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Tourette syndrome (TS) as well as its most common comorbidities are associated with a higher propensity for risky behaviour in everyday life. However, it is unclear whether this increased risk propensity in real-life contexts translates into a generally increased attitude towards risk. We aimed to assess decision-making under risk and ambiguity based on prospect theory by considering the effects of comorbidities and medication.
Fifty-four individuals with TS and 32 healthy controls performed risk and ambiguity decision-making tasks under both gains and losses conditions. Behavioural and computational parameters were evaluated using (i) univariate analysis to determine parameters difference taking independently; (ii) supervised multivariate analysis to evaluate whether our parameters could jointly account for between-group differences (iii) unsupervised multivariate analysis to explore the potential presence of sub-groups.
Except for general ‘noisier’ (less consistent) decisions in TS, we showed no specific risk-taking behaviour in TS or any relation with tics severity or antipsychotic medication. However, the presence of comorbidities was associated with distortion of decision-making. Specifically, TS with obsessive–compulsive disorder comorbidity was associated with a higher risk-taking profile to increase gain and a higher risk-averse profile to decrease loss. TS with attention-deficit hyperactivity disorder comorbidity was associated with risk-seeking in the ambiguity context to reduce a potential loss.
Impaired valuation of risk and ambiguity was not related to TS per se. Our findings are important for clinical practice: the involvement of individuals with TS in real-life risky situations may actually rather result from other factors such as psychiatric comorbidities.
Tourette disorder (TD), hallmarks of which are motor and vocal tics, has been related to functional abnormalities in large-scale brain networks. Using a fully data driven approach in a prospective, case–control study, we tested the hypothesis that functional connectivity of these networks carries a neural signature of TD. Our aim was to investigate (i) the brain networks that distinguish adult patients with TD from controls, and (ii) the effects of antipsychotic medication on these networks.
Using a multivariate analysis based on support vector machine (SVM), we developed a predictive model of resting state functional connectivity in 48 patients and 51 controls, and identified brain networks that were most affected by disease and pharmacological treatments. We also performed standard univariate analyses to identify differences in specific connections across groups.
SVM was able to identify TD with 67% accuracy (p = 0.004), based on the connectivity in widespread networks involving the striatum, fronto-parietal cortical areas and the cerebellum. Medicated and unmedicated patients were discriminated with 69% accuracy (p = 0.019), based on the connectivity among striatum, insular and cerebellar networks. Univariate approaches revealed differences in functional connectivity within the striatum in patients v. controls, and between the caudate and insular cortex in medicated v. unmedicated TD.
SVM was able to identify a neuronal network that distinguishes patients with TD from control, as well as medicated and unmedicated patients with TD, holding a promise to identify imaging-based biomarkers of TD for clinical use and evaluation of the effects of treatment.
Mild cognitive impairment (MCI) often precedes Alzheimer’s Dementia (AD), and in a high proportion of individuals affected by MCI, there are already neuropathological processes ongoing that become more evident when patients progress to AD. Accordingly, there is a need for reliable biomarkers to distinguish between normal aging and incipient AD. Recent research suggests that, in addition to established biomarkers such as CSF Aß42, total tau and hyperphosphorylated tau, resting state connectivity established by functional magnetic resonance imaging might also be a feasible biomarker for prodromal stages of AD. In order to explore this possibility, we investigated resting state functional connectivity as well as cerebrospinal fluid (CSF) biomarker profiles in patients with MCI (n = 30; age 66.43 ± 7.06 years) and cognitively healthy controls (n = 38; age 66.89 ± 7.12 years). CSF Aß42, total tau and hyperphosphorylated tau concentrations were correlated with measures of cognitive performance (immediate and delayed recall, global cognition, processing speed). Moreover, MCI-related alterations in intrinsic functional connectivity within the default mode network were investigated using functional resting state MRI. As expected, MCI patients showed decreased CSF Aß42 and increased total tau concentrations. These alterations were associated with cognitive performance. However, there were no differences between MCI patients and cognitively healthy controls regarding intrinsic functional connectivity. In conclusion, our results indicate that CSF protein profiles seem to be more closely related to cognitive decline than alterations in resting state activity. Thus, resting state connectivity might not be a reliable biomarker for early stages of AD.
Bulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological, nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the efficacy of these interventions in up to 19 different interventions.
Database search terms were combined for BN and RCTs from database inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome variables. Retrieved RCTs were meta-analyzed using fixed and random effects models.
RCT (79 trials; 5775 participants) effects post-treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help, pharmacotherapy, and combined therapies.
Most psychological and pharmacological interventions revealed to be effective in BN treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration, CBT can be recommended as the best intervention for the initial treatment of BN.
In this paper we discuss the range of a co-analytic Toeplitz operator. These range spaces are closely related to de Branges–Rovnyak spaces (in some cases they are equal as sets). In order to understand its structure, we explore when the range space decomposes into the range of an associated analytic Toeplitz operator and an identifiable orthogonal complement. For certain cases, we compute this orthogonal complement in terms of the kernel of a certain Toeplitz operator on the Hardy space, where we focus on when this kernel is a model space (backward shift invariant subspace). In the spirit of Ahern–Clark, we also discuss the non-tangential boundary behavior in these range spaces. These results give us further insight into the description of the range of a co-analytic Toeplitz operator as well as its orthogonal decomposition. Our Ahern–Clark type results, which are stated in a general abstract setting, will also have applications to related sub-Hardy Hilbert spaces of analytic functions such as the de Branges–Rovnyak spaces and the harmonically weighted Dirichlet spaces.
The spectrally and temporally resolved luminescence of three-dimensional (3D) InGaN/GaN microrods and planar light emitting diode (LED) structures is studied for different energy densities of fs-laser excitation pulses and for different sample temperatures. We find an energy density threshold above which irreversible modifications of the structures take place, which leads to a decrease of the luminescence intensity and a change in the intensity ratio of the GaN to the InGaN luminescence. Due to the quantum confined Stark effect, a biexponential decay characteristic is found in the planar structure, while the 3D microrods with nonpolar InGaN quantum wells on their sidewalls show a monoexponential decay of the InGaN luminescence. For both structures, the decay of the luminescence becomes faster with increasing energy density per pulse. However, the luminescence of the planar LED decays faster with increasing temperature, while the opposite trend is found for the 3D sample.
In studies of Holocaust representation and memory, scholars of literature and culture traditionally have focused on particular national contexts. At the same time, recent work has brought the Holocaust into the arena of the transnational, leading to a crossroads between localized and global understandings of Holocaust memory. Further complicating the issue are generational shifts that occur with the passage of time, and which render memory and representations of the Holocaust ever more mediated, commodified, and departicularized. Nowhere is the inquiry into Holocaust memory more fraught or potentially more productive than in German Studies, where scholars have struggled to address German guilt and responsibility while doing justice to the global impact of the Holocaust, and are increasingly facing the challenge of engaging with the broader, interdisciplinary, transnational field. Persistent Legacy connects the present, critical scholarly moment with this long disciplinary tradition, probing the relationship between German Studies and Holocaust Studies today. Fifteen prominent scholars explore how German Studies engages with Holocaust memory and representation, pursuingcritical questions concerning the borders between the two fields and how they are impacted by emerging scholarly methods, new areas of inquiry, and the changing place of Holocaust memory in contemporary Germany.
Contributors: David Bathrick, Stephan Braese, William Collins Donahue, Tobias Ebbrecht-Hartmann, Katja Garloff, Andreas Huyssen, Irene Kacandes, Jennifer M. Kapczynski, Sven Kramer, Erin McGlothlin, Leslie Morris, Brad Prager, Karen Remmler, Michael D. Richardson, Liliane Weissberg.
Erin McGlothlin and Jennifer M. Kapczynski are both Associate Professors in the Department of Germanic Languages and Literatures at Washington University in St. Louis.