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Adolescence is a critical time point in the lifecourse. LifeLab is an educational intervention engaging adolescents in understanding Developmental Origins of Health and Disease (DOHaD) concepts and the impact of the early life environment on future health, benefitting both their long-term health and that of the next generation. We aimed to assess whether engaging adolescents with DOHaD concepts improves scientific literacy and whether engagement alone improves health behaviours.
Six schools were randomized, three to intervention and three to control. Outcome measures were changed in knowledge, and intended and actual behaviour in relation to diet and lifestyle. A total of 333 students completed baseline and follow-up questionnaires. At 12 months, intervention students showed greater understanding of DOHaD concepts. No sustained changes in behaviours were identified.
Adolescents’ engagement with DOHaD concepts can be improved and maintained over 12 months. Such engagement does not itself translate into behaviour change. The intervention has consequently been revised to include additional components beyond engagement alone.
Background:ATP8A2 mutations have only recently been associated with human disease. We present the clinical features from the largest cohort of patients with this disorder reported to date. Methods: An observational study of 9 unreported and 2 previously reported patients with biallelic ATP8A2 mutations was carried out at multiple centres. Results: The mean age of the cohort was 9.4 years old (range: 2.5-28 yrs). All patients demonstrated developmental delay, severe hypotonia and movement disorders: chorea/choreoathetosis (100%), dystonia (27%) or facial dyskinesia (18%). Hypotonia was apparent at birth (70%) or before 6 months old (100%). Optic atrophy was observed in 75% of patients who had a funduscopic examination. MRI of the brain was normal for most patients with a small proportion showing mild cortical atrophy (30%), delayed myelination (20%) and/or hypoplastic optic nerves (20%). Epilepsy was seen in two older patients. Conclusions:ATP8A2 gene mutations have emerged as a cause of a novel phenotype characterized by developmental delay, severe hypotonia and hyperkinetic movement disorders. Optic atrophy is common and may only become apparent in the first few years of life, necessitating repeat ophthalmologic evaluation. Early recognition of the cardinal features of this condition will facilitate diagnosis of this disorder.
Human rhinoviruses (HRVs) are widespread respiratory pathogens and a major cause of acute respiratory tract infections. The aim of this study was to investigate the molecular epidemiology of rhinovirus infections in children in Cyprus over three consecutive winter seasons. From a total of 116 rhinovirus-positive samples, 68 were sequenced in the 5’-UTR and VP4/VP2 regions. Thirty-six (52·9%) samples were identified as HRV-A and 27 (39·7%) as HRV-C, with only five (7·4%) samples belonging to the HRV-B species. Of these, a total of 46 different genotypes were identified. In the VP2/VP4 phylogenetic tree all strains clustered in three different well-defined clades, whereas the 5’-UTR tree exhibited clades with a mixed clustering of HRV-A and HRV-C strains reflecting the evolutionary history of recombination between HRV-A and HRV-C that has been observed previously. In summary, a high intra- and inter-season diversity of HRV types was observed. Despite its geographical isolation the frequency of HRV species in Cyprus is comparable to that reported in other regions of the world supporting the concept of an unrestricted global circulation. This study assesses, for the first time, the epidemiology of rhinovirus infections in Cypriot children and will be helpful to clinicians and researchers interested in the treatment and control of viral respiratory tract infections.
This study reports the epidemiology of respiratory syncytial virus (RSV) in hospitalized children in Cyprus over three successive seasons (2010–2013) and the association between prevalent genotypes and disease severity. RSV infections had a circulation pattern from December to March. Most RSV-positive children (83%) were aged <2 years. Genotyping of RSV isolates showed that during the first winter season of the study (2010–2011), the only RSV genotype circulating was GA2 (RSV-A), followed by genotype BA (RSV-B) in the next winter season with only few sporadic cases of GA2. During the last winter season of the study (2012–2013) the newly emerged RSV genotype ON1 (RSV-A) was virtually the only circulating genotype. Children infected with genotype ON1 suffered a significantly milder illness compared to infections with genotypes GA2 and BA with a higher percentage of BA-infected children requiring oxygen. Our findings are in contrast to the majority of published reports that suggest RSV-A causes more severe illness than RSV-B. Therefore, further investigation of the association between RSV genotypes and disease severity is required, as it might affect treatment strategies in the future.
Abnormalities in incentive decision making, typically assessed using the Iowa Gambling Task (IGT), have been reported in both schizophrenia (SZ) and bipolar disorder (BD). We applied the Expectancy–Valence (E–V) model to determine whether motivational, cognitive and response selection component processes of IGT performance are differentially affected in SZ and BD.
Performance on the IGT was assessed in 280 individuals comprising 70 remitted patients with SZ, 70 remitted patients with BD and 140 age-, sex- and IQ-matched healthy individuals. Based on the E–V model, we extracted three parameters, ‘attention to gains or loses’, ‘expectancy learning’ and ‘response consistency’, that respectively reflect motivational, cognitive and response selection influences on IGT performance.
Both patient groups underperformed in the IGT compared to healthy individuals. However, the source of these deficits was diagnosis specific. Associative learning underlying the representation of expectancies was disrupted in SZ whereas BD was associated with increased incentive salience of gains. These findings were not attributable to non-specific effects of sex, IQ, psychopathology or medication.
Our results point to dissociable processes underlying abnormal incentive decision making in BD and SZ that could potentially be mapped to different neural circuits.
Gender is known to modulate the clinical course and severity of bipolar disorder (BD). Although cognitive abnormalities are an established feature of BD, there is limited information regarding whether gender also influences the pattern and severity of cognitive impairment.
We evaluated the performance of 86 remitted patients with BD, type 1, (BD-I) (36 male and 50 female) and 46 healthy participants (21 male and 25 female) on tasks of general intellectual ability, memory encoding, recognition and retrieval, response inhibition and executive function (abstraction and perseveration). The impact of illness severity in patients was assessed using the global assessment of functioning (GAF).
We found a gender effect and an interaction between diagnosis and gender on immediate memory, implicating encoding and retrieval processes, both showing male BD-I patients being disadvantaged compared with female patients and healthy controls. Immediate memory correlated with GAF scores and this association was statistically significant for male BD-I patients.
Our findings suggest that gender differences in BD-I are associated with memory function, particularly processes relating to encoding and retrieval, and may contribute to poor functional outcome particularly in men.
Baseline predictors of cognitive change were explored in a sample of persons with multiple sclerosis (MS). Potential predictors included demographic features, baseline clinical characteristics, and psychological state. Participants were 38 individuals diagnosed with either relapsing remitting or secondary progressive MS who did not meet criteria for a current major depressive episode. Subjects were tested at baseline and approximately 1 year in an ongoing longitudinal study of cognition in MS. Participants completed neuropsychological tests sensitive to impairment in MS. They also completed self-report measures of depression, anxiety, fatigue, apathy, and positive and negative affect. Baseline measures of negative affect (e.g., depressed mood, state anxiety, and negative affective state) consistently predicted cognitive change over the course of the study. Higher baseline levels of negative affect were associated with greater relative declines in cognitive performance. This longitudinal relation occurred in the absence of a cross-sectional relation between negative affect and overall cognition. High baseline negative affect particularly predicted a relative decline in episodic memory for newly learned verbal and visuospatial information. The negative affect measures were unique in their predictive value among all the baseline measures assessed. (JINS, 2009, 15, 53–61.)
Background: The aim of this survey is to investigate professional attitudes to the presence and value of spiritual care from Old Age Psychiatrists.
Method: All registered members of the Faculty of the Psychiatry of Old Age in the United Kingdom were asked to complete a 21-question semi-structured questionnaire. The first mail shot took place in 2002 and the second mail shot to non-respondents in 2003. Quantitative and qualitative analyses were carried out on the answers received.
Results: The response rate was 46%. The majority of respondents (92%) recognize the importance of spiritual dimensions of care for older people with mental health needs and about a quarter of respondents appear to consider referring patients to the chaplaincy service. In contrast, integration of spiritual advisors within the assessment and management of individual cases is rare.
Conclusions: Opinions vary as to whether provision of spiritual care should become widely available to older people with mental health needs who are admitted to hospital. Old age psychiatrists recognize that awareness of spiritual dimensions may be important for their patients. They seem less clear about the role of spiritual advisors and how NHS multidisciplinary clinical teams and spiritual and pastoral care services can be best integrated. Much work needs to be done on developing effective training and operational policies in this area.
The relation between self-reported cognitive dysfunction and
neuropsychological performance over 24 weeks was assessed in a sample of
53 multiple sclerosis patients. Subjects were assessed at Weeks Zero and
24 as part of a clinical trial to enhance cognition. At baseline, subjects
had at least mild cognitive impairment on the Rey Auditory Verbal Learning
Test and an absence of depression. Neuropsychological performance was
assessed with a modification of the well standardized Brief Repeatable
Battery. The 5-item Perceived Deficits Questionnaire and a 2-item memory
and attention/concentration questionnaire assessed self-perceived
cognitive impairment. Self-assessed cognition did not correlate with
neuropsychological performance at either baseline or 24 weeks. However,
changes in the self-assessment measures did correlate with changes in
neuropsychological performance. Patients accurately perceived some changes
in their level of cognitive dysfunction, though they were insensitive to
the degree of their current dysfunction. Possible explanations of this
pattern of results are discussed. (JINS, 2005, 11,
Patients with psychosis have activation of the hypothalamic-pituitary-adrenal (HPA) axis during the acute phase of the psychosis. Whether this has any morphological consequences for the pituitary gland is currently unknown.
To examine pituitary volume variation in people at different stages of psychotic disorder.
Pituitary volume was measured using 1.5 mm, coronal magnetic resonance images in 24 people with first-episode psychosis, 51 with established schizophrenia and 59 healthy controls.
Compared with the control group, the people with first-episode psychosis had pituitary volumes that were 10% larger, whereas those with established schizophrenia had pituitary volumes that were 17% smaller. In both of the groups with psychosis, there was no difference in pituitary volume between those receiving typical antipsychotic drugs and those receiving atypical antipsychotics.
The first episode of a psychosis is associated with a larger pituitary volume, which we suggest is due to activation of the HPA axis. The smaller pituitary volume in the group with established schizophrenia could be the consequence of repeated episodes of HPA axis hyperactivity.
To compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.
Classical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).
Alternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.
There is increasing evidence-based knowledge in the drug treatment of psychotic and behavioural symptoms in dementia, but drugs do not possess a formal licence for these indications. Drug companies, health authorities, NHS trusts and medical defence unions were asked for their advice on the medico-legal implications for the prescribing clinician.
Drug companies, health authorities, medical defence unions and NHS trusts are aware of out-of-licence prescribing and leave ultimate accountability with the clinician. A suggested best practice is that of obtaining the patient's consent.
Out-of-licence prescribing for psychotic and behavioural symptoms in dementia is widespread. This patient group may be unable to grant consent. The accountability of individual clinicians should be supported by more adequate medico-legal frameworks.
The integration of a bowtie antenna with a double electron layer tunneling transistor (DELTT) device for the purposes of THz detection is investigated in this paper. The concept of THz detection, based on photon-assisted tunneling (PAT) between the two electron layers in a double quantum well (DQW) heterostructure, will be explained. The detector is expected to have narrowband, electrically tunable, fast response, and the possibility to operate at relatively high temperatures. Since the active area of the detector is very small, which is necessary to achieve fast response, it is not efficient in collecting THz radiation. Therefore, a broadband bowtie antenna is integrated with the detector to efficiently collect the THz radiation. Characteristics of different bowtie antenna geometries at THz frequencies were studied. An equivalent circuit model of the THz detector was developed, for the first time, to estimate the impedance characteristics at THz frequencies. Such a model is crucial for achieving impedance matching between the DELTT and the antenna to increase the overall coupling efficiency.
This study compares bone mass in a national sample of girls with Rett syndrome (RS) with a sample of control children. The Australian RS Database was the source of cases for this population-based study. Hand radiographs were available from 101 of 137 subjects (74% of the known Australian population of girls with RS aged [les ]20 years). Control radiographs matched for age, sex, and laterality were obtained from hospital radiology departments. A measure of cortical thickness was made from the difference between the outer diameter and the medullary space in the second metacarpal bone. A mean z-score value for cortical thickness and percentage cortical area for each individual was calculated. The mean cortical thickness (z score) for girls with RS was −1.94 compared with −0.38 for control children (P<0.001). In girls with RS, the mean cortical thickness decreased with age (P<0.001). In girls who were taking epilepsy medication it was −2.21 compared with −1.23 in those not taking epilepsy medication (P<0.001). There was no evidence of a beneficial effect of increased calcium intake on cortical thickness. A similar pattern was obtained when percentage cortical area was estimated. In multivariate analysis, increasing age and use of anticonvulsant medication were associated with decreased cortical thickness and only use of anticonvulsant medication with decreased percentage cortical area. Fractures had occurred in one-third of cases and it was estimated that just over 40% of girls would sustain a fracture by the age of 15 years. Girls with RS may be at increased risk of fractures and their bone quality compromised as determined by cortical thickness and percentage cortical area measurements from the second metacarpal.
We have recently obtained some interesting results on the global stability characteristics of gaseous and stellar systems using a free–energy variational formulation and Ginzburg–Landau phase transition theory (Christodoulou et al. 1995a, b). For m = 2 nonaxisymmetric modes in particular, we have been able to formulate a new, robust, global stability criterion (Christodoulou, Shlosman, & Tohline 1995, hereafter CST) that avoids many of the problems that plagued the well–known Ostriker & Peebles (1973) criterion. In this article, we briefly summarize the conclusions from the above–cited investigations and we proceed to comment on the stability properties of some interesting stellar models that were discussed during this conference and that are not trivially understood in terms of the new stability criterion.
During the stage of galaxy formation, or because of subsequent accretion events, cold, rotationally supported matter carrying substantial angular momentum is deposited and organized in disks/rings at the outer parts of many types of galaxies. Examples are warped HI disks in spirals, disks of gas and dust in ellipticals, and polar rings around SOs/ellipticals. The observed nuclear activity in many galaxies has its origin in mass transfer from large radii into the centers of galaxy potential wells. We describe two stages of such a mass transfer process and present related numerical multidimensional hydrodynamical simulations. In the first stage, gas still carrying some angular momentum flows toward the nuclear region as a moderately inclined outer disk is attempting to settle toward an energetically “preferred orientation.” In the second stage, a nuclear accretion disk, influenced by the gravitational potential well of a central massive black hole and possibly by a coherent weak magnetic field, suffers one of several known dynamical nonaxisymmetric instabilities that drives gas deeper into the potential well and regulates its accretion onto the black hole.
Although gas is predominantly found in spiral galaxies distributed in rotationally supported large-scale disks (∼ 10 kpc), recent observations reveal the existence of counter-rotating gaseous disks in the central regions of many elliptical and SO galaxies (Franx and Illingworth 1988; Bertola et al. 1990; Bertola, Buson, and Zeilinger 1992). The accepted interpretation of such observations is that gas in ellipticals and SOs must be of external origin.