To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Addictive disorders effect millions of people and have an economic impact that continues to grow each year. Although research is making headway in dealing with addictive substances and behavioral disorders, finding underlying mechanisms that span across disorders is less common. Behavioral economics is one continually developing and refining tool researchers have been using as a means to understand addictions. The first, and most researched area of behavioral economics is delay discounting (DD), which is the subjective devaluation of a reward as a function of the time to receiving it. Researchers use DD to evaluate choice and how that underlies addictive disorders and decision making; yet, they still debate whether discounting rates are stable or change over time. Probability discounting (PD) is another piece of the behavioral economics puzzle. Commonly used in gambling disorder research, PD evaluates behavioral decision making involving the chance of receiving the reinforcer, as opposed to the time delay to receiving it. The final major piece of behavioral economics is demand. This area looks at the amount of effort or resources an organism is willing to expend to access a reinforcer. In this chapter each of these areas will be further explored and understood through the lens of behavioral economics as a whole.
As digitalisation progresses, the demands placed on companies are increasing at all stages of the product generation process. In order to address these requirements and maintain economic strength, companies must implement innovative and intelligent technologies. Small and medium-sized enterprises in particular are confronted with various obstacles, the overcoming of which is addressed by the “Potential Model” presented in this publication.
Complementary feeding (CF) and overweight relationships during early childhood are inconsistent in the literature. We described the association of CF during the first year of life with risk of overweight at 24 months of age in the population-based 2004 and 2015 Pelotas (Brazil) Birth Cohorts (2004c and 2015c). CF introduction was evaluated at the 3 and 12 months’ follow-ups by asking mothers using a list of foods. Risk of overweight at 24 months of age was BMI-for-age z-score above +1sd from the median of the WHO 2006 growth standards. Our analyses included 3823 (2004c) and 3689 (2015c) children. Early introduction CF (before 6 months of age) prevalence in 2004c was 93·3 (95 % CI 92·5, 94·1) % and in 2015c was 87·2 (95 % CI 86·1, 88·2) %. Tea was the item introduced earlier in both 2004c (68·8 %) and 2015c (55·7 %). At 6 months of age, vegetable mash was the most introduced food in 2004c (33·5 %) and 2015c (47·9 %). Between 2004c and 2015c, the introduction of fresh milk decreased 82·1 to 60·5 % and yogurt from 94·4 to 78·1 % during the first year. Risk of overweight prevalence at 24 months was 33·0 (95 % CI 31·6, 34·5) % in 2004c and 32·0 (95 % CI 30·5, 33·5) % in 2015c. In 2015c, the adjusted odds of risk of overweight at 24 months were increased 1·66 and 1·50 times with the early introduction of fresh/powdered milk: plus water, tea or juice, and plus semi-solid/solid food groups, respectively. It is essential to reinforce the adherence to global recommendations on timely feeding introduction and encourage exclusive breast-feeding until 6 months of age to prevent child overweight.
Family and twin studies point towards a partial heritability of suicidal behavior. We investigated the role of a comprehensive set of genes in this behavior. Their selection was driven by results from post mortem and genetic studies. 250 suicide attempters with various psychiatric disorders were compared with 2200 volunteers which were randomly selected from the general population. All subjects were administered standard psychiatric interviews including SCID as well as self-report questionnaires for anger-related traits. Especially, aggressive-impulsive behavior has been studied and associations with these intermediate phenotypes will be presented.
Additionally a large-scale gene expression analysis using cDNA-microarrays to identify new candidate-genes for suicide was conducted. We found several genes to be differentially expressed in the orbitofrontal cortex of suicide completers. Cross-validation experiments using quantitative RT-PCR validated a few genes so far. These genes have been genotyped in our patients and controls and associations with suicidal behavior and intermediate phenotypes, like aggression and impulsivity will be presented.
We investigated the contribution of polymorphisms shown to moderate transcription of serotonin transporter (5HTT) and monoamine oxidase A (MAOA) to the development of violence, and furthermore to test for gene x environment interactions. To do so, a cohort of 184 adult male volunteers referred for forensic assessment were assigned to a violent or non-violent group. 45% of violent, but only 30% of non-violent individuals carried the low-activity, short MAOA allele. In the violent group, carriers of low-function variants of 5HTT were found in 77%, as compared to 59%. Logistic regression was performed and the best fitting model revealed a significant, independent effect of childhood environment and MAOA genotype. A significant influence of an interaction between childhood environment and 5HTT genotype was found (Fig. 1). MAOA thus appears to be independently associated with violent crime, while there is a relevant 5HTT x environment interaction.
In a recent randomised controlled trial (Exercise-I) the effect of aerobic indoor cycling on hippocampal volume as well as magnetic resonance imaging (MRS) metabolites, neuropsychological and clinical variables an physical fitness were determined comparing patients with multi-episode schizophrenia and healthy controls (Pajonk et al. 2010).
In a subsequent three-armed study (Exercise-II) male and female patients with schizophrenia attending a day hospital program or an outpatient clinic were randomised to either aerobic exercise training (cycling) or playing table football as control group for 3×30 minutes per week over a period of three months. After six weeks of intervention additional cognitive training was conducted (CogPack®, 2×30 minutes per week). All patients were undergoing treatment receiving either first or second generation antipsychotics with no differences in dosage or duration of illness between groups. Cycling at heart rate corresponding to a blood lactate concentration of 1,5–2 mmol/L was performed on standardized bikes in a local gym and the amount of exercise was monitored by measuring power (Watt/kg) heart rate, gas exchange (VO2, carbon dioxide output) and blood lactate levels. In the exercise groups, parameters of physical fitness increased. In schizophrenia patients, negative symptoms, short- and long-term memory, executive function as well as GAF score improved mainly during the intervention period of week 6 up to three months.
Data of the impact of this intervention on brain structure and function as well as clinical and neuropsychological variables in multi-episode schizophrenia will be presented.
The aim of this study was to detect longitudinal differences in white matter brain structures in adults with schizophrenia compared to healthy controls.
Twenty adult patients with multi-episode schizophrenia under stable antipsychotic medication and twenty-two age- and sex-matched healthy subjects were included in the study. Diffusion Tensor Imaging (DTI) was applied at baseline (t1), after 6weeks (t2) and after 3months (t3) and data processing was done with tract-based spatial statistics (p<0.05, corrected). Two subjects in the schizophrenic sample dropped out at t2 and one healthy subject at t3. Clinical and neuropsychological variables were measured and correlated with the most significant DTI findings.
Compared with healthy age- and sex-matched controls schizophrenic patients showed widespread decreases in mean fractional anisotropy values (p<0.05, corrected). The most obvious FA decrease in the long-term was found in the anterior part of the corpus callosum (p<0.005, corrected), the left temporal lobe (p<0.004, corr.) and the mid-cingulate gyrus bilateral (p<0.004, corr.). Correlations to demographic variables, clinical rating scales (PANSS, CGI and GAF), verbal learning and memory and working memory will be presented.
Magnetic resonance imaging was able to detect altered structural connectivity in patients with multi-episode schizophrenia in a longitudinal design.
Cognitive impairment substantially contributes to functional disability in schizophrenia. Methods to improve functioning in long-term hospitalized patients are lacking. Cognitive Adaptation Training (CAT) improves functional outcomes in schizophrenia outpatients living in the US.
To investigate the efficacy of CAT in long-term hospitalized schizophrenia patients living in the Netherlands.
Twenty schizophrenia inpatients participated in this study. Ten patients received treatment as usual (TAU), the other 10 patients received TAU plus CAT. CAT uses environmental supports (e.g. calendars, alarm clocks) in order to compensate the impact of cognitive impairment. CAT was provided for 8 months. Assessments of the Multnomah Community Ability Scale (MCAS) and SOFAS were conducted at baseline, halfway, and after 8 months. In addition, participation in work-related activities (e.g. woodworking, graphic center) was recorded every month for a duration of 12 months. Anayses of mixed models were conducted, using the baseline score as a covariate.
After 6 months, CAT patients spent significantly more partial days at activity centers, compared to TAU patients. Differences remained significant after 12 months. With regard to the other measures, CAT patients showed improvement on the SOFAS and the MCAS after 8 months (trend) with a large effect size (0.8).
These findings suggest that inpatients with schizophrenia may benefit from CAT. In particular, the method may be effective to increase productivity in this chronic population. These results are promising, research with a larger sample size is needed to further investigate the effect of CAT in long-term hospitalized psychiatric patients.
The speed of onset of depressive episodes is a clinical aspect of affective disorders that has not been sufficiently investigated. Thus, we aimed to explore whether patients with fast onset of the full-blown depressive symptomatology (≤ 7 days) differ from those with slow onset (> 7 days) with regard to demographic and clinical aspects.
Subjects and methods:
Data were obtained within an observational study conducted in outpatients with major depression who were treated with duloxetine (30–120 mg/day). Onset of depression (without any preceding critical life event) was fast in 416 (less than one week) and slower in 2220 patients.
Compared to patients with slow onset, those with fast onset of depression had more suicide attempts in the previous 12 months (2.7% versus 1.3%, P = 0.046) and less somatic comorbidity (61.7% versus 74.1%, P < 0.0001). In addition, they were slightly younger at onset of depression (mean ± SD 40.2 ± 14.6 versus 42.8 ± 14.2 years, P < 0.001) and used analgesics at baseline significantly less frequently (22.8% versus 33.4%, P < 0.0001).
Discussion and conclusion:
The speed of onset of depression has to be regarded as a relevant clinical characteristic in patients with unipolar depression.
The use of clozapine (CLZ) for treatment-resistant schizophrenia is well established in adults. However, it is seldom used in youth with early onset schizophrenia (EOS) largely because of lack of clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS with the aim to assist clinical decision-making.
We conducted a systematic review of the primary literature on the clinical efficacy and adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance.
CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up (up to 9 years). No fatalities linked to CLZ treatment were reported. Sedation and hypersalivation were the most common complaints, reported by over 90% of patients. Other common ADRs (reported in 10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Less common ADRs (reported in 10-30% of patients) were akathisia, tachycardia and changes in blood pressure. Neutropenia was reported in 6–15% of cases but was usually transient while agranulocytosis was rare (< 0.1%). Seizures were also uncommon (< 3%). Metabolic changes were relatively common (8–22%) but emergent diabetes was not frequently observed (< 6%). Overall the rate of discontinuation was low (3–6%). Current guidelines recommend the use of CLZ in EOS patients who have failed to respond to two adequate trials with different antipsychotics and provide detailed schedules of assessments to evaluate and assess potential ADRs both prior to initiation and throughout CLZ treatment.
Available data although limited in terms of number of studies are consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored
The use of clozapine (CLZ) for treatment-resistant schizophrenia is well established in adults. However, it is seldom used in children and adolescents with early onset schizophrenia (EOS) largely because of lack of clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS with the aim to assist clinical decision-making.
We conducted a systematic review of the primary the literature on the clinical efficacy and adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance.
CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up. No fatalities linked to CLZ treatment were reported. Sedation and hypersalivation were the most common complaints (90% of patients). Other common ADRs (10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Neutropenia was reported in 6-15% while agranulocytosis was rare. Seizures were also uncommon. Metabolic changes were relatively common (8-22%). Overall the rate of discontinuation was low (3-6%). Current guidelines recommend the use of CLZ in treatment-resistant EOS patients and provide detailed schedule of assessments to evaluate and assess potential ADRs both prior to initiation and throughout CLZ treatment.
Available data is consistent in demonstrating that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored.
Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
To understand the implications of archaeological site recording practices and associated inventories for studying Indigenous persistence after the arrival of Europeans, we examined the documentary record associated with nearly 900 archaeological sites in Marin County, California. Beginning with the first regional surveys conducted during the early 1900s and continuing into the present, the paper trail created by archaeologists reveals an enduring emphasis on precontact materials to the exclusion of more recent patterns of Indigenous occupation and land use. In assessing sites occupied by Indigenous people from the late sixteenth through the mid-twentieth centuries, we discuss how the use of multiple lines of evidence—including temporally diagnostic artifacts, chronometric dating techniques, and historical documentation—may help illuminate subtle but widespread patterns of Native presence that have been obscured by essentialist assumptions about Indigenous culture change. Our findings further reveal the shortcomings of traditional site recording systems, in which archaeologists typically categorize sites within the prehistoric-protohistoric-historic triad on the basis of commonsense decisions that conflate chronology with identity. Instead, we argue for recording practices that focus specifically on the calendric ages of occupation for any given site.
With the recent discovery of a dozen dusty star-forming galaxies and around 30 quasars at z > 5 that are hyper-luminous in the infrared (μ LIR > 1013 L⊙, where μ is a lensing magnification factor), the possibility has opened up for SPICA, the proposed ESA M5 mid-/far-infrared mission, to extend its spectroscopic studies toward the epoch of reionisation and beyond. In this paper, we examine the feasibility and scientific potential of such observations with SPICA’s far-infrared spectrometer SAFARI, which will probe a spectral range (35–230 μm) that will be unexplored by ALMA and JWST. Our simulations show that SAFARI is capable of delivering good-quality spectra for hyper-luminous infrared galaxies at z = 5 − 10, allowing us to sample spectral features in the rest-frame mid-infrared and to investigate a host of key scientific issues, such as the relative importance of star formation versus AGN, the hardness of the radiation field, the level of chemical enrichment, and the properties of the molecular gas. From a broader perspective, SAFARI offers the potential to open up a new frontier in the study of the early Universe, providing access to uniquely powerful spectral features for probing first-generation objects, such as the key cooling lines of low-metallicity or metal-free forming galaxies (fine-structure and H2 lines) and emission features of solid compounds freshly synthesised by Population III supernovae. Ultimately, SAFARI’s ability to explore the high-redshift Universe will be determined by the availability of sufficiently bright targets (whether intrinsically luminous or gravitationally lensed). With its launch expected around 2030, SPICA is ideally positioned to take full advantage of upcoming wide-field surveys such as LSST, SKA, Euclid, and WFIRST, which are likely to provide extraordinary targets for SAFARI.
The springtail Megalothorax laevis Denis, 1948 is redescribed from a broad sampling in the intertropical zone: Vietnam (including type locality), Ivory Coast, Gabon, Réunion island and French Guiana. Pseudopore-like elements are for the first time reported on the trunk and legs of Megalothorax species. New molecular data for M. laevis (16S rDNA, 28S rDNA d1 and d2 and COI Barcode) are provided. The phylogenetic position of the species within the Megalothorax genus is analysed. Megalothorax laevis belongs to the incertus group but shares similitudes with the minimus group acquired through evolutionary convergences (such as smooth lamellae of the mucro). Those similitudes might have created confusion between M. minimus and M. laevis. While M. minimus used to be regarded cosmopolitan, M. laevis has been overlooked since its original discovery. However, the present sampling led us to believe that M. laevis replace M. minimus as the commonest edaphic Megalothorax species in the intertropical zone. A key to the Megalothorax species with smooth mucro lamellae is provided.