To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
While effective project planning is crucial for the success of a clinical research project, being able to execute the plan is even more important. In Denmark, approval for health research projects is applied for at regional or national committees on health research ethics, which have been reluctant to approve clinical research projects involving forensic psychiatric in-patients, due to the admission usually being pursuant to treatment sanctions. However, recently we received approval for a clinical research project exclusively targeted towards inpatients at a large medium secure forensic psychiatric facility in Denmark.
Describing the process of project execution from planning to submitting the manuscript which is inherently multi-faceted and inundated with stress factors. How to connect theory, knowledge, project with clinical practice, with clinical research?
Qualitative data collecting while undertaking an exploratory, open-label, non-randomised weight reducing trial with a glucagon-like peptide-1 receptor agonist.
Challenges in finding, screening, motivating, recruiting, obtaining valid confirmed consent from potential study participants and other stakeholders, team communication, responsibilities and accountabilities within the team, Pareto Principle, scope creep, building project reports manually, real-time data gathering, unpredictable and other project deliverables will be presented
Experiences of the hospital staff (psychiatrists, doctors and nurses) in execution process of the project investigation performed and made possible through participation of their forensic psychiatric in-patients.
OBJECTIVES/GOALS: Our overall goal is to identify the processes used by the human visual system to encode visual stimuli into perceptual representations. In this project, our objective is (i) to collect a dataset of human neural activity in response to 1000 naturalistic color images and (ii) to determine how image parameters drive different parts of the human brain. METHODS/STUDY POPULATION: We recorded iEEG data in 4 human subjects who had been implanted for epilepsy monitoring. Each subject was presented 10 sets of 100 naturalistic stimuli, taken from the Natural Scenes Dataset (Allen et al., 2021), on a screen for 1 second each with 1 second rest intervals between stimuli. The subjects were instructed to fixate on a red dot at the center of the screen and were prompted to recall whether they had seen 3 additional test stimuli at the end of each set to encourage attentiveness. We calculated significant neural responses at each electrode by comparing evoked potentials and high frequency power changes during each stimulus vs. rest. Electrodes with significant responses were then mapped to anatomic locations in each subjects brain and then collectively to a standard brain. RESULTS/ANTICIPATED RESULTS: The natural image set elicited significant evoked potentials and high frequency responses at electrodes in each subject. Response latencies, from 80 to 300 ms after stimulus onset, portrayed the evolution of visual processing along the visual pathways, through key sites such as the early visual cortex, ventral temporal cortex, intraparietal sulcus, and frontal eye field. These responses differed significantly from those elicited by simple patterns, which drove early visual cortex but less so in later regions. DISCUSSION/SIGNIFICANCE: These data show that the human brain responds differently to more complex images. Determining the human brains response to naturalistic images is essential for encoding models that describe the processing in the human visual system. These models may further future efforts for electrical neurostimulation therapies such as for restoring vision.
The various interventions that governments took in the first wave of the Covid-19 outbreak impacted people severely. Given the low satisfaction with the government performance in Austria compared to Denmark, though both governments set out with a suppression strategy early on and were able to lower infection rates, we analyse the changes in civil, political and social citizenship and the governmental communicative practices during the first Covid response phase from March to August 2020. Employing a case-oriented qualitative comparison, we find that a combination of factors explains the different degree of satisfaction. In Austria, there was a combination of politics of fear, extensive and authoritarian regulations of civil citizenship, political citizenship was challenged and social citizenship undermined. In Denmark, an engaging and caring communicative strategy was employed, political citizenship was maintained and civil citizenship was curtailed less obstructively and was less policed. Social citizenship also was upheld for larger groups.
Background: Adults with obstructive hydrocephalus often present with cognitive and/or gait dysfunction in addition to symptoms of raised ICP. We previously reported improvement of cognitive and gait function 3 months following primary adult ETV. This abstract presents long-term results in this group. Methods: Obstructive hydrocephalus was identified based on tri-ventriculomegaly on CT and/or MRI. Gait velocity (10 m timed gait) and cognitive function (Montreal Cognitive Assessment [MoCA]) were measured at two timepoints: pre-ETV and ≥9 months post-ETV. Results: Sixteen adults underwent primary ETV and completed a long-term assessment. Mean age was 60 years and 10 (63%) were male. Etiology: 10 (62.5%) congenital and 6 (37.5%) acquired. Mean long-term follow-up time for cognitive and gait assessments was 14.4 and 13.7 months, respectively. The long-term MoCA within patient median change was +2 points (n= 15; p = 0.007). Group medians were 23/30 (pre-ETV) and 26/30 (post-ETV). The long-term gait velocity within patient median change was +0.4 m/s (n= 12; p < 0.001). Group medians were 0.7 m/s (pre-ETV) and 1.3 m/s (post-ETV). Conclusions: ETV in adults with obstructive hydrocephalus results in long-term improvement of cognition and gait velocity when assessed ≥9 months post-ETV. Larger cohorts will determine the generalizability of these results. Hydrocephalus Association supported project.
Recovery orientated care emphasizes equality in relations. Forensic psychiatric professionals need to engage in care-relationships with patients in ways where power is symmetrically distributed among them. However, professionals also need to focus on security at the ward. This promotes patient-professional power-relations that are asymmetrically skewed towards professionals. New practical ways of balancing between the power-relations defined by a care and custody dichotomy in forensic care need to be developed and studied to guide clinical practice.
To study how power-relations are articulated between patient-professional within a social gaming activity (E – sport) in a Danish medium secure forensic psychiatric ward.
Three months of observational data, collected via anthropological fieldwork Interviews with 3 professionals and 6 patients Data was analyzed using sociologist Pierre Bourdieu’s notions of field, capital and power
The E-sport intervention consists of two fields “in-game” and “over-game” In-game concerns the practice of gaming Over-game concerns the interventions organization Power in each field is driven by specific values and access to certain competencies Power in-game was equally open to patients and professionals leading to symmetric power relations Power over-game was open to professionals only leading to asymmetrical power relations Professionals may allow power distribution to patients during gameplay, while still retaining the overall power over the intervention
It is possible to balance between care-and-custody in forensic psychiatry. This study provides important insights to guide further practice.
Recently video gaming, have attracted considerable attention for its possible beneficial therapeutic effects, the possibility for testing behavior in safe artificial environments and as a tool for professionals and patients to build specific competencies for the everyday life. Also, a substantial amount of research suggests that videogaming might improve the participants social and cognitive skills and emotional regulation. There is little or no evidence that videogaming increases long term aggression or leads to physical aggression. At a medium secure forensic psychiatric in-patient ward, the patients and staff engage in weekly E – Sport sessions (primarily counterstrike) to further the recovery process.
To provide a standardized description of how E-sport is organized and used in the recovery process among forensic psychiatric patients.
The Template for Intervention Description and Replication (TIDieR) checklist and guide is widely used to in health research to describe interventions in clinical trials and other health research contexts. By use of TIDieR we describe a newly developed E-sport intervention, in which staff members and patients in a medium secure forensic psychiatric ward engage in weekly E-Sport sessions (primarily counterstrike) to improve patient–staff relationship.
The E-sport intervention is detailed by use of the 12 TIDieR items and practical experiences and insights will be described.
This standardized and detailed description of how is used in a recovery-oriented process in forensic psychiatry can be used for future studies that wishes to implement the intervention or for research studies replicating the treatment.
To evaluate the cost and cost-effectiveness of a farm-to-Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) intervention to promote vegetable intake and the redemption of WIC vouchers for produce purchases at farmers’ markets.
An economic analysis was undertaken using data from a pilot of the intervention. Vegetable intake was assessed with a reflection spectroscopy device (the Veggie Meter® [VM]) and via self-report. Voucher redemption was reported by WIC. Total and per participant intervention costs and cost-effectiveness ratios (expressed as cost per intervention effect) were estimated in 2019 US dollars over a 6-month period from the perspective of the agency implementing the intervention.
A large, urban WIC agency.
Participants were 297 WIC-enrolled adults.
Post-intervention, VM scores, self-reported vegetable intake and voucher redemption were higher in the intervention as compared with the control study group. Over the 6-month period, intervention costs were $31 092 ($194 unit cost per participant). Relative to the control group, the intervention cost $8·10 per increased VM score per participant, $3·85 per increased cup/d of vegetables consumed per participant and $3·29 per increased percentage point in voucher redemption per participant.
Intervention costs and cost-effectiveness ratios compared favourably with those reported for other interventions targeting vegetable intake in low-income groups, suggesting that the programme may be cost effective in promoting vegetable purchases and consumption. As there is no benchmark against which to compare cost-effectiveness ratios expressed as cost per unit of effectiveness, conclusions regarding whether this is the case must await further research.
Improved survival has led to a growing population of adults with congenital heart disease (CHD), followed by numerous reports of late complications. Liver disease is a known complication in some patients, with most studies focusing on Fontan associated liver disease. Whether liver disease also exists in other patients with CHD is not fully investigated. Elevated central venous pressure is considered pivotal in the development of liver disease in Fontan associated liver disease, and other patients with alterations in central venous pressure may also be at risk for developing liver fibrosis. We wanted to see if liver fibrosis is present in patients with tetralogy of Fallot. Many patients with tetralogy of Fallot have severe pulmonary regurgitation, which can lead to elevated central venous pressure. Patients with tetralogy of Fallot may be at risk of developing liver fibrosis.
Materials and methods:
Ten patients (24–56 years) with tetralogy of Fallot and pulmonary regurgitation were investigated for liver fibrosis. All patients were examined with magnetic resonance elastography of liver, hepatobiliary iminodiacetic acid scan, indocyanine green elimination by pulse spectrophotometry, elastography via FibroScan, abdominal ultrasound including liver elastography, and blood samples including liver markers.
Three out of ten patients had findings indicating possible liver fibrosis. Two of these had a liver biopsy performed, which revealed fibrosis stage 1 and 2, respectively. The same three patients had an estimated elevated central venous pressure in previous echocardiograms.
Mild liver fibrosis was present in selected patients with tetralogy of Fallot and may be related to elevated central venous pressure.
Subglacial hydrological systems require innovative technological solutions to access and observe. Wireless sensor platforms can be used to collect and return data, but their performance in deep and fast-moving ice requires quantification. We report experimental results from Cryoegg: a spherical probe that can be deployed into a borehole or moulin and transit through the subglacial hydrological system. The probe measures temperature, pressure and electrical conductivity in situ and returns all data wirelessly via a radio link. We demonstrate Cryoegg's utility in studying englacial channels and moulins, including in situ salt dilution gauging. Cryoegg uses VHF radio to transmit data to a surface receiving array. We demonstrate transmission through up to 1.3 km of cold ice – a significant improvement on the previous design. The wireless transmission uses Wireless M-Bus on 169 MHz; we present a simple radio link budget model for its performance in cold ice and experimentally confirm its validity. Cryoegg has also been tested successfully in temperate ice. The battery capacity should allow measurements to be made every 2 h for more than a year. Future iterations of the radio system will enable Cryoegg to transmit data through up to 2.5 km of ice.
The role of education in promoting social justice theories and principles has grown exponentially in the United States since the middle of the 1980s. Many groups of people, including those with disabilities, have fought for social justice and have gained greater access to societal rights, including educational opportunities within schools and universities. This chapter presents social justice and rule-of-law considerations for children and young people with disabilities. Consensus statements and federal mandates that guide the educational system within the United States are described from an educational perspective and the cultural context of law as it relates to the educational rights of children and young people with disabilities. Issues such as young people with disabilities being bullied, socially excluded by their peers, and denied educational access are described. Implications for practice in relation to known issues are discussed.
Many cognitive functions are under strong genetic control and twin studies have demonstrated genetic overlap between some aspects of cognition and schizophrenia. How the genetic relationship between specific cognitive functions and schizophrenia is influenced by IQ is currently unknown.
We applied selected tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) to examine the heritability of specific cognitive functions and associations with schizophrenia liability. Verbal and performance IQ were estimated using The Wechsler Adult Intelligence Scale-III and the Danish Adult Reading Test. In total, 214 twins including monozygotic (MZ = 32) and dizygotic (DZ = 22) pairs concordant or discordant for a schizophrenia spectrum disorder, and healthy control pairs (MZ = 29, DZ = 20) were recruited through the Danish national registers. Additionally, eight twins from affected pairs participated without their sibling.
Significant heritability was observed for planning/spatial span (h2 = 25%), self-ordered spatial working memory (h2 = 64%), sustained attention (h2 = 56%), and movement time (h2 = 47%), whereas only unique environmental factors contributed to set-shifting, reflection impulsivity, and thinking time. Schizophrenia liability was associated with planning/spatial span (rph = −0.34), self-ordered spatial working memory (rph = −0.24), sustained attention (rph = −0.23), and set-shifting (rph = −0.21). The association with planning/spatial span was not driven by either performance or verbal IQ. The remaining associations were shared with performance, but not verbal IQ.
This study provides further evidence that some cognitive functions are heritable and associated with schizophrenia, suggesting a partially shared genetic etiology. These functions may constitute endophenotypes for the disorder and provide a basis to explore genes common to cognition and schizophrenia.
Leukoaraiosis, or white matter rarefaction, is a common imaging finding in aging and is presumed to reflect vascular disease. When severe in presentation, potential congenital or acquired etiologies are investigated, prompting referral for neuropsychological evaluation in addition to neuroimaging. T2-weighted imaging is the most common magnetic resonance imaging (MRI) approach to identifying white matter disease. However, more advanced diffusion MRI techniques may provide additional insight into mechanisms that influence the abnormal T2 signal, especially when clinical presentations are discrepant with imaging findings.
We present a case of a 74-year-old woman with severe leukoaraoisis. She was examined by a neurologist, neuropsychologist, and rheumatologist, and completed conventional (T1, T2-FLAIR) MRI, diffusion tensor imaging (DTI), and advanced single-shell, high b-value diffusion MRI (i.e., fiber ball imaging [FBI]).
The patient was found to have few neurological signs, no significant cognitive impairment, a negative workup for leukoencephalopathy, and a positive antibody for Sjogren’s disease for which her degree of leukoaraiosis would be highly atypical. Tractography results indicate intact axonal architecture that was better resolved using FBI rather than DTI.
This case illustrates exceptional cognitive resilience in the face of severe leukoaraiosis and the potential for advanced diffusion MRI to identify brain reserve.
In the mink industry, feed costs are the largest variable expense and breeding for feed efficient animals is warranted. Implementation of selection for feed efficiency must consider the relationships between feed efficiency and the current selection traits BW and litter size. Often, feed intake (FI) is recorded on a cage with a male and a female and there is sexual dimorphism that needs to be accounted for. Study aims were to (1) model group recorded FI accounting for sexual dimorphism, (2) derive genetic residual feed intake (RFI) as a measure of feed efficiency, (3) examine the relationship between feed efficiency and BW in males (BWM) and females (BWF) and litter size at day 21 after whelping (LS21) in Danish brown mink and (4) investigate direct and correlated response to selection on each trait of interest. Feed intake records from 9574 cages, BW records on 16 782 males and 16 875 females and LS21 records on 6446 yearling females were used for analysis. Genetic parameters for FI, BWM, BWF and LS21 were obtained using a multivariate animal model, yielding sex-specific additive genetic variances for FI and BW to account for sexual dimorphism. The analysis was performed in a Bayesian setting using Gibbs sampling, and genetic RFI was obtained from the conditional distribution of FI given BW using genetic regression coefficients. Responses to single trait selection were defined as the posterior distribution of genetic superiority of the top 10% of animals after conditioning on the genetic trends. The heritabilities ranged from 0.13 for RFI in females and LS21 to 0.59 for BWF. Genetic correlations between BW in both sexes and LS21 and FI in both sexes were unfavorable, and single trait selection on BW in either sex showed increased FI in both sexes and reduced litter size. Due to the definition of RFI and high genetic correlation between BWM and BWF, selection on RFI did not significantly alter BW. In addition, selection on RFI in either sex did not affect LS21. Genetic correlation between sexes for FI and BW was high but significantly lower than unity. The high correlations across sex allowed for selection on standardized averages of animals’ breeding values (BVs) for RFI, FI and BW, which yielded selection responses approximately equal to the responses obtained using the sex-specific BVs. The results illustrate the possibility of selecting against RFI in mink with no negative effects on BW and litter size.
Psychotic depression (PD) is classified as a sybtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception that psychotic features in depression arise as a consequence of depressive severity.
To determine whether the severity of depression and psychosis correlate in accordance with the “severity-psychosis” hypothesis and to detect potential differences in clinical features of psychotic and non-psychotic depression (non-PD).
We aimed to answer the following questions:
Does the clinical profile differ between patients with PD and non-PD?
Is the severity of depression and psychosis correlated in patients with depression?
Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital between 2000 and 2010 due to a severe depressive episode.
A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD = 0.33 vs. PD = 1.37, p < 0.001), aggression (non-PD = 0.20 vs. PD = 0.36, p = 0.044) and on the total score (non-PD = 10.55 vs. PD = 11.87, p = 0.024). the HoNOS scores on the two items “depression” and “hallucinations and delusions” were very weakly correlated (Spearman coefficient = 0.12).
The results suggest that the severity of depression is unlikely to be the key determinant for the development of psychosis and supports the hypothesis that the psychotic- and non-psychotic subtypes of depression are in fact distinct clinical syndromes.
Denmark and Sweden are rather similar in most societal dimensions, but differ markedly with regard to the employment rate among older workers, which in 2015 was 65 per cent in Denmark and 75 per cent in Sweden. Using a qualitative (or case-oriented) comparative approach, this article seeks to identify configurations or combinations of conditions that have produced these differences in older workers’ work patterns. From an inter-disciplinary perspective, the article draws on the conceptual framework of push (e.g. involuntary retirement due to poor health), pull (e.g. voluntary retirement because of generous welfare benefits), jump (e.g. exit due to a search for life conditions that are more fulfilling than paid work), stay (e.g. older workers remain voluntarily in the labour market because work is fulfilling and well paid) and stuck (e.g. older workers remain involuntarily in the labour market because they cannot afford to retire). Findings are that low employment rates in Denmark are an outcome of a relatively strong combination of push–pull–jump factors, while Sweden, with its high employment rate, exhibits a combination of stay–stuck conditions.
To validate the diagnosis of hyperkinetic disorders (HD) in the Danish Psychiatric Central Research Registry (DPCRR) for children and adolescents aged 4 to 15 given in the years 1995 to 2005.
From a total of 4568 participants, a representative random subsample of n = 387 patients were used to validate the diagnosis. Patient files were systematically scored for the presence of ICD-10 criteria for HD and oppositional defiant disorder/conduct disorder (ODD/CD; F91). Further to this, an inter-rater reliability study was also conducted, whereby two experienced child and adolescent psychiatrists who were blind to patients discharge diagnoses, rated a random subsample of n = 101 participants.
Information was available for 372 out of 387 patients. Out of n = 372 available files, n = 324 (86.8%) were evaluated to fulfil diagnostic criteria for HD. Due to missing information it was not possible to reach a conclusion for 5.1% of the cases, 3.8% of the diagnoses were registration errors, and in 4.3% of the files the diagnosis had to be rejected. Inter-rater agreement was high (κ = 0.83, z = 10.9, P < .001). The validity of hyperkinetic disorders, unspecified (F90.9) was lower and comorbid CD/ODD were under-diagnosed in the sample. All participants fulfilling HD criteria also fulfilled DSM-5-criteria for ADHD.
The risk of misclassification of patients with HD in the DPCRR is relatively low, with the exception of the diagnosis of hyperkinetic disorders, unspecified (F90.9).
Early Intervention services with team-based intensive case management and family involvement are superior to standard treatment in reducing psychotic and negative symptoms and comorbid substance abuse and improving social functioning and user satisfaction. The results of the OPUS-trial will be presented together with meta-analyses based on similar trials. The implementation of OPUS all over Denmark will be presented together with the Danish OPUS-fidelity study. Specialized elements are being are being developed such as inclusion of new methods in CBT for psychotic and negative symptoms, neurocognitive and social cognitive training programs, interventions for supported employment and focus on physical health. Results of long term follow-up studies indicate that the prognosis of first episode psychosis is very diverse with the extremes represented by one group being well functioning and able to quit medication without relapse; and another group having a long term chronic course of illness with a need for support to maintain daily activities. The Danish TAILOR-trial–testing dose reduction versus maintenance therapy will be presented. It will be of immense value to be able to intervene in risk groups identified in the premorbid phase, and there are few examples of ongoing trial for children of parent with schizophrenia and bipolar disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The typical onset of schizophrenia coincides with the maturational peak in cognition; however, for a significant proportion of patients the onset is before age 18 and after age 30 years. While cognitive deficits are considered core features of schizophrenia, few studies have directly examined the impact of age of illness onset on cognition.
The aim of the study was to examine if the effects of age on cognition differ between healthy controls (HCs) and patients with schizophrenia at illness onset. We examined 156 first-episode antipsychotic-naïve patients across a wide age span (12–43 years), and 161 age- and sex-matched HCs. Diagnoses were made according to ICD-10 criteria. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS), and IQ was estimated using subtests from the Wechsler adult- or child-intelligence scales. Multivariate analysis of covariance (MANCOVA) was used to examine linear and quadratic effects of age on cognitive scores and interactions by group, including sex and parental socioeconomic status as covariates.
There was a significant overall effect of age on BACS and IQ (p < 0.001). Significant group-by-age interactions for verbal memory (for age-squared, p = 0.009), and digit sequencing (for age, p = 0.01; age-squared, p < 0.001), indicated differential age-related trajectories between patients and HCs.
Cognitive functions showing protracted maturation into adulthood, such as verbal memory and verbal working memory, may be particularly impaired in both early- and late-schizophrenia onset. Our findings indicate a potential interaction between the timing of neurodevelopmental maturation and a possible premature age effect in late-onset schizophrenia.
Early changes in biomarker levels probably occur before bloodstream infection (BSI) is diagnosed. However, this issue has not been fully addressed. We aimed at evaluating the kinetics of C-reactive protein (CRP) and plasma albumin (PA) in the 30 days before community-acquired (CA) BSI diagnosis. From a population-based BSI database we identified 658 patients with at least one measurement of CRP or PA from day −30 (D–30) through day −1 (D–1) before the day of CA-BSI (D0) and a measurement of the same biomarker at D0 or D1. Amongst these, 502 had both CRP and PA measurements which fitted these criteria. CRP and PA concentrations began to change inversely some days before CA-BSI diagnosis, CRP increasing by day −3.1 and PA decreasing by day −1.3. From D–30 to D–4, CRP kinetics (expressed as slopes – rate of concentration change per day) was −1.5 mg/l/day. From D–3 to D1, the CRP slope increased to 36.3 mg/l/day. For albumin, the slope between D–30 to D–2 was 0.1 g/l/day and changed to −1.8 g/l/day between D–1 and D1. We showed that biomarker levels begin to change some days before the CA-BSI diagnosis, CRP 3.1 days and PA 1.3 days before.