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It is now well known that unaffected first-degree relatives of patients with alcohol disorder have electrophysiological abnormalities (less P3 amplitude). These abnormalities are associated with higher scores in impulsivity self-rating scales and are assumed to reflect central nervous system disinhibition and/or hyperexcitability. However very much less is known about the performance of this population in neuropsychological tests assessing executive functioning and in particular the inhibition process.
Thirty-five first-degree relatives of patients with alcohol dependence were compared to thirty-five healthy controls, matched in terms of age, gender and education level. They completed a self-rating scale of impulsiveness (Barratt Impulsiveness Scale) and a battery of neuropsychological tests. The test battery included the Wisconsin Card Sorting Test, a measure of overall executive functioning, and two performance measures of inhibition process (a Stroop task and a Go-No Go task).
As expected, the Barratt Impulsiveness Scale showed differences between the two groups, with first-degree relatives having higher overall scores and increased scores in the non-planning subscale. Results from neuropsychological testing indicated significant differences among the three tasks (WCST, Stroop task and Go-No Go).
Our findings are consistent with the view that unaffected first-degree relatives of patients with alcohol dependence show decrements in executive functioning and inhibition process. Studies are underway to identify genes associated with the underlying predisposition involved in disinhibitory disorders in this population.
A growing body of research now documents a specific pattern of brain activation during emotional tasks in patients with social phobia. Furthermore, recent studies indicate that non-clinical participants show a similar pattern of responses. Clinical and physiological data from literature highlight that social anxiety is associated with difficulties in emotional managing. However, much less is known about the part of alexithymia in social phobia, as far as clinical and infra-clinical (high shyness) approaches are concerned.
Four hundred undergraduate university students were screened with an anxiety and social phobia questionnaire. Forty participants, with low and high levels of social phobia, were then included according to a dimensional approach. Each participant underwent a comprehensive psychiatric evaluation that included a structured clinical interview for current and past psychiatric disorders and psychometric scales, including the Liebowitz Social Anxiety Scale (LSAS) and the Toronto Alexithymia Scale (TAS-20). Participants were asked to make gender discrimination choices when viewing faces that showed happiness, fear, anger, sadness, neutral expressions or distractors while in a 3 Tesla fMRI scanner.
As expected, social phobia trait was correlated with TAS-20 scores, and specifically in “difficulties identifying feelings”. Brain activations showed an evolutionary pattern response in correlation with social phobia and alexithymia concerning limbic regions (amygdala and insula). Social phobia trait seems to be particularly receptive to anger faces.
Our findings support the hypothesis that alexithymia play a major role in social anxiety disorder. Identifying feelings could explain alexithymic functioning in social phobia, clinically and physiologically.
NICE guidelines advise to consider admission for patients with borderline personality disorder (BPD) for the management of crises involving significant risk to self or others. Furthermore, to consider structured psychological interventions of greater than three months’ duration and twice-weekly sessions according to patients’ needs and wishes.
We aimed to assess reasons for admission and access to psychological interventions in an acute inpatient BPD population.
Case notes of patients with a diagnosis of BPD (ICD-10 F60.3 and F60.31), discharged from four acute general adult wards in Sheffield during a period of twelve months were studied retrospectively, using a structured questionnaire based on BPD NICE guidance.
Of the 83 identified BPD patients, seventy-eight percent were female and 82% between 16–45 years old. Eleven patients had four or more admissions. Eighty percent reported suicidal ideation at admission, with 50% having acted on it (70% by overdose, 50% cutting, 10% hanging). Of this cohort, 58% reported they intended to die. Psychosocial factors at admission were identified in 59 cases, including relationship breakdown (47.5%), alcohol/drug use (30.5%) and accommodation issues (17%). Disturbed/aggressive behaviour was documented in 27.1% of these cases. Sixty-eight percent of patients had psychology input in the 5 years preadmission: 38% (21 patients) received structured therapy, whilst 62% received only one assessment or advise to teams.
Patients were mainly admitted for risk management. A high proportion received unstructured psychological interventions. Services offering structured psychological interventions should be supported, as hospitalisations only temporarily address BPD patients’ suicidality and psychosocial difficulties.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In this chapter, we argue that to understand intelligence one must understand motivation. In the past, intelligence was often cast as an entity unto itself, relatively unaffected by motivation. In our chapter, we spell out how motivational factors determine (1) whether individuals initiate goals relating to the acquisition and display of intellectual skills, (2) how persistently they pursue those goals, and (3) how effectively they pursue those goals, that is, how effectively they learn and perform in the intellectual arena. As will be seen, motivational factors can have systematic and meaningful effects on intellectual ability, performance, and accomplishment over time. Our discussion emphasizes that heritability is not incompatible with the malleability of intelligence and that motivation is the vehicle through which intellectual skills are successfully acquired, expressed, and built upon.
Introduction: Clinicians treating children in the emergency department (ED) are especially concerned with the efficacy and safety of imaging. Interventions to limit imaging have been proposed to maximize benefits and avoid risks; however, the types and effectiveness of interventions employed in pediatric EDs have not been examined in detail. Methods: Electronic databases and grey literature were systematically searched by a medical librarian. Comparative studies of ED-based interventions reporting computed tomography (CT), radiography (XR), or ultrasound (US) outcomes were included. Interventions introducing new imaging equipment or personnel to the ED, ED diversion strategies, and pre-admission protocols were excluded. At least two independent reviewers assessed each study for inclusion based on pre-defined criteria and extracted data. Disagreements were resolved through consensus. Descriptive results are reported. Results: Overall, 38 pediatric studies were included. Most (66%) interventions implemented two or more components; the most common intervention components were clinical guidelines or pathways (87%) and education or information (66%). Studies were categorized by presentation type: traumatic (n = 27); non-traumatic (n = 19), or combined ‘all-comers’ (n = 2). Included studies reported 62 imaging outcomes (CT = 29; XR = 20; US = 13). Among traumatic studies, 26 imaging outcomes were reported; CT was the most commonly reported outcome (CT = 15; XR = 9; US = 1). Of the CT outcomes, 33% reported significant decreases and five decreased but were either not significant or did not report significance. XR significantly decreased in 44% (4/9). In the non-traumatic studies, the most common imaging outcome remained CT (12 outcomes); 58% of which reported significant decreases. XR was the second most frequent outcome, with 63% reporting significant reductions. Combined success of the interventions to reduce CT and XR was 60%. Reported changes in ordering were less consistent in US. Conclusion: Multifaceted passive interventions have been implemented to reduce imaging in pediatric EDs. Most reported some success changing ordering practices, specifically among patients with non-trauma presentations. Future research exploring relationships between intervention content, effectiveness, and fidelity may provide insight into how to develop more effective interventions to change image ordering in the ED and guide which presentations to target.
Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
Toasting time (TT) of rapeseed meal (RSM), the diet processing (DP) method and the interaction between both on the apparent CP digestion along the gastrointestinal tract and the apparent ileal digestibility (AID) of amino acids of growing pigs were investigated. The experiment consisted of a 3×3 factorial design of TT of RSM (0, 60 and 120 min) and DP method (mash, pelleting and extrusion). In total, 81 boars with a starting BW of 20 kg were euthanized 4 h after their last feeding. The gastrointestinal tract was dissected and the small intestine divided in three sections of similar length. Samples were collected from the stomach, 1.5 m from the ends of each of the three sections of the small intestine, and the rectum. The apparent digestibility (AD) of CP for each of the small intestine sections was used to calculate the rate of CP digestion. Increasing the TT of RSM resulted in lower protein solubility, lower lysine/reactive lysine contents and higher protein denaturation, indicative of the occurrence of protein aggregation and Maillard reactions. There were significant effects (P⩽0.01) of TT on the AD of CP in the different sections of the gastrointestinal tract. The rate of CP digestion of the 0 min toasted RSM diets was 23% and 35% higher than that of the 60 and 120 min toasted RSM diets, respectively. There was a significant interaction (P=0.04) between TT and DP for the AID of CP. Although pelleting of the 0 and 60 min toasted RSM diets did not change the AID of CP with respect to the mash diets, pelleting of the 120 min toasted RSM diet increased the AID of CP by 9.3% units. Extrusion increased the AID of CP of the 0 and 60 min toasted RSM diets by 3.4% and 4.3% units with respect to the mash diets, whereas extrusion of the 120 min toasted RSM diet increased the AID of CP by 6.9% units. Similar positive effects of pelleting and extrusion were obtained for the AID of lysine and reactive lysine, especially in the diets with higher TT. In conclusion, processing (pelleting and extrusion) of RSM containing diets can ameliorate the negative effects of RSM toasting on protein and amino acid digestibility; these effects were larger for the RSM toasted for longer times.
Law enforcement agencies are adopting a variety of new surveillance technologies at a fast pace. These technologies could have substantial benefits in terms of public safety, but, for many of them, their ability to reduce crime is unknown. Although a small experimental literature addresses some of these technologies, many of the implementations have been too small to provide an accurate measurement of their potential. In this paper, I explore the advantages and make general suggestions about the use of quasi-experimental methodologies in estimating the public safety benefits of police technology. I also consider the specific case of license plate readers and provide some examples of difference-in-differences approaches that could be used to study their efficacy.
OBJECTIVES/SPECIFIC AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the United States and increases risk for cirrhosis and liver cancer. Identifying modifiable risk factors for NAFLD could allow better targeting of prevention programs. Insulin resistance (IR) plays a significant role in the development and progression of NAFLD. IR is also an important precursor to the development of type 2 diabetes (T2DM). However, the development and duration of IR during young adulthood and its association with NAFLD and T2DM in midlife is unclear. To test whether trajectories of IR using homeostatic model assessment (HOMA-IR) change throughout early adulthood are associated with risk of prevalent NAFLD and T2DM among persons with NAFLD in midlife independent of current or baseline HOMA-IR. METHODS/STUDY POPULATION: Participants from the CARDIA study, a prospective multicenter population-based biracial cohort of adults (baseline age 18–30 years), underwent HOMA-IR measurement (≥8 h fasting and not pregnant) at baseline (1985–1986) and follow-up exam years 7, 10, 15, 20, and 25. At Year 25 (Y25, 2010–2011), liver fat was assessed by noncontrast computed tomography (CT). NAFLD was defined as CT liver attenuation <51 Hounsfield Units after exclusion of other causes of liver fat (alcohol/hepatitis/medications). Latent mixture modeling was used to identify 25-year trajectories in HOMA-IR over time. Multivariable logistic regression models were used to assess associations between HOMA-IR trajectory groups and prevalent NAFLD with adjustment for baseline or Y25 HOMA-IR. RESULTS/ANTICIPATED RESULTS: Among 3060 participants, we identified 3 distinct trajectory groups for HOMA-IR for individuals free from diabetes in middle adulthood: qualitatively low-stable (46.7% of the cohort), moderate-increasing (42.0%), and high-increasing (11.3%) with a NAFLD prevalence at Y25 of: 8.3%, 33.4%, and 63.5%, respectively (p-trend<0.0001). After adjustment for confounders (baseline smoking status, alcohol use, body mass index, physical activity score, systolic blood pressure, antihypertensive medication use, and total/HDL cholesterol ratio) and baseline HOMA-IR, increasing HOMA-IR trajectories were associated with greater NAFLD prevalence compared with the low-stable trajectory group [odds ratio (95% CI): 5.8 (4.3–7.9) and 22.3 (14.2–34.9) for moderate and high, respectively]. These associations were attenuated, but remained significant, even after controlling for current Y25 HOMA-IR [OR=3.6 (2.6–5.0) for moderate and 5.9 (3.4–10.3) for high (referent: low)]. Among participants with NAFLD (n=511), high-increasing HOMA-IR trajectory was associated with greater prevalent [OR=6.5 (1.6–25.7)] and incident [OR=8.7 (2.2–34.4)] T2DM at Y25 independent of confounders and Y25 HOMA-IR (referent: low-stable). DISCUSSION/SIGNIFICANCE OF IMPACT: In this community-based sample of individuals free from diabetes at baseline, an increasing HOMA-IR trajectory through young adulthood was associated with greater NAFLD prevalence in midlife. Knowledge of changes in IR throughout adulthood provides new information on the risk of T2DM among persons with NAFLD in midlife independent of current level of IR. These findings highlight early identification of increasing IR as a potential target for primary prevention of T2DM in the setting of NAFLD.
Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients’ fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients’ social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.
Fasting heat production (FHP) is used for characterizing the basal metabolic rate of animals and the corresponding maintenance energy requirements and in the calculation of net energy value of feeds. In broilers, the most recent FHP estimates were obtained in the 1980s in slow-growing and fatter birds than nowadays. The FHP values (n=73; six experiments) measured in 3 to 6-week-old modern lines of broilers weighing 0.6 to 2.8 kg and growing at 80 to 100 g/day were used to update these literature values. Each measurement was obtained in a group of fasting broilers (5 to 14 birds) kept in a respiration chamber for at least 24 h. The FHP estimate corresponds to the asymptotic heat production corrected for zero physical activity obtained by modeling the decrease in heat production during the fasting day. The compilation of these data indicates that FHP was linearly related to the BW0.70 (in kg), which can be considered as the metabolic BW of modern broilers. The 0.70 exponent differs from the conventional value of 0.75 used for mature animals. The FHP per kg of BW0.70 ranged between 410 and 460 kJ/day according to the experiment (P<0.01). An experiment conducted with a shorter duration of fasting (16 h) indicated that FHP values are higher than those obtained over at least 24 h of fasting. Our values are similar to those obtained previously on fatter and slow-growing birds, even though the comparison is difficult since measurement conditions and methodologies have changed during the last 30 years. The FHP values obtained in our trials represent a basis for energy nutrition of modern broilers.
Objectives: Differences in the process of using liver imaging technologies might be important to patients. This study aimed to investigate preferences for scanning modalities used in diagnosing focal liver lesions.
Methods: A discrete choice experiment was administered to 504 adults aged ≥25 years. Respondents made repeated choices between two hypothetical scans, described according to waiting time for scan and results, procedure type, the chance of minor side-effects, and whether further scanning procedures were likely to be required. Choice data were analyzed using mixed-logit models with respondent characteristics used to explain preference heterogeneity.
Results: Respondents preferred shorter waiting times, the procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner, no side-effects, and no follow‑up scans (p ≤ .01). The average respondent was willing to wait an additional 2 weeks for the scan if it resulted in avoiding side-effects, 1.5 weeks to avoid further procedures or to be told the results immediately, and 1 week to have the scan performed on a couch with a handheld scanner. However, substantial heterogeneity was observed in the strength of preference for desirable imaging characteristics.
Conclusions: An average individual belonging to a general population sub‑group most likely to require imaging to characterize focal liver lesions in the United Kingdom would prefer contrast‑enhanced ultrasound over magnetic resonance imaging or computed tomography. Insights into the patient perspective around differential characteristics of imaging modalities have the potential to be used to guide recommendations around the use of these technologies.
Thirty pelleted diets were given to broiler chickens (eight birds per diet; 21 to 35 days of age) for individual in vivo measurements of dietary net energy (NE) value, using three trials with 10 diets/trial. Amino acid formulation of diets was done on the basis of ratios to CP. NE was measured according to the body analysis method. The basal metabolism component of NE values was calculated on the basis of mean metabolic weight using a coefficient obtained in a previous experiment. Information about apparent metabolisable energy (AME) value of diets, AME corrected to zero nitrogen retention (AMEn) and digestibilities of proteins, lipids, starch and sugars was available from a previous publication. In each trial, mean NE/AME ratios of diets varied by about 6%. From the multiple regressions (n=30) expressing NE and AMEn values as functions of digestible component contents, it was deduced that the NE/AMEn ratios assigned to dietary components were 0.760, 0.862, 0.806, 0.690 and 0.602 for CP, lipids, starch, (sucrose+glucose) and fermentable sugars (α-galacto-oligosaccharides and lactose), respectively. The NE/AME ratio of CP was 0.680. Regression calculations showed that the NE values assigned to individual birds (n=240) could also be predicted with diet AMEn values (NE=0.80 AMEn; R2=0.770) or with an equation combining AMEn value and CP/AMEn ratio (R2=0.773). The latter ratio was found to be the only additional parameter that was significant when added in the NE regression scheme based on AMEn.