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The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST).
This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science.
Program activities took place in San Diego County, mainly within clients’ homes or community, with some activities in-office.
Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD.
A manualized, mobile protocol that incorporated CREST was utilized.
The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation.
Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three.
Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.
The physiological demands of weight-pulling dogs have yet to be investigated. Two groups of competitive weight-pulling dogs both underwent two identical pull series 3 h apart. The control group (n 8) was compared with a group fed a rapidly digestible carbohydrate and protein supplement after the first pull series (n 9). Blood was drawn before and after each pull series as well as at 15 and 30 min after the first pull series finished. Biochemistry values remained unremarkable throughout the study in both groups regardless of supplementation or exercise over time. Lactic acid showed mild significant increases post-exercise (2·1 (sd 1·2) mmol/l) compared with baseline (1·4 (sd 0·3) mmol/l; P = 0·03) after the initial pull series. When examining the effects of time there was a significant increase in insulin from baseline (median of 10·8 (range 6·8–17·4) μIU/ml) compared with 30 min after supplementation (17·0 (range 8·1–33·0) μIU/ml) and at 3 h after supplementation (19·2 (range 9·7–53·4) μIU/ml). In the treatment group there was also a time effect, with glucagon being elevated from baseline (median of 100 (range 79–115) pg/ml) compared with 30 min after supplementation (114 (range 90–183) pg/ml) and after the second pull series (131 (range 107–152) pg/ml). Evaluation of each dog's ability to pull the same or greater amount of weight on the second pull series revealed no significant differences. In conclusion, weight-pulling dogs have mild elevations in lactate reflecting little anaerobic metabolism compared with other canine sprinting athletes; hormonal changes associated with carbohydrate absorption are reflected within the treatment group, and supplementation had no effect on performance.
The pathophysiology of auditory verbal hallucinations remains poorly understood.
To characterise the time course of regional brain activity leading to auditory verbal hallucinations.
During functional magnetic resonance imaging, 11 patients with schizophrenia or schizoaffective disorder signalled auditory verbal hallucination events by pressing a button. To control for effects of motor behaviour, regional activity associated with hallucination events was scaled against corresponding activity arising from random button-presses produced by 10 patients who did not experience hallucinations.
Immediately prior to the hallucinations, motor-adjusted activity in the left inferior frontal gyrus was significantly greater than corresponding activity in the right inferior frontal gyrus. In contrast, motor-adjusted activity in a right posterior temporal region overshadowed corresponding activity in the left homologous temporal region. Robustly elevated motor-adjusted activity in the left temporal region associated with auditory verbal hallucinations was also detected, but only subsequent to hallucination events. At the earliest time shift studied, the correlation between left inferior frontal gyrus and right temporal activity was significantly higher for the hallucination group compared with non-hallucinating patients.
Findings suggest that heightened functional coupling between the left inferior frontal gyrus and right temporal regions leads to coactivation in these speech processing regions that is hallucinogenic. Delayed left temporal activation may reflect impaired corollary discharge contributing to source misattribution of resulting verbal images.
Objective: Increased impulsivity has been shown to be a trait feature of adults with bipolar disorder (BD), yet impulsivity has received little study in adolescents with BD. Thus, it is unknown whether it is a trait feature that is present early in the course of the disorder. We tested the hypotheses that self-reported impulsiveness is increased in adolescents with BD, and that it is present during euthymia, supporting impulsiveness as an early trait feature of the disorder.
Methods: Impulsiveness was assessed in 23 adolescents with BD and 23 healthy comparison (HC) adolescents using the self-report measure of impulsivity, the Barratt Impulsiveness Scale (BIS), comprised by attentional, motor and non-planning subscale scores. Effects of subscale scores and associations of scores with mood state and course features were explored.
Results: Total and subscale BIS scores were significantly higher in adolescents with BD than HC adolescents. Total, attentional and motor subscale BIS scores were also significantly higher in the subset of adolescents with BD who were euthymic, compared to HC adolescents. Adolescents with BD with rapid-cycling and chronic mood symptoms had significantly higher total and motor subscale BIS scores than adolescents with BD without these course features.
Conclusion: These results suggest increased self-reported impulsiveness is a trait feature of adolescents with BD. Elevated impulsivity may be especially prominent in adolescents with rapid-cycling and chronic symptoms.
Convergent evidence implicates white matter abnormalities in bipolar disorder. The cingulum is an important candidate structure for study in bipolar disorder as it provides substantial white matter connections within the corticolimbic neural system that subserves emotional regulation involved in the disorder.
To test the hypothesis that bipolar disorder is associated with abnormal white matter integrity in the cingulum.
Fractional anisotropy in the anterior and posterior cingulum was compared between 42 participants with bipolar disorder and 42 healthy participants using diffusion tensor imaging.
Fractional anisotropy was significantly decreased in the anterior cingulum in the bipolar disorder group compared with the healthy group (P=0.003); however, fractional anisotropy in the posterior cingulum did not differ significantly between groups.
Our findings demonstrate abnormalities in the structural integrity of the anterior cingulum in bipolar disorder. They extend evidence that supports involvement of the neural system comprising the anterior cingulate cortex and its corticolimbic gray matter connection sites in bipolar disorder to implicate abnormalities in the white matter connections within the system provided by the cingulum.
A tendency to extract spurious, message-like meaning from meaningless noise was assessed as a risk factor leading to shizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms. These individuals were randomised to olanzapine v. placebo groups during year 1 followed by no pharmacological treatment for those with no disorder conversion during year 2. A time-dependent Cox regression analysis of conversion to schizophrenia-spectrum disorder revealed a significant interaction between condition (olanzapine v. no drug) and length of speech illusion, with the latter strongly predicting subsequent conversion during medication-free intervals but not during olanzapine treatment.
AIGaN HFETs are attractive devices for high power microwave applications. Sapphire, which is the typical substrate for AlGaN epitaxy, has a very poor thermal conductivity, and the power performance of AlGaN HFETs fabricated on sapphire substrates is severely limited due to this large thermal impedance. We report on HFETs fabricated on high thermal conductivity electrically insulating SiC substrates. Excellent RF power performance for large area devices is demonstrated. On-wafer CW measurements at 10 GHz of a 320 micron wide FET resulted in an RF power density of 2.8 Watts/mm, and measurements of a 1280 micron wide FET resulted in a total power of 2.3 Watts. On-wafer pulsed measurements, at 8 GHz, of a 1280 micron wide FET resulted in a total power of 3.9 Watts. Design of a hybrid microwave amplifier will be discussed.
In this study, the causes of biaxial and hydrostatic stress components in epitaxially grown thin GaN films on sapphire are analyzed. It is observed that growth by Molecular Beam Epitaxy (MBE) and by Metal Organic Chemical Vapor Deposition (MOCVD) are governed by very similar physical principles. Differences in the absolute stress values are mainly due to the difference in growth temperature. It is argued that in the case of MOCVD growth the onset of plasticity for higher growth temperatures is responsible for a larger stress relaxation in the buffer layer. It is further found that either process can result in highly off-stoichiometric GaN layers, as manifested by the large variations in the a and c lattice parameters caused by intrinsic point defects.
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