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Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed.
we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment.
Eighty-seven people with schizophrenia were included and allocated to either the RR group (n = 57) or the TR group (n = 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP], p < 0.001, d = 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative, p < 0.001, d = 0.827; PANSS GP, p < 0.001, d = 0.991; PANSS positive, p = 0.009, d = 0.594), verbal abstraction (p = 0.008, d = 0.554), aggression bias (p = 0.008, d = 0.627), and self-stigma (stereotype endorsement, p = 0.019, d = 0.495; discrimination experiences, p = 0.047; d = 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up.
Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.
The Grotte Chauvet is world renowned for the quality and diversity of its Palaeolithic art. Fire was particularly important to the occupants, providing light and producing charcoal for use in motifs. Charcoal samples were taken systematically from features associated with the two main occupation phases (Aurignacian and Gravettian). Analysis showed it to be composed almost entirely of pine (Pinus sp.), indicating the harsh climatic conditions at this period. No distinction in wood species was found between either the two occupation episodes or the various depositional contexts. The results throw new light on the cultural and palaeoenvironmental factors that influenced choices underlying the collection of wood for charcoal production.
We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.
The Accountability for Reasonableness (A4R) framework addresses the legitimacy of coverage decision processes by defining four conditions for accountable and reasonable processes: Relevance, Publicity, Appeals, Implementation. Cost-per-quality-adjusted life year (QALY) and multicriteria-centered processes may have distinct implications for meeting A4R conditions. The aim of this study was to reflect on how the diverse features of decision-making processes can be aligned with A4R conditions to guide legitimized decision-making. Rare disease and regenerative therapies (RDRTs) pose special decision-making challenges and offer a useful case study.
To support reflection on how different approaches address the A4R conditions, thirty-four features operationalizing each condition were defined and organized into a matrix. Seven experts from six countries explored and discussed these features during a panel (Chatham House Rule) and provided general and RDRT-specific recommendations for each feature. Responses were analyzed to identify converging and diverging recommendations.
Regarding Relevance, panelists highlighted the importance of supporting deliberation, stakeholder participation and grounding coverage decision criteria in the legal framework, goals of sustainable healthcare and population values. Among seventeen criteria, thirteen were recommended by more than half of panelists. Although the cost-effectiveness ratio was deemed sometimes useful, the validity of universal thresholds to inform allocative efficiency was challenged. Regarding Publicity, panelists recommended communicating the values underlying a decision in reference to broader societal objectives, and being transparent about value judgements in selecting evidence. For Appeals, recommendations included clear definition of new evidence and revision rules. For Implementation, one recommendation was to perform external quality reviews of decisions. While RDRTs raise issues that may warrant special consideration, rarity should be considered in interaction with other aspects (e.g. disease severity, age, budget impact).
Improving coverage decision-making towards accountability and reasonableness involves supporting participation and deliberation, enhancing transparency, and more explicit consideration of multiple decision criteria that reflect normative and societal objectives.
Background: Individuals with Parkinson’s disease (PD) often present with visual symptoms (e.g., difficulty in reading, double vision) that can also be found in convergence insufficiency (CI). Our objective was to estimate the prevalence of CI-type visual symptomatology in individuals with PD, in comparison with controls. Methods: Participants ≥50 years with (n=300) and without (n=300) PD were recruited. They were administered the Convergence Insufficiency Symptom Survey (CISS–15) over the phone. A score of ≥21 on the CISS–15, considered positive for CI-type symptomatology, served as the cutoff. Data from individuals (n=87 with, n=94 without PD) who were approached but who reported having a known oculovisual condition were analysed separately. Student’s t test and chi-square at the 0.05 level were employed for statistical significance. Results: A total of 29.3% of participants with versus 7.3% without PD presented with a score of ≥21 on the CISS–15 (p=0.001). Of the participants having a known oculovisual condition, 39.1% with versus 19.1% without PD presented with a score of ≥21 on the CISS–15 (p=0.01). Conclusions: The prevalence of CI-type visual symptoms is higher in individuals with versus without PD whether or not they have a coexisting oculovisual condition. These results suggest that PD per se places individuals with the disease at greater risk of visual symptomatology. These results further underline the importance of providing regular eye exams for individuals with PD.
Prebiotic supplementation modulates immune system development and function. However, less is known about the effects of maternal prebiotic consumption on offspring intestinal defences and immune system responsiveness. We investigated the effects of maternal short-chain fructo-oligosaccharide (scFOS) supplementation on mucin-secreting cells, ileal secretory IgA and cytokine secretion of weaned offspring and their humoral response to an oral vaccine against obligate intracellular Lawsonia intracellularis. Sows were fed a control diet (CTRL) or scFOS-supplemented diet during the last third of gestation and throughout lactation. At weaning, each litter was divided into two groups receiving a post-weaning CTRL or scFOS diet for a month. Pigs from the four groups were either non-vaccinated (n 16) or vaccinated (n 117) at day 33. Biomarkers related to intestinal defences and immune parameters were analysed 3 weeks later. SCFA production was assessed over time in suckling and weaned pigs. Maternal scFOS supplementation improved ileal cytokine secretions (interferon (IFN)-γ, P<0·05; IL-4, P=0·07) and tended to increase caecal goblet cell number (P=0·06). It increased IgA vaccine response in the serum (P<0·01) and ileal mucosa (P=0·08). Higher bacterial fermentative activity was observed during lactation (total faecal SCFA, P<0·001) and after weaning (colonic butyrate, P=0·10) in pigs from scFOS-supplemented mothers. No synergistic effect between maternal and post-weaning scFOS supplementation was observed. Therefore, maternal scFOS supplementation has long-lasting consequences by strengthening gut defences and immune response to a vaccine against an intestinal obligate intracellular pathogen. Prebiotic consumption by gestating and lactating mothers is decisive in modulating offspring intestinal immunity.
The current study assessed whether home-based data collection by trained data collectors can produce high-quality physical measurement data in young children.
The study assessed the quality of intra-examiner measurements of blood pressure, pulse rate and anthropometric dimensions using intra-examiner reliability and intra-examiner technical error of measurement (TEM).
Non-clinical, primarily private homes of National Children’s Study participants in twenty-two study locations across the USA.
Children in four age groups: 5–7 months (n 91), 11–16 months (n 393), 23–28 months (n 1410) and 35–40 months (n 800).
Absolute TEM ranged in value from 0·09 to 16·21, varying widely by age group and measure, as expected. Relative TEM spanned from 0·27 to 13·71 across age groups and physical measures. Reliabilities for anthropometric measurements by age group and measure ranged from 0·46 to >0·99 with most exceeding 0·90, suggesting that the large majority of anthropometric measures can be collected in a home-based setting on young children by trained data collectors. Reliabilities for blood pressure and pulse rate measurements by age group ranged from 0·21 to 0·74, implying these are less reliably measured with young children when taken in the data collection context described here.
Reliability estimates >0·95 for weight, length, height, and thigh, waist and head circumference, and >0·90 for triceps and subscapular skinfolds, indicate that these measures can be collected in the field by trained data collectors without compromising data quality. These estimates can be used for interim evaluations of data collector training and measurement protocols.
Estimating population sizes in the heavily traded grey parrots of West and Central Africa would provide insights into conservation status and sustainability of harvests. Ideally, density estimates would be derived from a standardized method such as distance sampling, but survey efforts are hampered by the extensive ranges, patchy distribution, variable abundance, cryptic habits and high mobility of the parrots as well as by logistical difficulties and limited resources. We carried out line transect distance sampling alongside a simpler encounter rate method at 10 sites across five West and Central African countries. Density estimates were variable across sites, from 0–0.5 individuals km−2 in Côte d'Ivoire and central Democratic Republic of the Congo to c. 30 km−2 in Cameroon and > 70 km−2 on the island of Príncipe. Most significantly, we identified the relationship between densities estimated from distance sampling and simple encounter rates, which has important applications in monitoring grey parrots: (1) to convert records of parrot groups encountered in a day's activities by anti-poaching patrols within protected areas into indicative density estimates, (2) to confirm low density in areas where parrots are so rare that distance sampling is not feasible, and (3) to provide a link between anecdotal records and local density estimates. Encounter rates of less than one parrot group per day of walking are a reality in most forests within the species’ ranges. Densities in these areas are expected to be one individual km−2 or lower, and local harvest should be disallowed on this basis.
Structural gray matter characteristics of anxiety remain unclear. The aim of this study was to assess the influence of current depressive symptoms and history of depression on the gray matter characteristics of trait anxiety.
Structural magnetic resonance imaging (MRI) data from 393 individuals aged 65 years or older were used. Regions of interest (ROIs) included the amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. Trait anxiety was measured by the State-Trait Anxiety Inventory (STAI). Depression and depressive symptoms were measured using DSM-IV criteria and the Center for Epidemiological Studies Depression Scale (CESD).
After adjustments for sociodemographics and health-related variables, anxiety had a significant influence on the gray matter characteristics in all cortical ROIs. First, in participants without depression antecedents, higher trait anxiety was associated with a larger cortical thickness in all cortical ROIs. Second, in participants with a previous history of depression, higher trait anxiety was associated with a smaller cortical thickness in all cortical ROIs.
These results suggest that anxiety is related to cortical thickness differently in healthy older adults and in older adults with psychiatric antecedents. Anxiety associated with thinner cortical areas could reflect symptoms of a specific type of depression or a vulnerability to develop depression.
Despite the growing interest amongst gerontologists and literary and cultural scholars alike, in arts participation, ageing and the artistic outputs of older people, comparatively little attention has yet been paid to theatre and drama. Likewise, community or participatory theatre has long been used to address issues affecting marginalised or excluded groups, but it is a presently under-utilised medium for exploring ageing or for conveying positive messages about growing older. This paper seeks to address this lack of attention through a detailed case study of the place of one particular theatre – the Victoria/New Victoria Theatre in North Staffordshire, England – in the lives of older people. It provides an overview of the interdisciplinary Ages and Stages project which brought together social gerontologists, humanities scholars, psychologists, anthropologists and theatre practitioners, and presents findings from: the archival and empirical work exploring the theatre's pioneering social documentaries and its archive; individual/couple and group interviews with older people involved with the theatre (as audience members, volunteers, employees and sources); and ethnographic data gathered throughout the study. The findings reaffirm the continuing need to challenge stereotypes that the capacity for creativity and participation in later life unavoidably and inevitably declines; show how participation in creative and voluntary activities shapes meanings associated with key life transitions such as bereavement and retirement; and emphasise the positive role that theatre and drama can play as a medium for the inclusion of both older and younger people.
Evidence has grown supporting the role for short sleep duration as an independent risk factor for weight gain and obesity. The purpose of the present study was to examine the relationship between sleep duration and dietary quality in European adolescents. The sample consisted of 1522 adolescents (aged 12·5–17·5 years) participating in the European multi-centre cross-sectional ‘Healthy Lifestyle in Europe by Nutrition in Adolescence’ study. Sleep duration was estimated by a self-reported questionnaire. Dietary intake was assessed by two 24 h recalls. The Diet Quality Index for Adolescents with Meal index (DQI-AM) was used to calculate overall dietary quality, considering the components dietary equilibrium, dietary diversity, dietary quality and a meal index. An average sleep duration of ≥ 9 h was classified as optimal, between 8 and 9 h as borderline insufficient and < 8 h as insufficient. Sleep duration and the DQI-AM score were positively associated (β = 0·027, r 0·130, P< 0·001). Adolescents with insufficient (62·05 (sd 14·18)) and borderline insufficient sleep (64·25 (sd 12·87)) scored lower on the DQI-AM than adolescents with an optimal sleep duration (64·57 (sd 12·39)) (P< 0·001; P= 0·018). The present study demonstrated in European adolescents that short sleep duration was associated with a lower dietary quality. This supports the hypothesis that the health consequences of insufficient sleep may be mediated by the relationship of insufficient sleep to poor dietary quality.
To compare the responsiveness of different anthropometric indicators for measuring nutritional stress among children in developing countries.
Growth was studied within 6-month intervals in a rural Senegalese community during one dry and two rainy (hungry) seasons. Responsiveness was defined as the change divided by the standard deviation of each anthropometric indicator. Contrast was defined as the difference in responsiveness between dry and rainy seasons.
The study was conducted in Niakhar, a rural area of Senegal under demographic surveillance, with contrasted food and morbidity situations between rainy and dry seasons.
Some 5000 children under 5 years of age were monitored at 6-month intervals in 1983–1984. The present analysis was carried out on a sub-sample of children aged 6–23 months with complete measures, totalling 2803 children-intervals.
In both univariate and multivariate analysis, mid-upper arm circumference was found to be more responsive to nutritional stress than the commonly used weight-for-height Z-score (contrast = −0·64 for mid-upper arm circumference v. −0·53 for weight-for-height Z-score). Other discriminant indicators were: muscle circumference, weight-for-height, BMI and triceps skinfold. Height, head circumference and subscapular skinfold had no discriminating power for measuring the net effect of nutritional stress during the rainy season.
The use of mid-upper arm circumference for assessing nutritional stress in community surveys should be considered and preferred to other nutritional indicators. Strict standardization procedures for measuring mid-upper arm circumference are required for optimal use.
MarcoPolo-R is a sample return mission to a primitive Near-Earth Asteroid (NEA) selected in February 2011 for the Assessment Study Phase at ESA in the framework of ESAfs Cosmic Vision 2 program. MarcoPolo-R is a European-led mission with a proposed NASA contribution. MarcoPolo-R takes advantage of three industrial studies completed as part of the previous Marco Polo mission (see ESA/SRE (2009)3). The aim of the new Assessment Study is to reduce the cost of the mission while maintaining its high science level, on the basis of advanced studies and technologies, as well as optimization of the mission. MarcoPolo-R will rendezvous with a unique kind of target, a primitive binary NEA, scientifically characterize it at multiple scales, and return a unique pristine sample to Earth unaltered by the atmospheric entry process or terrestrial weathering. The baseline target of MarcoPolo-R is the primitive binary NEA (175706) 1996 FG3, which offers a very efficient operational and technical mission profile. A binary target also provides enhanced science return: the choice of this target will allow new investigations to be performed more easily compared to a single object, and also enables investigations of the fascinating geology and geophysics of asteroids that are impossible to obtain from a single object. Precise measurements of the mutual orbit and rotation state of both components can be used to probe higher-level harmonics of the gravitational potential, and therefore the internal structure. A unique opportunity is offered to study the dynamical evolution driven by the YORP/Yarkovsky thermal effects. Possible migration of regolith on the primary from poles to equator allows the increasing maturity of asteroidal regolith with time to be expressed as a latitude-dependent trend, with the most-weathered material at the equator matching what is seen in the secondary. MarcoPolo-R will allow us to study the most primitive materials available to investigate early solar system formation processes. Moreover, MarcoPolo-R will provide a sample from a known target with known geological context. Direct investigation of both the regolith and fresh interior fragments is also impossible by any means other than sample return. The main goal of the MarcoPolo-R mission is to return unaltered NEA material for detailed analysis in ground-based laboratories. The limited sampling provided by meteorites does not offer the most primitive material available in near-Earth space. More primitive material, having experienced less alteration on the asteroid, will be more friable and would not survive atmospheric entry in any discernible amount. Only in the laboratory can instruments with the necessary precision and sensitivity be applied to individual components of the complex mixture of materials that forms an asteroid regolith, to determine their precise chemical and isotopic composition. Such measurements are vital for revealing the evidence of stellar, interstellar medium, pre-solar nebula and parent body processes that are retained in primitive asteroidal material, unaltered by atmospheric entry or terrestrial contamination. It is no surprise therefore that sample return missions are considered a priority by a number of the leading space agencies.
Ras Ibn Hani peninsula, a wave-dominated tombolo (800 × 1000 m) on the Syrian coast, provides evidence for significant Holocene changes that can be linked to geological inheritance, rising post-glacial sea level, sediment supply and human impacts. Initial development of Ras Ibn Hani's coastal system began ~ 8000 years ago when shallow marine environments formed in a context of rising post-glacial sea level. Following relative sea-level stabilization ~ 6000 cal yr BP, beach facies trace the gradual formation of a wave-dominated sandbank fronted by a ~ 2300 × ~ 500 m palaeo-island whose environmental potentiality was attractive to Bronze Age societies. A particularly rapid phase of tombolo accretion is observed after ~ 3500 cal yr BP characterised by a two- to fourfold increase in sedimentation rates. This is consistent with (i) a pulse in sediment supply probably driven by Bronze Age/Iron Age soil erosion in local catchments, and (ii) positive feedback mechanisms linked to regionally attested neotectonics. Archaeological remains and radiocarbon datings confirm that the subaerial tombolo was probably in place by the Late Bronze Age. These data fit tightly with other eastern Mediterranean tombolo systems suggesting that there is a great deal of predictability to their geology and stratigraphy at the regional scale.