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One of the central concepts in rabbinic Judaism is the notion of the Evil Inclination, which appears to be related to similar concepts in ancient Christianity and the wider late antique world. The precise origins and understanding of the idea, however, are unknown. This volume traces the development of this concept historically in Judaism and assesses its impact on emerging Christian thought concerning the origins of sin. The chapters, which cover a wide range of sources including the Bible, the Ancient Versions, Qumran, Pseudepigrapha and Apocrypha, the Targums, and rabbinic and patristic literature, advance our understanding of the intellectual exchange between Jews and Christians in classical Antiquity, as well as the intercultural exchange between these communities and the societies in which they were situated.
We evaluated whether memory recall following an extended (1 week) delay predicts cognitive and brain structural trajectories in older adults.
Clinically normal older adults (52–92 years old) were followed longitudinally for up to 8 years after completing a memory paradigm at baseline [Story Recall Test (SRT)] that assessed delayed recall at 30 min and 1 week. Subsets of the cohort underwent neuroimaging (N = 134, mean age = 75) and neuropsychological testing (N = 178–207, mean ages = 74–76) at annual study visits occurring approximately 15–18 months apart. Mixed-effects regression models evaluated if baseline SRT performance predicted longitudinal changes in gray matter volumes and cognitive composite scores, controlling for demographics.
Worse SRT 1-week recall was associated with more precipitous rates of longitudinal decline in medial temporal lobe volumes (p = .037), episodic memory (p = .003), and executive functioning (p = .011), but not occipital lobe or total gray matter volumes (demonstrating neuroanatomical specificity; p > .58). By contrast, SRT 30-min recall was only associated with longitudinal decline in executive functioning (p = .044).
Memory paradigms that capture longer-term recall may be particularly sensitive to age-related medial temporal lobe changes and neurodegenerative disease trajectories.
Given the increase in life expectancy and increased number of older people, larger numbers of older people will develop more comorbidities and functional impairments. Wellness in older individuals includes the continuum of primary and secondary prevention toward healthy aging, to both help prevent and screen for these comorbidities and functional impairments. This chapter reviews primary and secondary prevention, with a focus on healthcare maintenance, social isolation, physical activity in older adults, and nutrition. The first section reviews United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Cancer Society (ACS) recommendations for immunizations and appropriate screening tools for age, as well as comprehensive geriatric assessment. Regarding physical activity in older adults, there is an extensive review of evidence-based recommendations for patients, including guidelines and tools providers may use. The international epidemic of social isolation is reviewed, along with the importance of screening for it and its associated morbidity and mortality. Finally, screening, risk factors, and interventions for nutritional problems in older persons are reviewed.
Individuals with schizophrenia are more likely to smoke and less likely to quit smoking than those without schizophrenia. Because task persistence is lower in smokers with than without schizophrenia, it is possible that lower levels of task persistence may contribute to greater difficulties in quitting smoking observed among smokers with schizophrenia.
To develop a feasible and acceptable intervention for smokers with schizophrenia.
Participants (N = 24) attended eight weekly individual cognitive behavioral therapy sessions for tobacco use disorder with a focus on increasing task persistence and received 10 weeks of nicotine patch.
In total, 93.8% of participants rated the intervention as at least a 6 out of 7 regarding how ‘easy to understand’ it was and 81.3% rated the treatment as at least a 6 out of 7 regarding how helpful it was to them. A total of 62.5% attended at least six of the eight sessions and session attendance was positively related to nicotine dependence and age and negatively related to self-efficacy for quitting.
This intervention was feasible and acceptable to smokers with schizophrenia. Future research will examine questions appropriate for later stages of therapy development such as initial efficacy of the intervention and task persistence as a mediator of treatment outcome.
OBJECTIVES/GOALS: Vitamin D [25(OH)D], known to have anti-inflammatory and anti-fibrotic effects in other tissues, may also impact adipose tissue. We designed parallel studies in humans and rodents to define the effects of vitamin D on adipose tissue inflammation and fibrosis, and on systemic insulin resistance. METHODS/STUDY POPULATION: We performed a randomized, double-blinded placebo-controlled trial to examine the effects of repleting vitamin D at to two levels (to >30 ng/ml and to > 50 ng/ml) in 25(OH)D-deficient (<20 ng/ml), insulin resistant, overweight-to-obese humans (n = 19). A comprehensive study of whole-body insulin action was undertaken with euglycemic stepped hyperinsulinemic clamp studies, both before (1st visit) and after administration of vitamin D or placebo (2nd visit and 3rd visit). Adipose tissue fibrosis and inflammation were quantified by ‘real-time’ rt-PCR and immunofluorescence. To determine whether vitamin D’s effects are mediated through adipocytes, we performed hyperinsulinemic clamp studies and adipose tissue analysis in an adipocyte-specific vitamin D receptor knockout (VDR KO) mouse model. RESULTS/ANTICIPATED RESULTS: 25(OH)D repletion (to >30 ng/ml) was associated with reductions in adipose tissue expression of inflammatory (0.6-0.7-fold decreased expression of TNF-α, IL-6, iNOS and PAI-1) and pro-fibrotic (0.4-0.8-fold decreased expression of TGF-β1, HiF1α, Collagen I, V, VI and MMP7) factors, decreased collagen VI immunofluorescence (p = 0.02) and improved hepatic insulin sensitivity in humans, with suppression of endogenous glucose production (EGP) (1.28 ± 0.20 vs 0.88 ± 0.18 mg/kg/min, p = 0.03). Compared to wild type (WT), VDR KO mice exhibited increased adipose tissue expression of several pro-inflammatory (Tnf-α, iNos, Pai-1, Mcp-1 and F4/80; 4-10 fold) and pro-fibrotic genes (Tgf-β1, Collagen VI, and Tsp1; 2-4 fold), in concert with hepatic insulin resistance (EGP 10 ± 3 vs 3 ± 2 mg/kg/min in WT, p = 0.021). DISCUSSION/SIGNIFICANCE OF IMPACT: Collectively, these complementary human and rodent studies establish a beneficial role of vitamin D to improve hepatic insulin resistance, likely by restraining adipose tissue inflammation and fibrosis. Thus, normalizing 25(OH)D levels could have metabolic benefits in targeted individuals. CONFLICT OF INTEREST DESCRIPTION: N/A
Experiences of childhood trauma (CT) are associated with increased psychological vulnerability. Past research suggests that CT might alter stress processing with a subsequent negative impact on mental health. However, it is currently unclear how different domains of CT exert effects on specific subjective experiences of stress during adulthood.
In the present study, we used network analysis to explore the complex interplay between distinct domains of CT and perceived stress in a large, general-population sample of middle-aged adults (N = 1252). We used a data-driven community-detection algorithm to identify strongly connected subgroups of items within the network. To assess the replicability of the findings, we repeated the analyses in a second sample (N = 862). Combining data from both samples, we evaluated network differences between men (n = 955) and women (n = 1159).
Results indicate specific associations between distinct domains of CT and perceived stress. CT domains reflecting a dimension of deprivation, i.e. experiences of neglect, were associated exclusively to a stress network community representing low perceived self-efficacy. By contrast, CT associated with threat, i.e. experiences of abuse, was specifically related to a stress community reflecting perceived helplessness. Our results replicated with high accordance in the second sample. We found no difference in network structure between men and women, but overall a stronger connected network in women.
Our findings emphasize the unique role of distinct domains of CT in psychological stress processes in adulthood, implying opportunities for targeted interventions following distinct domains of CT.
To examine rates of nonmedical use (NMU) of prescription extended-release (ER) amphetamines and ER methylphenidate, relative to availability.
Prescribing data were acquired from IMS Health. Data relevant to ER amphetamine and ER methylphenidate were collected from two studies in the RADARS® (Researched Abuse, Diversion and Addiction-Related Surveillance) System (Q3 2007-Q2 2009). First, the Drug Diversion System provides a law enforcement perspective based on surveys of diversion investigators throughout the US. Second, the Poison Center System provides data on exposures to prescription drugs based on spontaneous calls. RADARS System data are presented as rates per 1,000 Unique Recipients of Dispensed Drug (URDD) to account for drug availability.
From July 2007-June 2009, 18,315,404 prescriptions were filled for ER amphetamines, 26,674,152 for ER methylphenidate. RADARS System Drug Diversion trends nearly overlap for ER amphetamine and ER methylphenidate, relative to URDD (running average of 0.042 vs. 0.024 drug diversion reports per 1,000 URDD). Similarly, trends in RADARS System Poison Center calls are generally similar for ER amphetamine and ER methylphenidate, although ER amphetamine trends slightly lower (running average of 0.15 vs. 0.22 intentional exposures per 1,000 URDD).
Trends from the US RADARS System, which controls for utilization rates, suggest diversion and poison center call rates are similar for ER amphetamine and ER methylphenidate.
Activation of hypothalamic orexin neurons is a potential mediator of the weight gain associated with some antipsychotic drugs. Male rats display increased Fos expression in lateral hypothalamic orexin neurons following clozapine administration; however, amphetamines led to increased Fos expression in medially located orexin neurons. The rhesus monkey (Macaca mulatta) provides a model to examine the relationships between orexin neurons, weight and physical activity. Using stereology, the number of orexin-A immunoreactive neurons was quantified in 18 male (7.6-18.3kg) and 18 female (4.8-12.2kg) monkeys. In females, there was no relationship between weight and medial or lateral orexin-A neuron number. Conversely, in male monkeys, higher body weight was significantly associated with less medial orexin-A neurons (P<0.05), but the relationship with lateral orexin-A neurons only approached significance (P=0.075). Of the 36 animals in which orexin-A neurons was estimated, activity was monitored for 21 days via an Actiwatch-64 in 12 males and 12 females. Weight was negatively associated with activity in males (P<0.05), but not females. Comparisons of activity to orexin-A neurons revealed a significant association between higher activity levels and greater numbers of orexin-A neurons in the medial hypothalamus (P<0.05) but not with those in the lateral hypothalamus of males. Females showed no relationship between orexin-A neurons in either region and activity. The significant relationship between weight, activity, and medial orexin-A neurons of males, indicates that in monkeys, the medially located orexin neurons may be more influential in mediating body weight than in the rodent. (Supported by NIH Grant-P01-AG00001-29 and RR-00165).
Serotonin 2A receptors (5-HT2A), and serotonin reuptake transporters (5-HTU) are involved in regulating some autonomic and cognitive processes. While the pre-synaptic and post-synaptic distribution of 5-HT2A receptors is unknown in the primate hypothalamus, in cortex, the majority of 5-HT2A receptors are located post-synaptically on pyramidal and glial cells. The density of 5-HT2A and 5-HTU sites declines with age in the primate and rodent hippocampus and frontal lobe but such changes have not been documented in the hypothalamus. To assess age-related changes in the density of 5-HT2A and 5-HTU binding sites in the rhesus monkey (Macaca mulatta) hypothalamus, autoradiographic ligand binding was utilized within the anterior, tuberal, and posterior hypothalamus, and the mammillary body (MMB) of 11-17 monkeys (4.4-31.8 yo). 5-HTU binding was assayed with tritiated citalopram and 5-HT2A with iodinated dimethoxyaminopropane (DOI). The density of 5-HTU binding was significantly reduced with age in the anterior (R= -0.57, N= 16, P=0.021), tuberal (R= -0.627, N= 17, P= 0.007), and posterior (R= -0.053, N= 15, P= 0.042) hypothalamus. Conversely, only the MMB displayed a significantly lower 5-HT2A density in aged animals (R=- 0.631, N= 11, P= 0.037). These results show a significant age-related decline in CIT binding throughout the hypothalamus, suggesting an age-related reduction in its serotonergic innervation. While we were unable to evaluate 5-HT U binding in the MMB, our results show a significant decline in DOI binding in this nucleus. Future studies are needed to determine the 5-HT2A receptor distribution in the monkey hypothalamus. (Supported by NIH Grant-P01-AG00001-29 and RR-00165).
To evaluate the safety of phosphatidylserine (PS) enriched with omega3 fatty acids, mainly eicosapentaenoic (PS-Omega3) in children with attention-deficit hyperactivity disorder (ADHD).
Two hundred children diagnosed with ADHD were randomised to receive either PS-Omega3 (300 mg PS-Omega3/day) or placebo for 15 weeks. One hundred and fifty children continued into an open-label extension for an additional 15 weeks in which they all consumed PS-Omega3 (150 mg PS-Omega3/day). Standard blood biochemical and haematological safety parameters, blood pressure, heart rate, weight and height were evaluated. Adverse events and the Side Effect Rating Scale were also assessed.
One hundred and sixty-two participants completed the double-blind phase. No significant differences were noted between the two study groups in any of the safety parameters evaluated. One hundred and forty participants completed the open-label phase. At the end of this phase, no significant changes from baseline were observed in any of the studied parameters among participants who consumed PS-Omega3 for 30 weeks.
Study results demonstrate that consumption of PS-Omega3 by children with ADHD, as indicated in a 30-week evaluation period, is safe and well tolerated, without any negative effect on body weight or growth.
To study the efficacy and safety of phosphatidylserine (PS) containing Omega3 long-chain polyunsaturated fatty acids attached to its backbone (PS-Omega3) in reducing attention-deficit/ hyperactivity disorder (ADHD) symptoms in children.
A 15-week, double-blind, placebo-controlled phase followed by an open-label extension of additional 15 weeks. Two hundred ADHD children were randomized to receive either PS-Omega3 or placebo, out of them, 150 children continued into the extension. Efficacy was assessed using Conners’ parent and teacher rating scales (CRS-P,T), Strengths and Difficulties Questionnaire (SDQ), and Child Health Questionnaire (CHQ). Safety evaluation included adverse events monitoring.
The key finding of the double-blind phase was the significant reduction in the Global:Restless/impulsive subscale of CRS-P and the significant improvement in Parent impact-emotional (PE) subscale of the CHQ, both in the PS-Omega3 group. Exploratory subgroup analysis of children with a more pronounced hyperactive/impulsive behavior, as well as mood and behavior-dysregulation, revealed a significant reduction in the ADHD-Index and hyperactive components. Data from the open-label extension indicated sustained efficacy for children who continued to receive PS-Omega3. Children that switched to PS-Omega3 treatment from placebo showed a significant reduction in subscales scores of both CRS-P and the CRS-T, as compare to baseline scores. The treatment was well tolerated.
The results of this 30-week study suggest that PS-Omega3 may reduce ADHD symptoms in children. Preliminary analysis suggests that this treatment may be especially effective in a subgroup of hyperactive-impulsive, emotionally and behaviorally-dysregulated ADHD children.
Hypothyroidism is associated with changes in mental state that can range from mild cognitive impairment to depression to florid myxedema coma. A few cases have linked the occurence of psychotic symptoms in the context of severe hypothyroidism, an event referred in the literature as “myxedema madness”. We describe the case of a 48-year-old male with no past psychiatric history and a past medical history of hypertension and hypothyroidism who presented to the psychiatric unit for management of new-onset psychosis, particularly paranoid delusions. On basic medical screening, the patient was found to have severe hypothyroidism manifested by a TSH level of 51.85 and a free T4 level less than 0.4. The patient was treated with both an antipsychotic and thyroid hormone replacement, after which his hypothyroid symptoms and his psychosis improved. Liothyronine was also prescribed to speed up the recovery course, as his delusions were thought to be due to his hypothyroidism. The aim of this poster is to shed light on the possibility of development of psychosis concomitantly with severe hypothyroidism, given the rarity of such events, as well as to illustrate the importance of treating the underlying medical cause rather than only focusing on the treatment of the psychiatric symptoms. The use of Liothyronine proved to be beneficial in this case, as the patient's symptoms drastically improved after its administration. This could potentially illustrate the importance of using Liothyronine particularly in the treatment of delusional disorder in severe hypothyroidism.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In this brief reconsideration of the roles experts may play in legal proceedings - and concentrating on the role of social scientists in particular - it may, therefore, be useful to revisit some very familiar issues and to address some seemingly peripheral matters that are nevertheless quite central to the way we think about the involvement of experts in legal cases. For purposes of introducing some of these issues it may be helpful to focus on three interrelated concerns: the ascertaining of expert qualifications, the role of evidentiary procedure, and the extra-judicial use of social information.
Sex is a powerful way for couples to enhance their bond and promote the success and happiness of their relationship. Yet, maintaining sexual intimacy and passion is a challenging endeavor in romantic relationships, making it crucial to understand the role of sex in relationship maintenance. This chapter focuses on the role of sexuality in enabling couples to maintain satisfying relationships, focusing in particular on how couples can maintain sexual desire and satisfaction over time and as they navigate important relationship and life changes that may result in partners experiencing differences in their sexual interests, such as in the transition to parenthood. We begin the chapter by describing the ways that sex can benefit relationships, focusing on the roles of sexual frequency, physical affection, and sexual satisfaction in shaping the quality and maintenance of relationships. Then, we review research on how couples can prevent declines in sexual desire, or remain satisfied in spite of these declines, with a particular focus on sexual goals, sexual communal motivation, sexual communication, and sexual expectations. We conclude the chapter by highlighting several promising directions for future research on sex and relationship maintenance.
Sleep disturbances are prevalent in cancer patients, especially those with advanced disease. There are few published intervention studies that address sleep issues in advanced cancer patients during the course of treatment. This study assesses the impact of a multidisciplinary quality of life (QOL) intervention on subjective sleep difficulties in patients with advanced cancer.
This randomized trial investigated the comparative effects of a multidisciplinary QOL intervention (n = 54) vs. standard care (n = 63) on sleep quality in patients with advanced cancer receiving radiation therapy as a secondary endpoint. The intervention group attended six intervention sessions, while the standard care group received informational material only. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), administered at baseline and weeks 4 (post-intervention), 27, and 52.
The intervention group had a statistically significant improvement in the PSQI total score and two components of sleep quality and daytime dysfunction than the control group at week 4. At week 27, although both groups showed improvements in sleep measures from baseline, there were no statistically significant differences between groups in any of the PSQI total and component scores, or ESS. At week 52, the intervention group used less sleep medication than control patients compared to baseline (p = 0.04) and had a lower ESS score (7.6 vs. 9.3, p = 0.03).
Significance of results
A multidisciplinary intervention to improve QOL can also improve sleep quality of advanced cancer patients undergoing radiation therapy. Those patients who completed the intervention also reported the use of less sleep medication.
The constitutions of most liberal democracies contain provisions that constrain governmental action in relation to economic policy. Some provisions grant citizens rights: For example, Americans enjoy a right under the US constitution’s Contract Clause, prohibiting states from impairing the obligation of contracts. Most constitutions also provide individual rights protections against uncompensated and arbitrary taking of property. Structural provisions of constitutions also affect economic policy, sometimes by limiting government action directly, rather than through the claims of citizens. For example, balanced-budget rules constrain fiscal decision-making, as do legislative supermajorities required by some constitutions for financial decisions. Such structural provisions have spread in recent years, especially in response to the great recession of 2007 and 2008.