anxiety scale. Body weight was expressed as body-mass index (BMI, kg/m2) and treated both categorically and continuously.
The total MADRS score was not statistically different across the four BMI categories (underweight: 32.3 ± 0.6, normal weight: 30.9 ± 0.2, grade 1: 30.6 ± 0.3, and 2 overweight: 30.6 ± 0.6, P = 0.053 (NS)). In women with BMI ≤ 18.5 kg/m2 MADRS was significantly higher than that in other BMI categories (underweight: 32.4 ± 0.6, normal weight: 30.6 ± 0.2, grade 1: 30.6 ± 0.4, and 2 overweight: 30.6 ± 0.6: P = 0.036). Increasing BMI was related to a linear decrease in symptoms “Reduced appetite” (P < 0.0001) and “Pessimistic thoughts” (P < 0.003). The presence of melancholic or atypical features was not associated with lower or higher BMI, respectively.
In patients with major depression higher body weight is likely to be associated with less reduction in appetite and less pessimistic thoughts.
We investigated plasma cortisol in a psychological stress paradigm in seven weaned anhedonic alcoholics in comparison with seven age-matched healthy controls. Alcoholics had significantly higher mean plasma cortisol at baseline and no increase following a psychological stress paradigm. Anhedonic alcoholics judged the experimental situation less agreeable than controls. Anhedonic alcoholics may have blunted cortisol response to psychological stress.
Allele A1 of the TaqI A restriction fragment length polymorphism (RFLP) of the dopamine D2 receptor gene has been found to be associated with substance abuse and alcoholism. The personality trait of Novelty Seeking (NS) is also associated with substance abuse and dependence. We hypothesised, on the basis of involvement of dopaminergic mechanisms in substance abuse, that the presence of allele A1 of the dopamine D2 receptor gene may represent a genetic predisposition for the NS personality trait. We investigated, therefore, whether the allele A1 of the TaqI A RFLP of the dopamine D2 receptor gene is associated with the NS dimension of the Tridimensional Personality Questionnaire (TPQ) in healthy Caucasian subjects with no history of alcohol or substance abuse or dependence. We genotyped 204 subjects aged 18 to 30 years. There was no association between any of the alleles of the D2 receptor genes and any of the TPQ scores (NS, Harm Avoidance, Reward Dependence). We conclude that allele A1 of the TaqI A RFLP of the dopamine D2 receptor is not associated with NS personality trait in healthy Caucasian subjects.
There are concerns that children in out-of-home care take psychotropicdrugs at a much higher rate than other children and that some treatmens mightbe inappropriate.
To study the prescription of psychotropic drugs to children in out-of-home care in Sweden.
To describe the prevalent use of psychotropic drugs among children in out-of-home care in Sweden and pinpoint possible inappropriate treatment.
Data on drugs dispensed from the national Swedish Prescribed Drug Registerfor 2013. Individuals with at least three dispensations were defined as usersand included in the study.
A widespread use of different types of psychotropic drugs was foundamong children in out-of-home care in Sweden. The concurrent use of methylphenidateand antipsychotics was notable – about 20% of the children were simultaneouslytreated with these drugs.
Children in out-of-home care take psychotropic drugs at a much higherrate than other children in Sweden. Evidence supporting effectiveness andsafety of certain treatments is lacking.
An increasing number of young people in Sweden are diagnosed with mental disorders and there appears to be significant gender differences in disease pattern.
To more thoroughly characterize the increase in mental disorders among young people with focus on gender differences.
To increase the knowledge of age and sex-specific trends in incidence and prevalence rates of mental disorders among children and adolescents.
Data on psychiatric diagnoses for the last 10 years were obtained from Swedish national registers held by the National Board of Health and Welfare in Sweden.
Neuropsychiatric, depressive and anxiety disorders have increased markedly among young people the last decade. In addition, men are increasingly diagnosed with substance-related disorders whereas women with borderline personality disorder.
The increase in mental disorders among young people is marked and disease affects men and women differently. Because of greater awareness today, some conditions like ADHD are more frequently diagnosed. However, the increase in depressive and anxiety disorders appears genuine and represents an additional challenge.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Hyperbaric oxygen therapy (HBOT) shows promising results in treating radionecrosis (RN) but there is limited evidence for its use in brain RN. The purpose of this study is to report the outcomes of using HBOT for symptomatic brain RN at a single institution.
This was a retrospective review of patients with symptomatic brain RN between 2008 and 2018 and was treated with HBOT. Demographic data, steroid use, clinical response, radiologic response and toxicities were collected. The index time for analysis was the first day of HBOT. The primary endpoint was clinical improvement of a presenting symptom, including steroid dose reduction.
Thirteen patients who received HBOT for symptomatic RN were included. The median time from last brain radiation therapy to presenting symptoms of brain RN was 6 months. Twelve patients (92%) had clinical improvement with median time to symptom improvement of 33 days (range 1–109 days). One patient had transient improvement after HBOT but had recurrent symptomatic RN at 12 months. Of the eight patients with evaluable follow-up MRI, four patients had radiological improvement while four had stable necrosis appearance. Two patients had subsequent deterioration in MRI appearances, one each in the background of initial radiologic improvement and stability. Median survival was 15 months with median follow-up of 10 months. Seven patients reported side effects attributable to HBOT (54%), four of which were otologic in origin.
HBOT is a safe and effective treatment for brain RN. HBOT showed clinical and radiologic improvement or stability in most patients. Prospective studies to further evaluate the effectiveness and side effects of HBOT are needed.
Text readability assessment is a challenging interdisciplinary endeavor with rich practical implications. It has long drawn the attention of researchers internationally, and the readability models since developed have been widely applied to various fields. Previous readability models have only made use of linguistic features employed for general text analysis and have not been sufficiently accurate when used to gauge domain-specific texts. In view of this, this study proposes a latent-semantic-analysis (LSA)-constructed hierarchical conceptual space that can be used to train a readability model to accurately assess domain-specific texts. Compared with a baseline reference using a traditional model, the new model improves by 13.88% to achieve 68.98% of accuracy when leveling social science texts, and by 24.61% to achieve 73.96% of accuracy when assessing natural science texts. We then combine the readability features developed for the current study with general linguistic features, and the accuracy of leveling social science texts improves by an even higher degree of 31.58% to achieve 86.68%, and that of natural science texts by 26.56% to achieve 75.91%. These results indicate that the readability features developed in this study can be used both to train a readability model for leveling domain-specific texts and also in combination with the more common linguistic features to enhance the efficacy of the model. Future research can expand the generalizability of the model by assessing texts from different fields and grade levels using the proposed method, thus enhancing the practical applications of this new method.
Purpose: We identified key clinicopathologic features of brain metastasis (BM) patients who are long-term survivors (LTS). Methods: We screened a prospective database of 1892 patients (treated 2006-2017), identified 92 (5%) who lived > 3 years following BM diagnosis, and performed per patient analyses. Results: Median age at diagnosis of BM was 57 years (range 19-77), 77% were women. The most common tumors were lung (50%), breast (26%), thyroid (7%) and skin (5%). 42% had tumors with drug-targetable oncoproteins (e.g. EGFR mutant) and 15% expressed hormonal receptors. ECOG was <2 in 70%. 47% had stage IV disease at diagnosis (75% with brain as the first site). 55% had controlled extracranial disease at the time of BM diagnosis. Median BM diameter was 1.5 cm (range 0.2-7) and 62% had a single lesion. Treatment was with surgery, radiosurgery, whole brain radiation (WBRT), or systemic therapy alone in 38%, 62%, 52%, and 4%, respectively. 53% received targeted- or immuno-therapy. Median follow up was 63 months (range 36-113). 61% failed intracranially at a median 24 months (range 1-99). 5 and 10- year survival (from BM diagnosis) was 82%, and 34%, respectively. Neither upfront WBRT nor other variables tested correlated with improved survival. In patients who died, an MRI was available within 3 months from death in 57%; of those 55% had no active intracranial disease, suggesting that the majority of deaths were non-neurologic. Conclusion: In general, LTS of BM had a limited number of BM, inactive extracranial disease, and drug targetable mutations.