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Associations between smell identification deficits (SID) and impairments in basic cognitive domains have been shown in patients with neuropsychiatric disorders.
We analyzed social and basic cognitive deficits and SID.
To assess differences in affective decision making tasks in patients with schizophrenia-spectrum disorders, their 1st degree relatives and healthy controls. Methods: We examined 51 patients with schizophrenia-spectrum disorders (49% female, age 33.1 years, SD 11), 21 first-degree relatives (61.9% female, age 49.5 years, SD 17.6, one affected, others non-affected) and 51 matched healthy controls (49% female, age 33 years, SD 12.1). Psychopathology was evaluated using the Positive and Negative Syndrome Scale (PANSS). Subjects were administered the University of Pennsylvania Smell Identification Test (UPSIT), the Facially Expressed Emotion Labelling (FEEL) test, the spatial span subtest of the Wechsler Memory Scale-Revised (WMS-R) and the Mehrfachwahl-Wortschatz Test (MWT-B).
Patients, controls and 1st degree relatives differed in age (p = 0.000), WMS-R (p = 0.000) and FEEL scores (p = 0.007). In healthy controls, patients and 1st degree relatives FEEL correlated with age (p = 0.005, p = 0.003, p = 0.004, respectively). In patients FEEL also correlated with MWT-B (p = 0.000), UPSIT (p = 0.000) and PANSS negative scores (p = 0.016); furthermore, UPSIT correlated with MWT-B (p = 0.001). In 1st degree relatives age correlated with WMS-R (p = 0.04) and FEEL (p = 0.004), both of which inter-correlated (p = 0.006).
We found that SID, basic and social cognition, i.e. affective decision-making processes, inter-correlate in patients with schizophrenia-spectrum disorders and are partly under the influence of negative symptoms. Some of these relationships can also be seen in 1st degree relatives of patients.
Schizophrenia has often been associated with a reduced skin flush response to niacin. Blunted response suggests potential disturbance in phospholipid metabolism.
We performed niacin skin tests in patients with schizophrenia, their first-degree relatives and healthy controls.
To examine possible differences in skin flush response to niacin.
We examined 51 patients (female 49%, age 33.1 years, SD 11), with schizophrenia-spectrum disorders, 51 matched healthy controls (female 49%, age 33 years, SD 12.1), and 21 first-degree relatives (female 61,9%, age 49,5 years, SD 17,6, one affected, others non-affected). The Positive and Negative Syndrome Scale and the Mini International Neuropsychiatrie Interview were used to assess psychopathology and diagnosis, respectively. The non-invasive niacin skin flush test was used to assess vasodilatative reaction to four different concentrations of niacin on the forearms of subjects.
We found no differences in total scores on the niacin skin flush test between the three groups (p = 0.774). Mean scores were 60.27 (SD 14.2) in healthy controls, 58.84 (SD 10.2) in patients and 58.48 (SD 9.4) in first-degree relatives.
Contrary to our expectations we did not find a significantly blunted niacin skin flush reaction in patients with schizophrenia-spectrum disorders compared to healthy controls or 1st degree relatives.
Sex-related differences in smell identification have been shown in healthy subjects, however, in patients with schizophrenia these findings are still controversial.
We analyzed sex-related differences with respect to smell identification in patients with schizophrenia, their first-degree relatives and healthy controls.
To assess possible sex-related differences in smell identification.
The sample consisted of 51 patients with schizophrenia-spectrum disorders (49% female; mean age 33.1 years; SD: 11), 21 first-degree relatives (61.9% female, age 49.5 years, SD 17.6, one affected, others non-affected) ; mean age 49.5 years; SD: 17.6) and 51 matched healthy controls (49% female; mean age 33 years; SD: 12.1). The Positive and Negative Syndrome Scale (PANSS) and the Mini International Neuropsychiatric Interview (M.I.N.I.) were used to assess psychopathology and diagnosis, respectively. The University of Pennsylvania Smell Identification Test (UPSIT), a standardized, multiple- and forced-choice scratch- and sniff test consisting of 40 items, was administered to all subjects.
We found no significant differences in smell identification between the three groups (p = 0.182). Also, the female and male subgroups did not differ significantly in smell identification (p = 0.105, p = 0.387, respectively). The mean UPSIT scores were 34.4 (SD: 4.1) for healthy women (males: 33.2; SD: 3.5), 32.0 (SD: 5.1) for women with schizophrenia-spectrum disorders (males: 32.5; SD: 4.4), and 34.5 (SD: 2.6) for female first-degree relatives (males: 30.5; SD: 2.8).
We found neither significant differences in smell identification in patients with schizophrenia-spectrum disorders, their first-degree relatives or healthy controls, nor sex-related differences.
Trust matters to fiduciary law in a variety of ways. This chapter will focus on the importance of trust in advisory relationships, and it will emphasize two settings: categorical fiduciary relationships and ad hoc fiduciary relationships. In the former setting, I will suggest that these relationships are appropriately treated as fiduciary in part due to the likelihood of a beneficiary’s epistemic dependence on a fiduciary’s judgements. It is not necessary for epistemic dependence to exist in any particular advisory relationship to support this categorical treatment, so long as the likelihood of epistemic dependence is high enough across the category. In turn, the presence of trust supports the likelihood of that epistemic dependence. In the ad hoc fiduciary setting, I will suggest that these relationships are sometimes best seen as a kind of “involvement” (as that concept is developed in David Owens’s work). Involvements are voluntary relationships even though they may have no precise moment when they come into existence. Importantly, the existence of involvements is generally recognizable by the parties involved. Trust is relevant here as an aid in legally identifying such relationships.
Irritability and anxiety are two common clinical phenotypes that involve high-arousal negative affect states (anger and fear), and that frequently co-occur. Elucidating how these two forms of emotion dysregulation relate to perturbed neurodevelopment may benefit from alternate phenotyping strategies. One such strategy applies a bifactor latent variable approach that can parse shared versus unique mechanisms of these two phenotypes. Here, we aim to replicate and extend this approach and examine associations with neural structure in a large transdiagnostic sample of youth (N = 331; M = 13.57, SD = 2.69 years old; 45.92% male). FreeSurfer was used to extract cortical thickness, cortical surface area, and subcortical volume. The current findings replicated the bifactor model and demonstrate measurement invariance as a function of youth age and sex. There were no associations of youth's factor scores with cortical thickness, surface area, or subcortical volume. However, we found strong convergent and divergent validity between parent-reported irritability and anxiety factors with clinician-rated symptoms and impairment. A general negative affectivity factor was robustly associated with overall functional impairment across symptom domains. Together, these results support the utility of the bifactor model as an alternative phenotyping strategy for irritability and anxiety, which may aid in the development of targeted treatments.
The idea that the state is a fiduciary to its citizens has a long pedigree - ultimately reaching back to the ancient Greeks, and including Hobbes and Locke among its proponents. Public fiduciary theory is now experiencing a resurgence, with applications that range from international law, to insider trading by members of Congress, to election law and gerrymandering. This book is the first of its kind: a collection of chapters by leading writers on public fiduciary subject areas. The authors develop new accounts of how fiduciary principles apply to representation; to officials and judges; to problems of legitimacy and political obligation; to positive rights; to the state itself; and to the history of ideas. The resulting volume should be of great interest to political theorists and public law scholars, to private fiduciary law scholars, and to students seeking an introduction to this new and increasingly relevant area of study.
To characterize the microbiology of hepatobiliary surgical site infections (SSIs) and to explore the relationship between specific antimicrobial prophylaxis regimens and the development of SSIs.
Retrospective matched case-control study comparing patient, procedure, and antimicrobial prophylaxis characteristics among patients undergoing a hepatobiliary surgical procedure with and without an SSI.
A tertiary referral acute-care facility.
Patients undergoing procedures defined as “BILI” (bile duct, liver, or pancreas surgery) using National Healthcare Safety Network (NHSN) definitions, excluding those undergoing concomitant liver transplantation, from January 2013 through June 2016 were included in the study population. The SSIs were identified through routine infection control surveillance using NHSN definitions. All patients who developed an SSI were considered cases. Controls were selected randomly matched 2:1 with cases based on fiscal quarter of the procedure. Logistic regression modeling was performed to explore variables associated with SSI, including antimicrobial prophylaxis received.
Among 975 procedures, 80 (8.2%) resulted in an SSI. Most cases involved an organism nonsusceptible to standard prophylaxis regimens, including cefazolin (68.8%), cefazolin plus metronidazole (61.3%), and ampicillin-sulbactam (52.5%). In a multivariate model, antimicrobial coverage against Enterococcus spp (aOR, 0.58; 95% confidence interval [CI], 0.17–2.04; P=.40) and against Pseudomonas spp (aOR, 2.40; 95% CI, 0.56–10.29; P=.24) were not protective against the development of an SSI. The presence of a documented β-lactam allergy was significantly associated with the development of an SSI (aOR, 3.54; 95% CI, 1.36–9.19; P=.009).
Although SSIs at the study institution were associated with pathogens nonsusceptible to the most commonly used prophylaxis regimens, broader-spectrum coverage was not associated with a reduction in SSIs.