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Objectives: Understanding how the importance of modifiable risk factors for dementia varies by cognitive status and sex is vital for the development of effective approaches to dementia prevention. We aimed to calculate population attributable fractions (PAFs) for incident dementia associated with sets of risk factors while exploring sex differences in individuals who are cognitively normal (CN) or has mild cognitive impairment (MCI).
Methods: Longitudinal data from the Rush University Memory and Aging Project (MAP) were analysed. Included participants were aged over 50 years and were CN or with a diagnosis of MCI at their baseline assessment. Analyses considered fifteen potential dementia risk factors covering cardiometabolic, lifestyle, psychosocial and sensory domains. We used Cox proportional hazard models to estimate the hazard ratios for incident dementia associated with dementia risk factors and calculated weighted PAFs. All analyses were repeated stratified by sex.
Results: The analytical sample comprised 754 cognitively normal participants (77.2% female) and 242 participants with a diagnosis of MCI (71.9% female), of whom 214 (28.4%) and 120 (49.6%) were diagnosed with dementia across the follow-up, respectively. Although the weighted overall PAF was similar for CN (24.7%) and MCI (25.2%) subgroups, sex differences were present in both. Compared to in females, PAFs were higher in males in both CN (42.5% vs. 25.1%) and MCI (51.6% vs 12.3%) subgroups. The profiles of contributing risk factors also varied by sex. In males, the highest PAFs were smoking (11.1%), vision impairment (6.2%) and stroke (6.0%) in CN and smoking (13.3%), physical inactivity (12.9%) and heart attack (7.9%) in MCI. In females, the highest PAFs were unmarried marital status (4.9%), depression (4.1%) and social isolation (3.8%) in CN and vision impairment (4.4%), increased alcohol intake (3.5%) and depression (2.6%) in MCI.
Conclusions: These findings support the notion that dementia risk is modifiable after the onset of MCI. They also highlight the potential benefits of considering an individual’s cognitive status and sex when formulating dementia prevention strategies.
Development and Psychopathology has been a premier resource for understanding stressful childhood experiences and the intergenerational continuity of psychopathology. Building on that tradition, we examined the unique and joint influences of maternal stress on children’s effortful control (age 7) and externalizing behavior (age 11) as transmitted via genetics, the prenatal environment, and the postnatal environment. The sample included N = 561 adopted children and their biological and adoptive parents. Path models identified a direct effect of biological mother life stress on children’s effortful control (β = −.08) and an indirect effect of her life stress on child externalizing behavior via effortful control (β = .52), but no main or indirect effects of biological parent psychopathology, prenatal stress, or adoptive mother adverse childhood experiences (ACES). Adoptive mother ACES amplified the association between biological mother life stress and child effortful control (β = −.08), externalizing behavior (β = 1.41), and the indirect effect via effortful control, strengthening associations when adoptive mothers reported average or high ACES during their own childhoods. Results suggest that novel study designs are needed to enhance the understanding of how life stress gets “under the skin” to affect psychopathology in the offspring of adults who have experienced stress.
Maintaining attention underlies many aspects of cognition and becomes compromised early in neurodegenerative diseases like Alzheimer’s disease (AD). The consistency of maintaining attention can be measured with reaction time (RT) variability. Previous work has focused on measuring such fluctuations during in-clinic testing, but recent developments in remote, smartphone-based cognitive assessments can allow one to test if these fluctuations in attention are evident in naturalistic settings and if they are sensitive to traditional clinical and cognitive markers of AD.
Method:
Three hundred and seventy older adults (aged 75.8 +/− 5.8 years) completed a week of remote daily testing on the Ambulatory Research in Cognition (ARC) smartphone platform and also completed clinical, genetic, and conventional in-clinic cognitive assessments. RT variability was assessed in a brief (20-40 seconds) processing speed task using two different measures of variability, the Coefficient of Variation (CoV) and the Root Mean Squared Successive Difference (RMSSD) of RTs on correct trials.
Results:
Symptomatic participants showed greater variability compared to cognitively normal participants. When restricted to cognitively normal participants, APOE ε4 carriers exhibited greater variability than noncarriers. Both CoV and RMSSD showed significant, and similar, correlations with several in-clinic cognitive composites. Finally, both RT variability measures significantly mediated the relationship between APOE ε4 status and several in-clinic cognition composites.
Conclusions:
Attentional fluctuations over 20–40 seconds assessed in daily life, are sensitive to clinical status and genetic risk for AD. RT variability appears to be an important predictor of cognitive deficits during the preclinical disease stage.
Female fertility is a complex trait with age-specific changes in spontaneous dizygotic (DZ) twinning and fertility. To elucidate factors regulating female fertility and infertility, we conducted a genome-wide association study (GWAS) on mothers of spontaneous DZ twins (MoDZT) versus controls (3273 cases, 24,009 controls). This is a follow-up study to the Australia/New Zealand (ANZ) component of that previously reported (Mbarek et al., 2016), with a sample size almost twice that of the entire discovery sample meta-analysed in the previous article (and five times the ANZ contribution to that), resulting from newly available additional genotyping and representing a significant increase in power. We compare analyses with and without male controls and show unequivocally that it is better to include male controls who have been screened for recent family history, than to use only female controls. Results from the SNP based GWAS identified four genomewide significant signals, including one novel region, ZFPM1 (Zinc Finger Protein, FOG Family Member 1), on chromosome 16. Previous signals near FSHB (Follicle Stimulating Hormone beta subunit) and SMAD3 (SMAD Family Member 3) were also replicated (Mbarek et al., 2016). We also ran the GWAS with a dominance model that identified a further locus ADRB2 on chr 5. These results have been contributed to the International Twinning Genetics Consortium for inclusion in the next GWAS meta-analysis (Mbarek et al., in press).
The International VLBI Service for Geodesy and Astrometry (IVS) regularly provides high-quality data to produce Earth Orientation Parameters (EOP), and for the maintenance and realisation of the International Terrestrial and Celestial Reference Frames, ITRF and ICRF. The first iteration of the celestial reference frame (CRF) at radio wavelengths, the ICRF1, was adopted by the International Astronomical Union (IAU) in 1997 to replace the FK5 optical frame. Soon after, the IVS began official operations and in 2009 there was a significant increase in data sufficient to warrant a second iteration of the CRF, ICRF2. The most recent ICRF3, was adopted by the IAU in 2018. However, due to the geographic distribution of observing stations being concentrated in the Northern hemisphere, CRFs are generally weaker in the South due to there being fewer Southern Hemisphere observations. To increase the Southern Hemisphere observations, and the density, precision of the sources, a series of deep South observing sessions was initiated in 1995. This initiative in 2004 became the IVS Celestial Reference Frame Deep South (IVS-CRDS) observing programme. This paper covers the evolution of the CRDS observing programme for the period 1995–2021, details the data products and results, and concludes with a summary of upcoming improvements to this ongoing project.
The love story between Chibinda Ilunga and Lueji, one of the best-known legends of Central African history, recounts the genesis of the Mwant Yav dynasty of the Lunda polity. Previous discussions of the narrative pitted symbolic interpretations against historical findings. This article asks why the Lunda love story became so influential from the middle of the nineteenth century. Instead of being an exclusively Lunda genesis narrative, the love story represented the interests and narratives of societies brought together by the caravan trade in Kasai and eastern Angola, including Chokwe, Ambakista, Luba, and Imbangala, all of whom added components to the legend compiled by Portuguese explorer and diplomat Henrique Dias de Carvalho. The legend took on importance as diverse factions competed for political titles and trading profits. In the hands of Carvalho and his informants the love story became a tool to construct a Pax Lunda guaranteed by the Portuguese. By demonstrating the quotidian politics of the love story, the article suggests the utility in the historical contextualization of the telling of oral traditions to appreciate their multiple meanings.
The iron-regulatory hormone hepcidin is transcriptionally up-regulated by gluconeogenic signals. Recent evidence suggeststhat increases in circulating hepcidin may decrease dietary iron absorption following prolonged exercise, however evidence is limited on whether gluconeogenic signals contribute to post-exercise increases in hepcidin. Mice with genetic knockout of regulated in development and DNA response-1 (REDD1) display greater glycogen depletion following exercise, possibly indicating greater gluconeogenesis. The objective of the present study was to determine liver hepcidin, markers of gluconeogenesis and iron metabolism in REDD1 knockout and wild-type mice following prolonged exercise. Twelve-week-old male REDD1 knockout and wild-type mice were randomised to rest or 60 min treadmill running with 1, 3 or 6 h recovery (n = 5–8/genotype/group). Liver gene expression of hepcidin (Hamp) and gluconeogenic enzymes (Ppargc1a, Creb3l3, Pck1, Pygl) were determined by qRT-PCR. Effects of genotype, exercise and their interaction were assessed by two-way ANOVAs with Tukey's post-hoc tests, and Pearson correlations were used to assess the relationships between Hamp and study outcomes. Liver Hamp increased 1- and 4-fold at 3 and 6 h post-exercise, compared to rest (P-adjusted < 0⋅009 for all), and was 50% greater in REDD1 knockout compared to wild-type mice (P = 0⋅0015). Liver Ppargc1a, Creb3l3 and Pck1 increased with treadmill running (P < 0⋅0001 for all), and liver Ppargc1a, Pck1 and Pygl were greater with REDD1 deletion (P < 0⋅02 for all). Liver Hamp was positively correlated with liver Creb3l3 (R = 0⋅62, P < 0⋅0001) and Pck1 (R = 0⋅44, P = 0⋅0014). In conclusion, REDD1 deletion and prolonged treadmill running increased liver Hamp and gluconeogenic regulators of Hamp, suggesting gluconeogenic signalling of hepcidin with prolonged exercise.
Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis.
Methods:
We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts.
Results:
Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT.
Conclusion:
Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.
Childhood trauma and adversity are common across societies and have strong associations with physical and psychiatric morbidity throughout the life-course. One possible mechanism through which childhood trauma may predispose individuals to poor psychiatric outcomes is via associations with brain structure. This study aimed to elucidate the associations between childhood trauma and brain structure across two large, independent community cohorts.
Methods
The two samples comprised (i) a subsample of Generation Scotland (n=1,024); and (ii) individuals from UK Biobank (n=27,202). This comprised n=28,226 for mega-analysis. MRI scans were processed using Free Surfer, providing cortical, subcortical, and global brain metrics. Regression models were used to determine associations between childhood trauma measures and brain metrics and psychiatric phenotypes.
Results
Childhood trauma associated with lifetime depression across cohorts (OR 1.06 GS, 1.23 UKB), and related to early onset and recurrent course within both samples. There was evidence for associations between childhood trauma and structural brain metrics. This included reduced global brain volume, and reduced cortical surface area with highest effects in the frontal (β=−0.0385, SE=0.0048, p(FDR)=5.43x10−15) and parietal lobes (β=−0.0387, SE=0.005, p(FDR)=1.56x10−14). At a regional level the ventral diencephalon (VDc) displayed significant associations with childhood trauma measures across both cohorts and at mega-analysis (β=−0.0232, SE=0.0039, p(FDR)=2.91x10−8). There were also associations with reduced hippocampus, thalamus, and nucleus accumbens volumes.
Discussion
Associations between childhood trauma and reduced global and regional brain volumes were found, across two independent UK cohorts, and at mega-analysis. This provides robust evidence for a lasting effect of childhood adversity on brain structure.
Why is misleading partisan content believed and shared? An influential account posits that political partisanship pervasively biases reasoning, such that engaging in analytic thinking exacerbates motivated reasoning and, in turn, the acceptance of hyperpartisan content. Alternatively, it may be that susceptibility to hyperpartisan content is explained by a lack of reasoning. Across two studies using different participant pools (total N = 1,973 Americans), we had participants assess true, false, and hyperpartisan news headlines taken from social media. We found no evidence that analytic thinking was associated with judging politically consistent hyperpartisan or false headlines to be accurate and unbiased. Instead, analytic thinking was, in most cases, associated with an increased tendency to distinguish true headlines from both false and hyperpartisan headlines (and was never associated with decreased discernment). These results suggest that reasoning typically helps people differentiate between low and high quality political news, rather than facilitate belief in misleading content. Because social media play an important role in the dissemination of misinformation, we also investigated willingness to share headlines on social media. We found a similar pattern whereby analytic thinking was not generally associated with increased willingness to share hyperpartisan or false headlines. Together, these results suggest a positive role for reasoning in resisting misinformation.
A substantial body of evidence suggests that favoring reason over intuition (employing an analytic cognitive style) is associated with reduced belief in God. In the current work, we address outstanding issues in this literature with two studies examining the relationship between analytic cognitive style (as measured by performance on the Cognitive Reflection Test) and belief in God. First, prior research focused on Judeo-Christian cultures, and it is uncertain whether the results generalize to other religious systems or beliefs. Study 1 helps to address this question by documenting a negative correlation between CRT performance and belief in God, r = −.18, in a sample of 513 participants from India, a majority Hindu country. Second, among 150 participants from the United Kingdom, Gervais et al. (2018) reported the first and (to date) only evidence for a positive relationship between CRT and belief in God. In Study 2, we assess the robustness of this result by recruiting 547 participants from the United Kingdom. Unlike Gervais et al., using the same items, we find a negative correlation between CRT and belief in God (r = −.19). Our results add further support to the argument that analytic thinking undermines belief in God.
A widely used measure of individual propensity to utilize analytic processing is the Cognitive Reflection Test (CRT), a set of math problems with intuitively compelling but incorrect answers. Here, we ask whether scores on this measure are temporally stable. We aggregate data from 11 studies run on Amazon Mechanical Turk in which the Cognitive Reflection Test (CRT) was administered and identify N = 3,302 unique individuals who completed the CRT two or more times. We find a strong correlation between an individual’s first and last CRT performance, r = .806. This remains true even when constraining to data points separated by over 2 years, r = .755. Furthermore, we find that CRT scores from one timepoint correlated negatively with belief in God and social conservatism from the other timepoint (and to a similar extent as scores gathered at the same timepoint). These results show that CRT scores are stable over time, and – given the stable relationship between CRT and religious belief and ideology – provide some evidence for the stability of analytic cognitive style more generally.
Chylothorax after congenital cardiac surgery is associated with increased risk of malnutrition. Nutritional management following chylothorax diagnosis varies across sites and patient populations, and a standardised approach has not been disseminated. The aim of this review article is to provide contemporary recommendations related to nutritional management of chylothorax to minimise risk of malnutrition.
Methods:
The management guidelines were developed by consensus across four dietitians, one nurse practitioner, and two physicians with a cumulative 52 years of experience caring for children with CHD. A PubMed database search for relevant literature included the terms chylothorax, paediatric, postoperative, CHD, chylothorax management, growth failure, and malnutrition.
Results:
Fat-modified diets and nil per os therapies for all paediatric patients (<18 years of age) following cardiac surgery are highlighted in this review. Specific emphasis on strategies for treatment, duration of therapies, optimisation of nutrition including nutrition-focused lab monitoring, and supplementation strategies are provided.
Conclusions:
Our deliverable is a clinically useful guide for the nutritional management of chylothorax following paediatric cardiac surgery.
Major depressive disorder (MDD) was previously associated with negative affective biases. Evidence from larger population-based studies, however, is lacking, including whether biases normalise with remission. We investigated associations between affective bias measures and depressive symptom severity across a large community-based sample, followed by examining differences between remitted individuals and controls.
Methods
Participants from Generation Scotland (N = 1109) completed the: (i) Bristol Emotion Recognition Task (BERT), (ii) Face Affective Go/No-go (FAGN), and (iii) Cambridge Gambling Task (CGT). Individuals were classified as MDD-current (n = 43), MDD-remitted (n = 282), or controls (n = 784). Analyses included using affective bias summary measures (primary analyses), followed by detailed emotion/condition analyses of BERT and FAGN (secondary analyses).
Results
For summary measures, the only significant finding was an association between greater symptoms and lower risk adjustment for CGT across the sample (individuals with greater symptoms were less likely to bet more, despite increasingly favourable conditions). This was no longer significant when controlling for non-affective cognition. No differences were found for remitted-MDD v. controls. Detailed analysis of BERT and FAGN indicated subtle negative biases across multiple measures of affective cognition with increasing symptom severity, that were independent of non-effective cognition [e.g. greater tendency to rate faces as angry (BERT), and lower accuracy for happy/neutral conditions (FAGN)]. Results for remitted-MDD were inconsistent.
Conclusions
This suggests the presence of subtle negative affective biases at the level of emotion/condition in association with depressive symptoms across the sample, over and above those accounted for by non-affective cognition, with no evidence for affective biases in remitted individuals.
Smartphones have the potential for capturing subtle changes in cognition that characterize preclinical Alzheimer’s disease (AD) in older adults. The Ambulatory Research in Cognition (ARC) smartphone application is based on principles from ecological momentary assessment (EMA) and administers brief tests of associative memory, processing speed, and working memory up to 4 times per day over 7 consecutive days. ARC was designed to be administered unsupervised using participants’ personal devices in their everyday environments.
Methods:
We evaluated the reliability and validity of ARC in a sample of 268 cognitively normal older adults (ages 65–97 years) and 22 individuals with very mild dementia (ages 61–88 years). Participants completed at least one 7-day cycle of ARC testing and conventional cognitive assessments; most also completed cerebrospinal fluid, amyloid and tau positron emission tomography, and structural magnetic resonance imaging studies.
Results:
First, ARC tasks were reliable as between-person reliability across the 7-day cycle and test-retest reliabilities at 6-month and 1-year follow-ups all exceeded 0.85. Second, ARC demonstrated construct validity as evidenced by correlations with conventional cognitive measures (r = 0.53 between composite scores). Third, ARC measures correlated with AD biomarker burden at baseline to a similar degree as conventional cognitive measures. Finally, the intensive 7-day cycle indicated that ARC was feasible (86.50% approached chose to enroll), well tolerated (80.42% adherence, 4.83% dropout), and was rated favorably by older adult participants.
Conclusions:
Overall, the results suggest that ARC is reliable and valid and represents a feasible tool for assessing cognitive changes associated with the earliest stages of AD.
Some children are more affected by specific family environments than others, as a function of differences in their genetic make-up. However, longitudinal studies of genetic moderation of parenting effects during early childhood have not been conducted. We examined developmental profiles of child behavior problems between 18 months and age 8 in a longitudinal parent–offspring sample of 361 adopted children. In toddlerhood (18 months), observed structured parenting indexed parental guidance in service of task goals. Biological parent psychopathology served as an index of genetic influences on children’s behavior problems. Four profiles of child behavior problems were identified: low stable (11%), average stable (50%), higher stable (29%), and high increasing (11%). A multinominal logistic regression analysis indicated a genetically moderated effect of structured parenting, such that for children whose biological mother had higher psychopathology, the odds of the child being in the low stable group increased as structured parenting increased. Conversely, for children whose biological mother had lower psychopathology, the odds of being in the low stable group was reduced when structured parenting increased. Results suggest that increasing structured parenting is an effective strategy for children at higher genetic risk for psychopathology, but may be detrimental for those at lower genetic risk.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
A standardised multi-site approach to manage paediatric post-operative chylothorax does not exist and leads to unnecessary practice variation. The Chylothorax Work Group utilised the Pediatric Critical Care Consortium infrastructure to address this gap.
Methods:
Over 60 multi-disciplinary providers representing 22 centres convened virtually as a quality initiative to develop an algorithm to manage paediatric post-operative chylothorax. Agreement was objectively quantified for each recommendation in the algorithm by utilising an anonymous survey. “Consensus” was defined as ≥ 80% of responses as “agree” or “strongly agree” to a recommendation. In order to determine if the algorithm recommendations would be correctly interpreted in the clinical environment, we developed ex vivo simulations and surveyed patients who developed the algorithm and patients who did not.
Results:
The algorithm is intended for all children (<18 years of age) within 30 days of cardiac surgery. It contains rationale for 11 central chylothorax management recommendations; diagnostic criteria and evaluation, trial of fat-modified diet, stratification by volume of daily output, timing of first-line medical therapy for “low” and “high” volume patients, and timing and duration of fat-modified diet. All recommendations achieved “consensus” (agreement >80%) by the workgroup (range 81–100%). Ex vivo simulations demonstrated good understanding by developers (range 94–100%) and non-developers (73%–100%).
Conclusions:
The quality improvement effort represents the first multi-site algorithm for the management of paediatric post-operative chylothorax. The algorithm includes transparent and objective measures of agreement and understanding. Agreement to the algorithm recommendations was >80%, and overall understanding was 94%.