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The assessment of older adult anxiety requires the mindset and skills of a detective, ideally those of Sherlock Holmes. In The Sign of Four (Doyle, 1890), Holmes offered the following quip regarding the investigation of a crime that is of considerable value for the clinician in the assessment process: “How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?” (p. 111). As with the investigation of crimes, much of the assessment of older adult anxiety involves first accounting for, and oftentimes ruling out, multiple factors that can contribute to anxiety symptoms. In our chapter, we explore the complexities of assessing older adult anxiety symptoms and disorders. We begin with a discussion of age-related diagnostic issues and differences in symptom experience and presentation that contribute to diagnostic complexity.
This study aimed to explore barriers and facilitators of the provision of dairy and plant-based dairy alternatives (PBDA) by parents of preschool-age children, a previously unexplored area of research.
Five focus groups of parents were conducted and audio-recorded. Verbatim transcripts were analysed using thematic analysis.
University of Guelph, in Guelph, ON, Canada in 2019.
Thirty-two (n 19 mothers, 13 fathers) parents of preschool-age children. Most (59 %) were university or college educated.
Facilitators common to both dairy and PBDA provision included perceived nutritional benefits, such as dairy’s Ca, protein and fat content, and PBDA’s protein content, and the perception that PBDA adds variety to the diet. Facilitators unique to dairy v. PBDA provision included the taste of, familiarity with, and greater variety and accessibility of dairy products, specifically child-friendly products. A facilitator unique to PBDA v. dairy provision was ethical concerns regarding dairy farming practices. Barriers common to both dairy and PBDA provision included perceived cost, concerns regarding the environmental impact of production, and high sugar content. Barriers specific to dairy included use of antibiotics and hormones in dairy production. A barrier specific to PBDA was the use of pesticides.
Behaviour change messages targeting parents of preschoolers can emphasise the nutrition non-equivalence of dairy and some PBDA and can educate parents on sources of affordable, unsweetened dairy and PBDA.
This research communication addressed the hypothesis that late lactation cows offered an oat-grain-based supplement or a high level of α-TOC supplementation at pasture would have improved milk composition and processability. Over a grazing period of 49 d, 48 Holstein Friesian dairy cows were randomly assigned to one of four dietary treatments. The dietary treatments were: control, pasture only (CTRL), pasture + 2.65 kg DM barley-based concentrate + 350 IU α-TOC/kg (BARLO), pasture + 2.65 kg DM oat-based concentrate + 350 IU α-TOC/kg (OATLO) and pasture + 2.65 kg DM oat-based concentrate + 1050 IU α-TOC/kg (OATHI). Within this randomised complete block design experiment cows were blocked on days in milk (DIM) and balanced for parity, milk yield and composition. Rennet coagulation time (RCT) was reduced in milk from cows offered OATHI compared to CTRL cows and OATLO. Concentration of conjugated linoleic acid (CLA) was increased by OATHI compared to OATLO and in OATLO compared to CTRL. Supplementation with OATHI reduced individual saturated fatty acids (SFAs) in milk compared to OATLO. In conclusion, supplementing grazing dairy cows with an oat-based supplement improved total milk CLA concentration compared to pasture only. Offering a high level of α-TOC (2931 IU/d) to dairy cows reduced RCT, individual SFA and increased total CLA concentration of milk compared to a lower α-TOC level (738 IU α-TOC/d).
Protecting frontline health care workers with personal protective equipment (PPE) is critical during the coronavirus disease (COVID-19) pandemic. Through an online survey, we demonstrated variable adherence to the Centers for Disease Control and Prevention (CDC) PPE guidelines among health care personnel (HCP).
CDC guidelines for optimal and acceptable PPE usage in common situations faced by frontline health care workers were referenced to create a short online survey. The survey was distributed to national, statewide, and local professional organizations across the United States and to HCP, using a snowball sampling technique. Responses were collected between June 15 and July 17, 2020.
Responses totaling 2245 were received from doctors, nurses, midwives, paramedics, and medical technicians in 44 states. Eight states with n > 20 (Arizona, California, Colorado, Louisiana, Oregon, South Carolina, Texas, and Washington) and a total of 436 responses are included in the quantitative analysis. Adherence to CDC guidelines was observed to be highest in the scenario of patient contact when COVID-19 was not suspected (86.47%) and lowest when carrying out aerosol generating procedures (AGPs) (42.47%).
Further research is urgently needed to identify the reasons underlying variability between professions and regions to pinpoint strategies for maximizing adherence and improving the safety of HCPs.
The excavation of a building in the village of Felanitx in the eastern part of the island of Mallorca (Balearic Islands) has revealed the existence of a small necropolis. The inhumations did not provide grave goods except for a bronze belt buckle for which the typological study suggests a Late Antique chronology. The stratigraphical sequence however seems to suggest a possible evolution of the space across time since some graves are cut by others. In order to obtain an absolute date for the necropolis and to verify if there are chronological differences between the graves, a total of 6 human bones samples have been 14C dated by AMS. The results of the radiocarbon dating confirm a Late Antique chronology (4th to 7th century AD) for the graves but do not suggest a chronological evolution. Despite the fact that the knowledge of the necropolis is still fragmentary, the results are extremely important because they provide an absolute date for a Late Antique necropolis in the Mallorcan rural area.
This study investigated the latent factor structure of the NIH Toolbox Cognition Battery (NIHTB-CB) and its measurement invariance across clinical diagnosis and key demographic variables including sex, race/ethnicity, age, and education for a typical Alzheimer’s disease (AD) research sample.
The NIHTB-CB iPad English version, consisting of 7 tests, was administered to 411 participants aged 45–94 with clinical diagnosis of cognitively unimpaired, dementia, mild cognitive impairment (MCI), or impaired not MCI. The factor structure of the whole sample was first examined with exploratory factor analysis (EFA) and further refined using confirmatory factor analysis (CFA). Two groups were classified for each variable (diagnosis or demographic factors). The confirmed factor model was next tested for each group with CFA. If the factor structure was the same between the groups, measurement invariance was then tested using a hierarchical series of nested two-group CFA models.
A two-factor model capturing fluid cognition (executive function, processing speed, and memory) versus crystalized cognition (language) fit well for the whole sample and each group except for those with age < 65. This model generally had measurement invariance across sex, race/ethnicity, and education, and partial invariance across diagnosis. For individuals with age < 65, the language factor remained intact while the fluid cognition was separated into two factors: (1) executive function/processing speed and (2) memory.
The findings mostly supported the utility of the battery in AD research, yet revealed challenges in measuring memory for AD participants and longitudinal change in fluid cognition.
Investigate protein intake patterns over the day and their association with total protein intake in older adults.
Cross-sectional study utilising the dietary data collected through two non-consecutive, dietary record-assisted 24-h recalls. Days with low protein intake (n 290) were defined using the RDA (<0·8 g protein/kg adjusted BW/d). For each day, the amount and proportion of protein ingested at every hour of the day and during morning, mid-day and evening hours was calculated. Amounts and proportions were compared between low and high protein intake days and related to total protein intake and risk of low protein intake.
739 Dutch community-dwelling adults ≥70 years.
The mean protein intake was 76·3 (sd 0·7) g/d. At each hour of the day, the amount of protein ingested was higher on days with a high protein intake than on days with a low protein intake and associated with a higher total protein intake. The proportion of protein ingested during morning hours was higher (22 v. 17 %, P < 0·0001) on days with a low protein intake, and a higher proportion of protein ingested during morning hours was associated with a lower total protein intake (P < 0·0001) and a higher odds of low protein intake (OR 1·04, 95 % CI 1·03, 1·06). For the proportion of protein intake during mid-day or evening hours, opposite but weaker associations were found.
In this sample, timing of protein intake was associated with total protein intake. Additional studies need to clarify the importance of these findings to optimise protein intake.
Generalization of conditioned-fear, a core feature of post-traumatic stress disorder (PTSD), has been the focus of several recent neuroimaging studies. A striking outcome of these studies is the frequency with which neural correlates of generalization fall within hubs of well-established functional networks including salience (SN), central executive (CEN), and default networks (DN). Neural substrates of generalization found to date may thus reflect traces of large-scale brain networks that form more expansive neural representations of generalization. The present study includes the first network-based analysis of generalization and PTSD-related abnormalities therein.
fMRI responses in established intrinsic connectivity networks (ICNs) representing SN, CEN, and DN were assessed during a generalized conditioned-fear task in male combat veterans (N = 58) with wide-ranging PTSD symptom severity. The task included five rings of graded size. Extreme sizes served as conditioned danger-cues (CS+: paired with shock) and safety-cues (CS−), and the three intermediate sizes served as generalization stimuli (GSs) forming a continuum-of-size between CS+ and CS–. Generalization-gradients were assessed as behavioral and ICN response slopes from CS+, through GSs, to CS–. Increasing PTSD symptomatology was predicted to relate to less-steep slopes indicative of stronger generalization.
SN, CEN, and DN responses fell along generalization-gradients with levels of generalization within and between SN and CEN scaling with PTSD symptom severity.
Neural substrates of generalized conditioned-fear include large-scale networks that adhere to the functional organization of the brain. Current findings implicate levels of generalization in SN and CEN as promising neural markers of PTSD.
Raw milk cheeses are commonly consumed in France and are also a common source of foodborne outbreaks (FBOs). Both an FBO surveillance system and a laboratory-based surveillance system aim to detect Salmonella outbreaks. In early August 2018, five familial FBOs due to Salmonella spp. were reported to a regional health authority. Investigation identified common exposure to a raw goats' milk cheese, from which Salmonella spp. were also isolated, leading to an international product recall. Three weeks later, on 22 August, a national increase in Salmonella Newport ST118 was detected through laboratory surveillance. Concomitantly isolates from the earlier familial clusters were confirmed as S. Newport ST118. Interviews with a selection of the laboratory-identified cases revealed exposure to the same cheese, including exposure to batches not included in the previous recall, leading to an expansion of the recall. The outbreak affected 153 cases, including six cases in Scotland. S. Newport was detected in the cheese and in the milk of one of the producer's goats. The difference in the two alerts generated by this outbreak highlight the timeliness of the FBO system and the precision of the laboratory-based surveillance system. It is also a reminder of the risks associated with raw milk cheeses.
Sensory system information is thought to play an important role in drug addiction related responses. However, how somatic sensory information participates in the drug related behaviors is still unclear. Many studies demonstrated that drug addiction represents a pathological usurpation of neural mechanisms of learning and memory that normally relate to the pursuit of rewards. Thus, elucidate the role of somatic sensory in drug related learning and memory is of particular importance to understand the neurobiological mechanisms of drug addiction.
In the present study, we investigated the role of somatosensory system in reward-related associative learning using the conditioned place preference model. Lesions were made in somatosensory cortices either before or after conditioning training. We found that lesion of somatosensory cortices before, rather than after morphine conditioning impaired the acquisition of place preference.
These results demonstrate that somatosensory cortices are necessary for the acquisition but not retention of morphine induced place preference.
It is to estimate the trend of suicide rate changes during the past three decades in China and try to identify its social and economic correlates.
Official data of suicide rates and economic indexes during 1982–2005 from Shandong Province of China were analyzed. The suicide data were categorized for the rural / urban location and gender, and the economic indexes include GDP, GDP per capita, rural income, and urban income, all adjusted for inflation.
We found a significant increase of economic development and decrease of suicide rates over the past decades under study. The suicide rate decrease is correlated with the tremendous growth of economy.
The unusual decrease of Chinese suicide rates in the past decades is accounted for within the Chinese cultural contexts and maybe by the Strain Theory of Suicide.
White matter abnormalities have been repeatedly reported in both schizophrenia and bipolar disorder (BD) diseases from diffusion tensor imaging (DTI) studies respectively, while the empirical evidences about the diagnostic specificity of white matter abnormalities in these disorders are still limited.
25 patients with paranoid schizophrenia and 18 patients with bipolar mania were recruited from the in-patient unit of the Mental Health Centre, West China Hospital, China.
Patients were diagnosed according to the criteria of Diagnostic and Statistical Manual of Mental Disorders-Version IV (DSM- IV). 30 healthy controls were recruited from the community by means of leaflets distributed throughout Chengdu city.
This study sought to investigate the alterations in fractional anisotropy (FA) in white matter throughout the entire brain of patients from Chengdu, China with paranoid schizophrenia and bipolar mania.
Diffusion tensor imaging (DTI) was used to assess white matter integrity in patients with paranoid schizophrenia and bipolar mania, as well as in normal controls. The differences in FA were measured by use of voxel-based analysis.
Reduced FA was found in the left posterior corona radiate (PCR) in patients with bipolar mania and paranoid schizophrenia compared to the controls. Patients with bipolar mania also showed a significant reduction in FA in right posterior corona radiate and in right anterior thalamic radiation (ATR).
Common abnormalities in the left PCR might imply an overlap in white matter pathology of both diseases and might be related to the shared risk factors for both disorders.
From 20,000 households regularly surveyed by a national survey institute (Sofres), two groups were selected and questioned (using a 23-item questionnaire) about sleep vigilance and quality of life. The first group was composed of insomniacs using zopiclone for the last 12 months and no other CNS treatments (167 subjects). The second group was composed of 381 “good sleepers” selected as having no or occasionally one sleep disturbance in the last 12 months. No difference was found between the two groups in average total sleep time. Sleep disturbances were statistically equal in the two groups except for difficulties in initiating sleep which is more present for zopiclone users (13% vs 3%). Vigilance was mostly comparable in both groups.Five aspects of quality of life explored by the questionnaires (the professional, relational and sentimental, domestic, leisure and safety aspects) appeared to be comparable in the two groups.
Tests of both structure and function of the corpus callosum have revealed abnormalities in schizophrenic patients. One such functional test employed lateralised Stroop stimuli presented tachistoscopically, to measure the transfer of interference and facilitation between the cerebral hemispheres. An attempt was made to relate indices of callosal transfer to clinical and demographic variables, including family history, as well as to indices of brain morphology. The latter included ventricle: brain ratio (VBR) measured by computed tomography (CT) scanning on 31 DSMIII schizophrenics, and the cross-sectional area of the corpus callosum from magnetic resonance imaging (MRI), obtained from 20 of these patients. VBR did not relate to functional measures; however, anterior callosal area correlated with indices of callosal connectivity. Patients with auditory hallucinations had smaller anterior callosal areas and tended to show less connectivity. The results show links between functional and structural measures of the corpus callosum, but their precise nature remains unclear.
The relative effect of the atypical antipsychotic drugs and conventional agents on neurocognition in patients with early-stage schizophrenia has not been comprehensively determined.
The present study aimed to assess the cognitive effects of atypical and conventional antipsychotic drugs on neurocognition under naturalistic treatment conditions.
In a 12 months open-label, multicenter study, 698 patients with early-stage schizophrenia (< 5 years) were monotherapy with chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine or aripiprazole. Wechsler Memory Scale--Revised Visual Reproduction Test, Wechsler Adult Intelligence Scale Revised Digit Symbol Test and Digit-span Task Test, Trail Making Tests Part A and Part B, and Wisconsin Card Sorting Test were administered at baseline and 12 months follow-up evaluation. The primary outcome was change in a cognitive composite score after 12 months of treatment.
Compared with scores at baseline, the composite cognitive test scores and individual test scores had significant improvement for all seven treatment groups at 12-month follow-up evaluation (all p-values ≤ 0.013). However, olanzapine and quetiapine provided greater improvement than that provided by chlorpromazine and sulpiride in the composite score, processing speed and executive function (all p-values ≤ 0.045).
Both conventional and atypical antipsychotic medication long-term maintenance treatment can benefit congitive function in patients with early-stage schizophrenia, but olanzapine and quetiapine may be superior to chlorpromazine and sulpiride in improving some areas of neurocognitive function.
Hierarchical social relationships are inherent to many species including humans. People evaluate its own actions and achievements using social comparisons. in social scenarios, people are more inclined to monitor for threats and evaluate its own behaviour. Recently it have been reported evidence demostrating that medial frontal negativity (MFN), an electrophysiological index that reflects performance evaluation, is significantly enhanced in situations of social comparisons. A growing cognitive literature in psychiatry have reported similar effects in MFN in OCD patients. in these patients have been documented changes in the modulation of the ERP components, collectively referred to as medial frontal negativities (MFNs)(error related negativity (ERN) and frontal related Negativity (FRN)), which are related with the activity of the anterior cingulate cortex (ACC) and surrounding medial prefrontal regions. These alterations are related with reported difficulties to supervise the performance and to evaluate the conflictive information. in this research, we have explored how OCD patients process hierarchical social information. To this purpose, we have used a complex computarized game where patients are stimulated to compare their performance in a perceptual task, with players with different social status. As we expected, we have observed increased modulations of MFNs components in the group of OCD patients vs. control group. Interestingly, we have observed different modulations in MFNs in the patients according to the social status of the competitor. These effects suggest that the reported effects in OCD patients to monitorize the performance are differently modulated for the type of hierarchical comparison.
Electroconvulsive therapy (ECT) is the most effective and fast acting therapy for treatment-resistant depression (TRD). Animal research has consistently pointed to neuroplasticity as a central mechanism of ECT action (1), however evidence in humans remains scarce (2; 3).
We assessed two independent samples of TRD patients referred for ECT. The Barcelona-sample included 13 subjects treated with bitemporal ECT and 10 healthy volunteers (HV). Four successive 3T structural MRIs were acquired: baseline, 24-48 hours after the 1st ECT session, 24-48 hours after the 9th ECT, and two weeks after ECT course completion. HV were scanned twice five weeks apart. Within the framework of the Barcelona-Sydney Clinical Imaging Collaboration, we also scanned 10 patients treated mainly with right unilateral ECT (Sydney-sample). Whole-brain longitudinal grey matter (GM) changes were measured using intra-subject diffeomorphic registration, within SPM12b.
In the Barcelona-sample, over the course of treatment bitemporal ECT produced a linear increase of GM volume in the limbic system (involving bilateral hippocampi and amygdalae). Additionally, volumetric increase within the right subgenual cortex was detected from baseline to the 9th ECT session. Such volume changes were not observed in HV. Furthermore, GM volume expansion correlated positively with depressive symptom improvement and neurocognitive performance (memory and executive function). Hippocampal and amygdalar volume increases were replicated in the Sydney-sample, although limited to the stimulated hemisphere.
ECT effects described here could be accounted for by the induction of regionally specific structural plasticity. Nevertheless, other mechanisms such as neurovascular changes should not be discarded.
Research integrating neuroimaging and molecular genetics has yielded important insights into how variability in brain chemistry predicts brain function and structure, behaviour and risk for psychopathology. Disrupted neurotransmission of glutamate within corticalstriatal-thalamocortical circuitry has been hypothesized to play a role in the pathogenesis of Obsessive-Compulsive Disorder (OCD). Candidate gene studies have identified associations between variants in glutamate system genes and OCD, particularly for SLC1A1, although these results remain controversial after GWAS and meta-analytical approaches.
To examine the effects of multiple polymorphisms of the glutamatergic pathway on frontostriatal connectivity, measured by resting state functional magnetic resonance imaging (fMRI), in OCD.
Individual multilocus genetic profile scores (MGPS) reflecting the additive effects of multiple alleles of the glutamatergic pathway, analysed by the Affymetrix GeneticChip® SNP array, were compiled for 134 OCD patients and 63 healthy controls. Association between these genetic scores and brain functional connectivity patterns between the dorsal and ventral striatal regions and limbic cortical areas including the orbitofrontal cortex and surrounding areas, such as the anterior prefrontal and perigenual anterior cingulate cortex, were investigated.
In the entire group, glutamatergic MGPS were significantly associated with connectivity patterns involving the ventral striatum and orbitofrontal cortex. Distinct relationships between MGPS and functional connectivity between the ventral striatum, amygdala, ventromedial frontal cortex and insula between OCD and healthy subjects emerged.
Glutamatergic genetic risk variants are related to normal frontostriatal connectivity; a fact that might explain the role of glutamatergic pathway disruptions in the susceptibility to develop OCD.
The main aim of the present studies is to determine whether, or to some extent, specific cognitive domains could differentiate the main subtypes of mood disorder in the depressed and clinically remitted status respectively.
Three groups of bipolar I (n = 92), bipolar II (n = 131) and unipolar depression patients (n = 293) were tested with a battery of neuropsychological tests at baseline and after 6 weeks of treatment, contrasting with 202 healthy controls on cognitive performance.
At the acute depressive state, the three patients groups (bipolar I, bipolar II and unipolar depression) showed cognitive dysfunction in processing speed, memory, verbal fluency and executive function but not attention compared with controls. And post comparisons revealed that bipolar I patients performed significantly worse in these impaired cognitive domain than bipolar II and unipolar depression patients in verbal fluency and executive function. After treatment, clinically remitted bipolar I and bipolar II patients only displayed cognitive impairment in processing speed and visual memory in relative to controls, while remitted unipolar depression patients showed cognitive impairment in executive function in addition to processing speed and visual memory.
Bipolar I, bipolar II and unipolar depression patients have a similar pattern of cognitive impairment during the state of acute depressive episodes. At the clinically remission, still both bipolar disorder and unipolar depression patients showed cognitive deficits in processing speed and visual memory, and executive dysfunction might be a status-maker for bipolar disorder, but a trait-marker for unipolar depression
Neuropsychological and neuroimaging studies of response inhibition in cannabis users have reported inconsistent results. The age of onset of cannabis use and individual genetic differences may play a critical role in the regulation of inhibition in cannabis users.
We examine the influence of COMT Val158Met functional polymorphism on the response inhibition brain network in a group of early-onset chronic cannabis users compared with healthy controls.
fMRI data was acquired from 27 chronic cannabis users who began use cannabis before 16 years of age, and 29 non-using control subjects matched in terms of age, educational level and intelligence quotient while undergoing the Multi-Source Interference Task (MSIT). Participants were male, Caucasians aged between 18 and 30 years. All were assessed by a structured psychiatric interview (PRISM) to exclude any lifetime Axis-I disorder (DSM-IV). COMT genotyping was performed and resonance imaging data was analysed by voxel-based morphometry (VBM).
Both groups did not differ on their behavioural performance and brain responses during the MSIT task. A significant group-by-genotype interaction was observed on task-related brain activation (and on MSIT reaction times), in which met carrier load was associated with increased activation in cannabis users and val carrier load with increased activation in controls. The interaction pattern included the medial frontal cortex, ACC, inferior frontal gyrus, ventral striatum, anterior mesencephalon, inferior parietal and superior temporal cortices and the PCC.
Chronic cannabis exposure interacts with the genetically driven dopamine function in the modulation of the neural mechanisms related to response inhibition.