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Nerve transfer surgery (NT) for patients with nerve and spinal cord injuries can result in dramatic functional improvements. As a result, interdisciplinary complex nerve injury programs (CNIPs) have been established in many Canadian centres, providing electrodiagnostic and surgical consultations in a single encounter. We sought to determine which allied health care services are included in Canadian CNIPs, at the 3rd Annual Canadian Peripheral Nerve Symposium. Twenty CNIPs responded to a brief survey and reported access as follows: occupational therapy=60%, physiotherapy=40%, social work=20%, mental health=10%. Access to allied health services is variable in CNIPs across Canada, possibly resulting in heterogeneity in patient care.
Decreased levels of polyunsaturated membrane fatty acids (PUFA) and increased activity of cytosolic phospholipase A2 (PLA2) enzymes (key regulating enzymes of membrane remodelling and PUFA availability) are supporting pillars of the “membrane phospholipids concept of schizophrenia”. Assuming that membrane PUFA profile and PLA2 activity are altered during the at risk phase of disorder and influenced by fatty acid supplementation, we investigated PUFA profiles and PLA2 activity simultaneously in ultra high-risk (UHR) subjects before and after (n-3) fatty acids supplementation.
In 81 UHR patients (aged between 13 and 25 years) PUFA levels were assessed in erythrocyte membranes using gas chromatography, and cytosolic PLA2 activity was measured in blood serum using a fluorometric HPTLC-based assay. Measurements were performed before and after a 6 month interval of placebo-controlled supplementation with n-3 fatty acids.
At baseline significant associations were found between (n-9) and (n-6)-PUFA levels and psychopathology (especially in negative symptoms) assessed by the PANSS according to PACE criteria. (n-3)-PUFA supplementation caused significant changes in (n-3)- and (n-6)-PUFA levels and a significant decrease of PLA2 activity.
Our results support associations between membrane biochemistry and psychopathology (especially negative symptoms) in people at risk to develop psychosis. Supplementation of n-3 PUFA increases PUFA availability at membrane level and modulates membrane repair and remodelling processes. Assuming that PLA2 activity reflects neuronal damage, PUFA supplementation might unfold neuroprotective effects.
In a number of studies, it has been shown that subjects with attention-deficit/hyperactivity disorder (ADHD) show deficits in executive functioning, i.e. in cognitive functions that subserve planning, monitoring and control of goal-directed behaviour (Martinussen et al., 2005; Willcutt et al., 2005), as well as in emotion regulation (Berlin et al., 2004; Desman et al., 2006). However, no study exists so far examining the interaction between cognition and emotion regulation in subjects with ADHD. In our study, we aimed to examine to what extend arousing emotional picture stimuli may account for differential effects in performance quality in subjects with and without ADHD. Thirty-nine males and females with ADHD aged 18 to 40 years and 40 matched healthy controls performed a working memory n-back task (1-back, 2-back). The task was performed with and without neutral and negative background pictures from the International Affective Picture System (IAPS) which varied in arousal (low, medium, high). Irrespective of ADHD diagnosis, all subjects were slower and demonstrated lower performance accuracy in the 2-back condition compared with the 1-back condition, and all subjects deteriorated with increasing picture arousal. In comparison to healthy controls, subjects with ADHD displayed a deficit in working memory performance in terms of prolonged reaction times and decreased performance accuracy. Beyond this, we found that whereas healthy controls did not display performance deficits until they were presented with high-arousal background pictures, subjects with ADHD were already impaired when presented with medium-arousal background pictures. The implications of these and further findings will be discussed.
To compare neuropsychological functions of individuals at risk (IR) for psychosis and patients with a first episode of psychosis (FE) with healthy control subjects (HC). And to determine cognitive factors which have the potential to discriminate IR with (IRtrans) and without (IRnon-trans) transition to psychosis.
N = 60 prodromal IR and N = 51 healthy control subjects were assessed with a comprehensive neuropsychological test battery. Besides general intelligence the test battery covered two functional domains (executive and attentional functions) and working memory. Within a follow up period of at least 30 month N = 19 IR transited to psychosis and N = 30 IR still have been followed up.
For each patient group (FE and IR), cognitive profiles were constructed by means of z-values adjusted for demographic and medication influence. The HC mean performance level was used as baseline of each group profile. A further profile was constructed by differential values considering IRtrans versus IRnon-trans. Comparisons were carried out by MANOVA and post- hoc t-tests.
In all functional domains FE and IR performed below HC except for specific sustained attention measures. There were no significant differences between FE and IR.
Executive functions and working memory measures were more compromised in IRtrans as compared to IRnon-trans.
Neuropsychological deficiencies precede psychotic breakdown. This indicates that neuropsychological assessments of affected domains may support early detection of psychosis.
Omega-3 fatty acid supplementation studies are inconclusive. We performed two intervention studies. The first study (Berger et al 2007) was a double blind, placebo-controlled randomized trial comparing 2 g Ethyl-eicosapentaenoic acid (EPA) versus placebo in addition to antipsychotic medication in 79 first episode psychosis patients. Mixed model analysis suggests that EPA augmented first episode psychosis patients respond quicker compared to placebo for time to response (p = 0.06). Post hoc analysis for cumulative response rates confirm a higher response rate at week 6 (42.9% versus 17.6% for all subjects, p = .036; 54,2% versus 17.2% for non-affective psychosis, p = .008) that was not significant anymore at week 12 (potential ceiling effect). In the second study (Amminger et al, 2010) using 840 mg EPA and 700 mg docosahexaenoic acid per day as sole treatment in 81 prodromal adolescents only 1 of 38 UHR adolescents (2.6%) in the EPA/DHA group compared to 8 of 38 (21.1%) prodromal adolescents in the placebo group met exit criteria for psychotic disorder (Chi-square Fisher's exact test =6.2, df = 1, p = 0.028; OR = 9.9). The change from baseline on the PANSS total symptom score (p = 0.006), and the GAF score (p = 0.025) were also significant between the treatment groups showing a clinically relevant advantage of EPA/DHA over placebo. Stage of illness may be more relevant for the use of the benign treatments such as omega-3 fatty acids in emerging psychosis and explain previous inconclusive findings. Research designs for future omega-3 fatty acid intervention trials and potential pitfalls will be discussed.
Les AVP sont le principal pourvoyeur d’ESPT (Kupchik et al., 2007), dont la prévalence fluctue de 6 à 45 % entre les études (Heron-Delaney et al., 2013). En l’absence de repérage clinique, l’ESPT peut se chroniciser (Kessler et al., 1995). Les outils actuels permettent son diagnostic (Jackson et al., 2011), mais pas de dépister précocement les sujets à risque de développer un ESPT post-AVP en aigu (8 semaines) comme en chronique (6 mois) ou en tardif (1 an). Nous présentons une étude longitudinale réalisée sur 274 patients répartis sur 6 centres de traumatologie ayant pour objectif principal de valider un outil infirmier de dépistage précoce d’ESPT après un AVP (DEPITAC). Dix questions ont été soumises à tout patient hospitalisé dans les 15 jours après un AVP, ainsi qu’une PDI et un MINI DSM-IV. La PCL-S (cut-off à 44) a permis le diagnostic à 8 semaines, 6 mois et 1 an. L’analyse statistique a été réalisée avec le logiciel SAS Institute 9.4. Le score total DEPITAC était significativement associé au diagnostic d’ESPT à 1 an (OR : 1,43 ; IC95 % : 1,14–1,79) avec un pouvoir discriminant de 0,64 (IC95 % : 0,56–0,72). DEPITAC était corrélé à l’échelle PDI (p < 0,0001) avec un faible coefficient de corrélation (r = 0,32) montrant une faible redondance. Seules 3 questions après analyses bivariées s’avèrent significatives : « présence d’autres blessés ou décédés lors de l’AVP », « présence d’une dissociation post-AVP » et « s’être vu mourir lors de l’AVP » avec un pouvoir discriminant de 0,65 (IC95 % : 0,57–0,73). Aucun effet centre n’a été mis en évidence (p = 0,90). Nos résultats semblent montrer qu’à l’aide de seulement 3 questions de dépistage, les équipes infirmières pourraient repérer les patients à risque de développer un ESPT aigu ou tardif, leur permettant ainsi d’alerter précocement les équipes psychiatriques de liaison ou de pschotraumatologie.
Obsessive-compulsive disorder (OCD) is characterized by repeated thoughts and behaviors. Several studies have detected deficient response inhibition ability in individuals with OCD, leading researchers to suggest this deficit as an endophenotype of OCD. However, other researchers maintain that the effect size of this deficit is modest and that it lacks clinical significance. The current investigation examines a potential alternative explanation for difficulties in response inhibition, namely enhanced action tendencies in response to stimuli. Therefore, early processes of motor response preparation preceding action performance (or inhibition) were studied with the event-related potential (ERP) component of readiness potential (RP). RP measures brain reactions related to motor activity in response to external stimuli. ERPs were recorded while 15 participants with OCD and 16 healthy controls performed a variation of a go/no-go task and a stop-signal task using schematic faces (angry and neutral). The OCD group presented with a greater RP slope gradient and amplitude over bilateral parietal areas corresponding to the motor cortex. The amplitude effect was further enhanced under negative valence, compared with the neutral condition. Differences in RP between the OCD and control groups remained significant when controlling for levels of trait anxiety. Results support the hypothesis that a stronger readiness for action might characterize OCD, especially in the presence of threatening stimuli. This finding, specific to OCD and not to anxiety symptoms, may underlie habitual tendencies in OCD. This study suggests that early-stages of motor preparation might be important to the etiology and maintenance of OCD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Conservation of animal genetic resources requires regular monitoring and interventions to maintain population size and manage genetic variability. This study uses genealogical information to evaluate the impact of conservation measures in Europe, using (i) data from the Domestic Animal Diversity Information System (DAD-IS) and (ii) a posteriori assessment of the impact of various conservation measures on the genetic variability of 17 at-risk breeds with a wide range of interventions. Analysis of data from DAD-IS showed that 68% of national breed populations reported to receive financial support showed increasing demographic trends, v. 51% for those that did not. The majority of the 17 at-risk breeds have increased their numbers of registered animals over the last 20 years, but the changes in genetic variability per breed have not always matched the trend in population size. These differences in trends observed in the different metrics might be explained by the tensions between interventions to maintain genetic variability, and development initiatives which lead to intensification of selection.
The identification of people at high risk for future mental disorders is accompanied by the imperative to provide stage-adequate treatments that successfully prevent progression to more severe illness stages. Current evidence-based treatments include psychological and psychosocial treatments on one hand as well as pharmacotherapy. The latter is limited by inadequate efficacy and prominent side effects in many cases, making the discovery of novel biological treatment strategies necessary. Such novel treatments need to be safe, effective, characterised by a benign side effect profile and accessible to young people. In this chapter, emerging biological treatment approaches are reviewed and discussed in regard to their potential impact on early intervention and clinical staging. Substances reviewed here include long-chain omega-3 fatty acids (fish oil), n-acetylcysteine (NAC), cannabidiol and repeated transcranial magnetic stimulation (rTMS) with a particular focus on recent advancements in their application in youth with incipient mental disorders. Finally, research priorities in the field of treatment trials are discussed in this chapter.
OBJECTIVES/SPECIFIC AIMS: The objective of this project is to determine whether HRV, collected peri-operatively, is predictive of cognitive decline among older adults who undergo elective surgery/anesthesia. METHODS/STUDY POPULATION: This project is a part of the ongoing INTUIT/PRIME study, which is collecting pre- and post-operative cognitive testing, fMRI imaging, CSF samples, and EEG recordings from 200 older adults (age ≥ 60) undergoing elective non-cardiac/non-neurologic surgery scheduled to last > 2 hours at Duke University Medical Center and Duke Regional Hospital. This project utilizes data from the first 60 INTUIT participants who contributed continuous heart rate data before and during surgery. Participants undergo cognitive testing prior to surgery (baseline) and at 6 weeks after surgery. Our primary dependent variable is the change in the composite score from baseline to 6-weeks. Delirium is assessed in the hospital with the twice daily 3D-CAM tool, so we will report the proportion of individuals with 6-week cognitive decline who exhibited delirium in the days following surgery. Participants’ echocardiogram (ECG) recordings are extracted pre- and intraoperatively from B650/B850 patient monitors with VSCapture software. HRV is defined as the variability between successive R-spikes or inter-beat-intervals on ECG. RESULTS/ANTICIPATED RESULTS: We anticipate that lower intraoperative HRV is associated with worse cognitive decline at 6 weeks after surgery. As secondary objectives, we will determine whether pre-operative HRV or change in HRV (from pre-operative to intra-operative measures) are predictive of cognitive decline after surgery. We expect that in-hospital delirium will be detected in a higher proportion of those with 6-week cognitive decline, compared to those with stable or improved cognition at 6 weeks. DISCUSSION/SIGNIFICANCE OF IMPACT: HRV may address the present need for pre- and intra-operative cognitive risk stratification in the elderly. Physiological indices like HRV have the potential to dramatically change our understanding of CI in older adults undergoing surgery, as they offer an accessible, cost-effective, and non-invasive means whereby clinicians, particularly those unfamiliar with the nuances of geriatric and CI/dementia-related care, can monitor patients and refer those at high-risk of CI after surgery for early intervention.
We present very detailed images of the photosphere of an AGB star obtained with the PIONIER instrument, installed at the Very Large Telescope Interferometer (VLTI). The images show a well defined stellar disc populated by a few convective patterns. Thanks to the high precision of the observations we are able to derive the contrast and granulation horizontal scale of the convective pattern for the first time in a direct way. Such quantities are then compared with scaling relations between granule size, effective temperature, and surface gravity that are predicted by simulations of stellar surface convection.
It is known that the poloidal field is at its maximum during solar minima, and that the behaviour during this time acts as a strong predictor of the strength of the following solar cycle. This relationship relies on the action of differential rotation (the Omega effect) on the poloidal field, which generates the toroidal flux observed in sunspots and active regions. We measure the helicity flux into both the northern and southern hemispheres using a model that takes account of the omega effect, which we find offers a strong quantification of the above relationship. We find that said helicity flux offers a strong prediction of solar activity up to 5 years in advance of the next solar cycle.
Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.
Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.
A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.
Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains.
We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons).
One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (pdiscovery = 3.82 × 10−8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (pdiscovery+replication = 1.10 × 10−6) with evidence of heterogeneity.
Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.
It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions.
A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined.
Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94).
Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.