bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics and outcomes of patients with post-stroke epilepsy: protocol for an individual patient data meta-analysis from the International Post-stroke Epilepsy Research Repository (IPSERR)
Authors: Mishra Nishant K , Kwan Patrick , Tanaka Tomotaka , Sunnerhagen Katharina S , Dawson Jesse , Zhao Yize , Misra Shubham , Wang Selena , Sharma Vijay K , Mazumder Rajarshi , Funaro Melissa C , Ihara Masafumi , Nicolo John-Paul , Liebeskind David S , Yasuda Clarissa L , Cendes Fernando , Quinn Terence J , Ge Zongyuan , Scalzo Fabien , Zelano Johan , Kasner Scott E
Published: November 2023

Introduction

Despite significant advances in managing acute stroke and reducing stroke mortality, preventing complications like post-stroke epilepsy (PSE) has seen limited progress. PSE research has been scattered worldwide with varying methodologies and data reporting. To address this, we established the International Post-stroke Epilepsy Research Consortium (IPSERC) to integrate global PSE research efforts. This protocol outlines an individual patient data meta-analysis (IPD-MA) to determine outcomes in patients with post-stroke seizures (PSS) and develop/validate PSE prediction models, comparing them with existing models. This protocol informs about creating the International Post-stroke Epilepsy Research Repository (IPSERR) to support future collaborative research.

Methods and analysis

We utilised a comprehensive search strategy and searched MEDLINE, Embase, PsycInfo, Cochrane, and Web of Science databases until 30 January 2023. We extracted observational studies of stroke patients aged ≥18 years, presenting early or late PSS with data on patient outcome measures, and conducted the risk of bias assessment. We did not apply any restriction based on the date or language of publication. We will invite these study authors and the IPSERC collaborators to contribute IPD to IPSERR. We will review the IPD lodged within IPSERR to identify patients who developed epileptic seizures and those who did not. We will merge the IPD files of individual data and standardise the variables where possible for consistency. We will conduct an IPD-MA to estimate the prognostic value of clinical characteristics in predicting PSE.

Ethics and dissemination

Ethics approval is not required for this study. The results will be published in peer-reviewed journals. This study will contribute to IPSERR, which will be available to researchers for future PSE research projects. It will also serve as a platform to anchor future clinical trials.

Trial registration number

NCT06108102
Changes in head staff members in male elite-level football teams are associated with increased hamstring injury burden for that season: the UEFA Elite Club Injury Study
Authors: Ekstrand Jan , Van Zoest Wart , Gauffin Håkan
Published: November 2023

Objective

To evaluate whether a change of head coach or other head staff before or during a season is correlated to hamstring injury (HI) burden in male elite-level football (soccer) in Europe.

Methods

The survey was conducted using a questionnaire reporting any staff change within the team. Data about the head staff changes and hamstring injury burdens were collected from 14 teams participating in the Elite Club Injury Study (ECIS) during the 2019/2020, 2020/2021 and 2021/2022 seasons.

Results

On average, replacing the head coach before or during a season happens in every second season. All changes, except for the change of the head coach during a season, indicate an association with an increase in HI burden (ranging from 10% to 81%). However, only changes in the fitness coach and team doctor roles reached statistical significance. The HI burden seems to be influenced by adding new staff members, such as the head of fitness/performance coach in 36% of the teams and the team doctor in 17%. New head coaches starting the season with their own, for the team new, fitness/performance coach was highly associated with increased HI burden (p<0.001).

Conclusions

Bringing their own fitness/performance coaches is common for managers entering a new elite male football club. However, this paper has highlighted that this trend seems to lead to a three times increase in HI burden. Similarly, replacing the team doctor was also associated with increased HI burden. Instability among head staff members in male elite-level football teams seems associated with increased HI burden during the season.
Sport specialisation and performance-enhancing substance use by young athletes
Authors: McNaughton Michael , Hunt Danielle L , O'Brien Michael , Sugimoto Dai , Meehan William P , Miller Patricia , Stracciolini Andrea
Published: November 2023

Objectives

To investigate the association of reported legal performance enhancing substance (PES) use and consideration of banned PES use among sport-specialised and non-sport-specialised young athletes.

Methods and design

Cross-sectional study of 1049 young athletes enrolled in an injury prevention programme from 2013 to 2020. We used logistic regression modelling to determine the independent association between sports specialisation. We reported (1) legal PES use and (2) consideration of banned PES use after adjusting for the effects of gender, age, having a relative as a coach, unrestricted internet access, use of a weight training regimen, and weeknight hours of sleep.

Results

The final cohort consisted of 946 athletes with a mean age of 14. 56% were female, and 80% were sport-specialised athletes. 14% reported legal PES use, and 3% reported consideration of banned PES use. No difference was found between sport-specialised athletes who reported legal PES use (OR=1.4; 95% CI 0.81 to 2.43; p=0.23) or consideration of banned PES use (OR=3.2; 95% CI 0.78 to 14.92; p=0.1) compared with non-sport-specialised athletes. Reported legal PES use was more common among athletes who were male, older, used weight training, and slept less. Reported consideration of banned PES use was more common among male and older athletes.

Conclusions

PES use is not independently associated with sport specialisation in young athletes. Athlete sex, age, training, and sleep patterns are important factors for young athletes to consider in PES use.
The international variability of surgery for rectal prolapse
Authors: Kelley Jesse K , Hagen Edward R , Gurland Brooke , Stevenson Andrew RL , Ogilvie James W
Published: November 2023

Objective

There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse.

Design

A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs.

Setting

Electronic survey distributed to colorectal surgeons of diverse practice settings

Participants

249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting.

Main outcome measures

Responses to questions regarding preoperative workup preferences and clinical scenarios.

Results

In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods.

Conclusion

There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.
Cardiac coronary tomography angiography (CCTA) use across geographical regions in the USA and the UK: a cross-sectional study
Authors: Banashefski Bryana , Ji Robin , Dhruva Sanket S. , Neuhaus John , Redberg Rita F
Published: November 2023

Objective

Increased use of CT imaging has been identified as a key component of unsustainable rising healthcare costs in the USA and globally. Understanding evidence and its relation to imaging coverage policies can help identify patterns of variation to better inform high value care initiatives. This cross-sectional study evaluates regional differences in US utilisation of cardiac coronary tomography angiography (CCTA) and compares use in the USA and England.

Design

We determined differences in CCTA order rates by US Medicare region and compared order rates in the US and England, compared CT scanner prevalence in the USA and UK, and reviewed the CCTA coverage policies for each region.

Setting

The US and the UK.

Participants

Medicare Coverage Database; Medicare 2018 Part B data; National Health Services 2018 data.

Interventions

CCTA orders, CT scanner prevalence.

Main outcome measures

CCTA orders per beneficiary, CT scanner prevalence, CCTA policy variation.

Results

We found that CCTA coverage policies are more permissive in the UK compared with the USA. However, CT scanner prevalence per beneficiary is four times greater in the USA than the UK. There was significant variation in number of CCTA ordered per 100 000 beneficiaries between regions in England and the USA, ranging from 74 to 313 in the US and 57–317 in England.

Conclusions

There is significant geographical variation in use of CCTA in both the USA and England, although overall use does not differ significantly between both countries. Similarities in order rates, despite a much higher CT scanner density in the USA, may be related to more permissive guidelines around use of CCTA in the UK. Variation in both countries may also reflect the lack of high-quality clinical outcomes data for use of CCTA, underscoring opportunities for more evidence and evidence-based policy to promote appropriate use of CCTA imaging.
Health-related quality of life among adolescents with type 1 diabetes since the second wave of the COVID-19 pandemic in Germany
Authors: Framme Juliane Regina , Kim-Dorner Su-Jong , Heidtmann Bettina , Kapellen Thomas Michael , Lange Karin , Kordonouri Olga , Saßmann Heike
Published: November 2023

Objective

The COVID-19 pandemic had an impact on everyday life and in general, reduced the health-related quality of life (HRQoL) of adolescents. In this study, we assess the HRQoL of adolescents with type 1 diabetes (T1D) in Germany since the second wave of the COVID-19 pandemic by using self-report and parent-proxy reports, to identify risk factors, to compare to peers and to examine the agreement of HRQoL between parents and their children.

Methods

A total of 445 adolescents (12–18 years) and 413 parents participated in an anonymous cross-sectional survey conducted at three German diabetes centres from January 2021 to June 2022. Inclusion criteria were diabetes duration ≥1 year and German-speaking. Teen HRQoL was assessed by using self-report and parent-proxy report versions of the KIDSCREEN-10 index.

Results

The majority of adolescents reported average (75.5%) HRQoL. Approximately 11.3% of teens reported high and 13.2% low HRQoL. Teen’s female gender, older age, higher diabetes burden and parental depression symptoms contributed to lower self-reported HRQoL among teens. For parent-proxy reports, increasing diabetes burdens, parental depression symptoms, non-migrant status, high education and ketoacidosis contributed to lower scores on teen HRQoL. The mean scores of the KIDSCREEN-10 index for adolescents did not differ from the German norm. In comparison to healthy peers during the first wave of the pandemic, adolescents in the current study reported higher HRQoL. The overall teen-parent agreement was fair although parents reported significantly lower teen HRQoL than adolescents did.

Conclusions

HRQoL of most adolescents with T1D during the COVID-19 pandemic was average with parents reporting significantly lower scores. Self-reported and parent-proxy-reported HRQoL and the level of agreement due to different perspectives can provide important information for clinical care and intervention planning.
Reasons for providing assisted suicide and the expressivist objection: a response to Donaldson
Authors: Braun Esther
Published: November 2023

According to the expressivist objection, laws that only allow assisted dying for those suffering from certain medical conditions express the judgement that their lives are not worth living. I have recently argued that an autonomy-based approach that legally allows assisted suicide for all who make an autonomous request is a way to avoid the expressivist objection. In response to this, Thomas Donaldson has argued that rather than avoiding the expressivist objection, an autonomy-based approach extends this objection. According to Donaldson, this is because helping a person achieve a goal requires endorsement of that goal. In this reply, I show that Donaldson misunderstands the target of the expressivist objection: it is not aimed at an individual’s attitude towards another person’s death but rather at a legal regulation. Moreover, helping someone end their life does not necessarily require endorsing this goal—instead, respect for a person’s autonomous choice can be another reason for providing assisted suicide. Donaldson also assumes that the autonomy-based approach requires doctors to accept autonomous requests for assisted dying. Yet, this approach merely makes it legal for individuals (not necessarily only doctors) to provide assisted suicide to autonomous persons but does not require anyone to do so.
Mechanical thrombectomy for the treatment of primary and secondary anterior cerebral artery occlusions: insights from STAR
Authors: Dabhi Nisha , Kumar Jeyan Sathia , Ironside Natasha , Kellogg Ryan T , Sowlat Mohammad-Mahdi , Uchida Kazutaka , Maier Ilko , Al Kasab Sami , Jabbour Pascal , Kim Joon-tae , Wolfe Stacey Q , Rai Ansaar , Starke Robert M , Psychogios Marios-Nikos , Samaniego Edgar A , Arthur Adam S , Yoshimura Shinichi , Cuellar Hugo , Howard Brian M , Alawieh Ali , Romano Daniele G , Tanweer Omar , Mascitelli Justin , Fragata Isabel , Polifka Adam J , Osbun Joshua W , Crosa Roberto Javier , Matouk Charles , Levitt Michael R , Brinjikji Waleed , Moss Mark , Dumont Travis M , Williamson Richard , Navia Pedro , Kan Peter , De Leacy Reade , Chowdhry Shakeel A , Ezzeldin Mohamad , Spiotta Alejandro M , Park Min S
Published: November 2023

Background

The safety and efficacy of mechanical thrombectomy (MT) for the treatment of acute anterior cerebral artery (ACA) occlusions have not clearly been delineated. Outcomes may be impacted based on whether the occlusion is isolated to the ACA (primary ACA occlusion) or occurs in conjunction with other cerebral arteries (secondary).

Methods

We performed a retrospective review of the multicenter Stroke Thrombectomy and Aneurysm (STAR) database. All patients with MT-treated primary or secondary ACA occlusions were included. Baseline characteristics, procedural outcomes, complications, and clinical outcomes were collected. Primary and secondary ACA occlusions were compared using the Mann–Whitney U test and Kruskal–Willis test for continuous variables and the χ
2
test for categorical variables.

Results

The study cohort comprised 238 patients with ACA occlusions (49.2% female, median (SD) age 65.6 (16.7) years). The overall rate of successful recanalization was 75%, 90-day good functional outcome was 23%, and 90-day mortality was 35%. There were 44 patients with a primary ACA occlusion and 194 patients with a secondary ACA occlusion. When adjusted for baseline variables, the rates of successful recanalization (68% vs 76%, P=0.27), 90-day good functional outcome (41% vs 19%, P=0.38), and mortality at 90 days (25% vs 38%, P=0.12) did not differ between primary and secondary ACA occlusion groups.

Conclusion

Clinical and procedural outcomes are similar between MT-treated primary and secondary ACA occlusions for select patients. Our findings demonstrate the need for established criteria to determine ideal patient and ACA stroke characteristics amenable to MT treatment.
A new science of emotion: implications for functional neurological disorder
Authors: Jungilligens Johannes
Published: November 2023

Johannes Jungilligens, PhD is a clinical neuropsychologist and affective neuroscience researcher focusing on neuropsychological and affective aspects of functional neurological disorder. Johannes is a post-doc at the Department of Neurology at the University Hospital Knappschaftskrankenhaus Bochum in Germany. After earning his PhD at Ruhr University Bochum, he was a visiting post-doc in the lab of Prof David Perez at Massachusetts General Hospital, Harvard Medical School. In his work as a clinician-researcher, he investigates the role of emotions, interoception, and metacognition in patients with functional neurological disorder using behavioral and neurobiological assessments.

Across ancient and modern times, functional neurological disorder has had a long and tumultuous history, with an evolving debate and understanding of how biopsychosocial factors (in early discussions also spiritual or supernatural elements) contribute to the manifestation of the disorder. A central issue in contemporary discussions has revolved around questioning the extent to which emotions play a mechanistic and aetiological role in functional neurological disorder. Critical in this context, however, is that this ongoing debate has largely omitted the question of what emotions are in the first place.

This talk first brings together advances in the understanding of working principles of the brain fundamental to introducing a new understanding of what emotions are. Building on a recent theoretical framework (the theory of constructed emotion; Lisa Feldman Barrett), the idea of how the predictive process of emotion construction can be an integral component of the pathophysiology of functional neurological disorder is discussed. This incorporates several themes including: (i) how chronic energy dysregulation can contribute to the emergence of neuropsychiatric illness, (ii) how functional neurological symptoms can occur in the process of aberrant emotion category construction, (iii) how the roles of alexithymia and ‘panic attack without panic’ can be re-conceptualized in this framework, and (iv) how life experiences influence emotion construction.
The psychological scars of Intensive Care
Authors: Wade Dorothy
Published: November 2023

Dr Dorothy Wade is Consultant health psychologist at Royal Free London NHS Foundation Trust. She has a PhD in health psychology and healthcare evaluation from University College London, where she is an honorary associate professor. Her clinical and research area of expertise is in psychological risk factors, outcomes and interventions in Critical Care.

While more people survive critical illness now than ever before, their physical and psychological recovery is often poor. There is strong evidence that people suffer adverse psychological outcomes including anxiety, depression, posttraumatic stress disorder and cognitive impairment after an Intensive Care admission.

Risk factors for adverse psychological outcomes include acute stress, delirium and delusional memories of the Intensive Care Unit (ICU). About half of patients suffer acute stress in the ICU. They may be in pain and undergo repeated invasive clinical interventions. The environment can be harsh, clinical and badly-lit. ICUs are frequently noisy and overcrowded, with patients and upset, grieving families in close proximity to each other. In addition, most patients become delirious, acutely confused and experience terrifying, long-lasting hallucinations and delusions.

In the past decade clinical health psychologists have become increasingly involved in supporting patients clinically in the ICU, and in research to develop and evaluate psychological interventions. Clinically they have a role in psychological assessment and care of patients along the pathway from ICU admission to follow-up reviews around 3 months post ICU-discharge. Current research includes a self-management intervention to reduce anxiety, and psychology-led support to reduce delirium-related distress in the ICU.
04 Should neuropsychiatry flow both ways? Neurology inreach into psychiatric hospital
Authors: Cope Thomas E
Published: November 2023

Objectives/Aims

To assess the utility of neurology inreach into acute psychiatric hospital wards, through the quantitative evaluation of the case series, and presentation of qualitative experiences of service users and care providers.

Methods

All consecutive referrals to a new service delivering neurology inreach to Fulbourn hospital in Cambridge were assessed over the first six months. Patients were categorised according to their primary presentation. Outcomes included whether diagnosis was clarified, whether medication was changed, and whether interventions were made that would otherwise not have occurred. Illustrative case examples are presented.

Results

Thirty-five unique patients were assessed over fourteen visits (some on multiple occasions). In 94% of cases a diagnostic opinion and management plan was reached. In 63% of cases medication was changed.

23% of patients presented with a combination of Parkinson’s disease and psychosis. 20% were diagnosed with a non-parkinsonian movement disorder. 14% were diagnosed with a dementia, 14% had epilepsy, and 17% had no neurological abnormality. Importantly, three patients (9%) had an autoimmune encephalitis with a demonstrable antibody.

Cases are presented where neurology inreach facilitated access to treatments that would otherwise have been unavailable, such as rapid plasma exchange and a duodopa infusion pump. Psychiatric interventions such as ECT and clozapine also occurred more rapidly, because of increased diagnostic certainty.

Conclusions

Overall, the service has demonstrably delivered patient and healthcare system benefits. It has also been enjoyable for the neurologist to deliver, and well received by the psychiatric inpatient teams. There have been some barriers to delivery, which are discussed, and are mainly to do with commissioning a new service and referral boundaries. Nonetheless, this has been a relatively small input a consultant time (0.5PA) to produce meaningful improvements in patient care, and reductions in length of stay. We advocate that a similar model should be rolled out by cooperation across all acute trusts delivering psychiatric and neurological care, to break down barriers between neurology and psychiatry.
09 Religiosity and risk of Parkinson’s disease in England and the USA
Authors: Otaiku Abidemi I
Published: November 2023

Objectives/Aims

Parkinson’s disease (PD) is associated with low religiosity cross-sectionally. Whether low religiosity might be associated with an increased risk for developing PD is unknown.

This study investigated whether low religiosity in adulthood is associated with increased risk for developing PD.

Methods

A population-based prospective cohort study was conducted. Participants from the English Longitudinal Study of Aging (ELSA) and the Midlife in the United States (MIDUS) study who were free from PD at baseline (2004–2011) and completed questionnaires on self-reported religiosity, were included in a pooled analysis. Incident PD was based on self-report. Multivariable logistic regression was used to estimate odds ratios (OR) for developing PD according to baseline religiosity, with adjustment for sociodemographic characteristics, health and lifestyle factors and engagement in religious practices.

Results

Among 9,796 participants in the pooled dataset, 74 (0.8%) cases of incident PD were identified during a median follow-up of 8.1 years. In the fully adjusted model, compared with participants who considered religion very important in their lives at baseline, participants who considered religion not at all important in their lives had a 10-fold risk of developing PD during follow-up (OR, 9.99; 95% CI, 3.28–30.36). Moreover, there was a dose-response relationship between decreasing religiosity and increasing PD risk (P<0.001 for trend). These associations were similar when adjusting for religious upbringing and when cases occurring within the first two years of follow-up were excluded from the analysis. The association was somewhat attenuated when religious practices were removed from the model as covariates, though it remained statistically significant (OR for ‘not at all important’ vs ‘very important’, 2.26; 95% CI, 1.03- 4.95) (P<0.029 for trend).

Conclusions

This longitudinal study provides evidence for the first time that low religiosity in adulthood may be a strong risk factor for developing PD.
12 A pilot investigation of interoceptive accuracy, awareness, and sensibility in functional neurological disorder
Authors: Merritt Millman LS , Short Eleanor , Stanton Biba , Winston Joel , Nicholson Timothy , Mehta Mitul , Reinders Simone , Edwards Mark , Goldstein Laura , David Anthony , Hotopf Matthew , Chalder Trudie , Pick Susannah
Published: November 2023

Objectives/Aims

Altered interoception may be a core pathophysiological mechanism in functional neurological disorder (FND). However, there have been inconsistent findings from interoceptive accuracy paradigms, with several studies reporting no significant group differences in comparisons to controls when tested at rest/baseline. This is contrary to evidence for alterations in other interoceptive dimensions including awareness (metacognitive evaluation of interoceptive accuracy) and sensibility (self- reported sensitivity to bodily sensations) in this population. We aimed to measure interoception across several dimensions, with the prediction that individuals with FND would show reduced accuracy, awareness, and sensibility compared to controls.

Methods

Individuals with FND (n=17, 13F:4M, 10 motor symptoms, 7 motor/seizures) and healthy controls (HC, n=17, 13F:4M) completed measures of interoceptive accuracy and awareness (modified heartbeat tracking task [HTT]) and a time estimation task (TET). Participants also completed a validated scale of interoceptive sensibility (Multidimensional Assessment of Interoceptive Awareness-2, MAIA-2).

Results

The groups were matched for age (p=.51), sex (p=1.00), and body mass index (p=.19). FND and HC groups did not differ in interoceptive accuracy (p=1.00) or awareness (p=.99), although the FND group displayed lower scores on the ‘Not- Distracting’ (p<.001,g=1.42) and ‘Trusting’ (p=.005,g=1.17) subscales of the MAIA-2, relative to controls. There was no relationship in either group between HTT and TET scores. There was a significant positive relationship between HTT accuracy and awareness (confidence) in the control group (r=.61,p=.016) but not in the FND group (r=.11,p=.69). Exploratory correlations revealed a significant positive relationship between interoceptive awareness and the ‘Self-Regulation’ subscale of the MAIA-2 in the FND group (r=.77,p=.002).

Conclusions

Individuals with FND did not differ from HCs on interoceptive accuracy or awareness, measured at rest. The lower levels of ‘Not-Distracting’ and ‘Trusting’ seen in this FND sample replicated our previous study, suggesting that there may be a separation between trait and state interoceptive awareness in FND, reinforcing the need for interoception to be considered within a multidimensional framework. The lack of relationship between interoceptive accuracy and awareness in the FND group also implies that there may be a disconnect between actual performance and subjective confidence. Our future work will explore the possibility that interoceptive impairments in FND may be state dependent, measuring these interoceptive domains with other paradigms, in larger samples, compared to both healthy and clinical controls.
14 Neural circuit mapping of waiting impulsivity and proactive inhibition with convergent evidence from fMRI and TMS
Authors: Skandali Nikolina , Baek Kwangyeol , Sallie Samantha N , Sonkusare Saurabh , Mandali Alekhya , Ritou Valentin , Casero Violeta , Voon Valerie
Published: November 2023

Objectives

Waiting and stopping are essential and distinct elements of appropriate behavioural control with its dysfunction implicated in various impulsivity related mental disorders. Although rodent and human studies have investigated both phenomena, the role of preparing to stop in waiting impulsivity has rarely been investigated. Furthermore, convergent evidence from multi-modal investigation tools remains a poorly utilized approach in addressing such questions.

Methods

Here, we conducted two separate, but hierarchical studies, using functional magnetic resonance imaging (fMRI) to map the neural circuit involved in waiting impulsivity and proactive stopping, and subsequently provide mechanistic and causal evidence of disruption of this circuit by transcranial magnetic stimulation (TMS). We used a validated human version of the 5-Choice Serial Reaction Time (5CSRT) task and developed a novel proactive stopping task.

Results

We first show a shared neural network comprising the pre-supplementary motor area and bilateral anterior insula underlying both waiting impulsivity and proactive stopping. We further demonstrate activity in dorsomedial prefrontal cortex and left inferior frontal gyrus (LIFG) negatively correlated with waiting impulsivity in trials with additional target onset delay. A subsequent study applying continuous theta burst stimulation (a TMS inhibitory protocol) to LIFG in fifty-one healthy volunteers in a single-blind, randomized control-design, demonstrated active stimulation of LIFG significantly increased waiting impulsivity.

Conclusions

Our findings highlight the relevance of task design in assessing waiting impulsivity with CSRT tasks and highlight the role of LIFG integrity and related neural circuitry in waiting impulsivity.
20 Reflexive downregulation of memory systems in dissociative amnesia: a case series
Authors: Marsh Laura , Nardo Davide , Poole Norman , Zeman Adam , Woodberry Emma , Kopelman Michael , Anderson Michael
Published: November 2023

Objectives/Aims

The neurocognitive mechanisms underlying dissociative amnesia are poorly understood. It has been proposed that personal memory retrieval is inhibited via top- down cognitive control mechanisms. We developed a behavioural paradigm to test this hypothesised mechanism in a prospectively-recruited case series.

Methods

Participants included 3 patients with dissociative amnesia, alongside two groups of 12 healthy controls. Patients were shown photographs of people from their personal past who were either recognisable, or who were forgotten due to their amnesia. We hypothesised that seeing forgotten faces would lead to global downregulation of the hippocampus/medial temporal memory systems, which would temporarily impair hippocampally-mediated encoding and stabilisation processes. To test this, we presented novel ‘bystander’ images immediately before and after presentation of personal reminders. These included photographs of objects in particular location, and participants were asked to generate a story for how the object came to be in the given location. Later, a surprise memory test assessed memory for these bystander objects. We predicted that recall of bystanders presented before/after forgotten faces would be impaired relative to those presented before/after recognised faces. Healthy controls were shown i) faces from their recent vs remote past, and ii) familiar vs novel faces, and were predicted to show no difference in bystander recall across conditions.

Results

In line with our hypothesis, all three patients showed impairments in later recall of novel bystander items that were presented immediately before and/or after forgotten faces, relative to recognisable faces. Neither group of healthy control showed differences across conditions, confirming that the deficit was not merely a consequence of seeing an unrecognisable face. The task was repeated with one patient following memory recovery, at which point he recognised all of the faces. We no longer observed any differences in bystander encoding between conditions.

Conclusions

Results indicate that memory systems are reflexively and globally downregulated when people with dissociative amnesia are reminded of people they no longer recognise, impairing encoding of novel information.
22 How does the free cog compare to the Addenbrooke’s cognitive examination (ACE III) in traumatic brain injury (TBI)?
Authors: Paramlall M , Swanepoel H , Cotton L , O’Roarke I , Leong KK , Harding S
Published: November 2023

Objectives

Cognitive dysfunction is the most frequent sequalae post TBI1with a prevalence of 25–70%2and has been implicated in poorer patient outcomes such as greater difficulties in employment, maintaining relationships, pursuing leisure activities and quality of life,3with impairments in attention, concentration, memory, language, executive functions and reduced speed of information processing.4Brief screening instruments may not identify frontal lobe disorders with impairments in executive and social function. Here we looked at the Free-Cog, a novel, hybrid, cognitive screening instrument that assess both cognitive and executive function in a single instrument5and comparing it to a known standard, the ACE III.

Methods

A cohort of 10 males with moderate to severe TBI admitted in a neuropsychiatry unit between 2021 and 2022 were assessed with both an ACE III and the Free Cog.

Results

Patients varied in age (20–71), TBI site and of differing chronicity. Z scores were calculated using published normative data. Spearman’s rho showed positive correlation between the two data sets (Correlation Coefficient 0.81818, p(2-tailed) = 0.00381).

Therefore, there was a statistically significant agreement between the subjective total Free Cog scores and the ACE III.

Conclusions

These findings indicate that the Free Cog may be a useful brief screening in TBI patients and is consistent with the Free-Cog index study which showed high correlation and similar diagnostic accuracy in old age memory clinics where it was compared with Mini Mental Screening Examination, Montreal Cognitive Assessment and the ACE-III.6These preliminary findings indicate further assessment of the Free Cog is warranted with examination of outcomes in different domains and in a wider range of TBI severity.

References

McAllister TW. Neurobehavioral sequelae of traumatic brain injury: evaluation and management.World Psychiatry2008;7(1):3–10.

Vaishnavi S, Rao V, Fann JR. Neuropsychiatric problems after traumatic brain injury: unraveling the silent epidemic.Psychosomatics2009;50(3):198–205.

Zhang J, Feinstein A. Screening for cognitive impairments after traumatic brain injury: a comparison of a brief computerized battery with the montreal cognitive assessment.J Neuropsychiatry Clin Neurosci.2016;28:328–331; doi: 10.1176/appi.neuropsych.16010005

Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury.Psychosomatics2000;41(2):95–103. Review.

Burns A, Larner AJ. Do we need yet another cognitive test? Free-Cog, a novel, hybrid, cognitive screening instrument.J Neurol Neurosurg Psychiatry2021;92:1359–1360.

Burns A, Harrison JR, Symonds C,et al. A novel hybrid scale for the assessment of cognitive and executive function: the Free-Cog.Int J Geriatr Psychiatry2020;14.
23 How the emotions of others capture our attention: a human amygdala disruption study
Authors: Jha Ashwani , Diehl Beate , Strange Bryan , Miserocchi Anna , Chowdhury Fahmida , McEvoy Andrew W , Nachev Parashkev
Published: November 2023

Aim

We instinctively look towards faces expressing strong emotions such as fear. This survival-critical response – potentially alerting us to danger – requires rapid detection (sensory) and orientation (motor) towards a facein advance ofconscious recognition of the emotion. But the neural basis of this response is unclear. Correlative evidence suggests the amygdala may play a role, but rare studies of humans with chronic amygdala damage conflict variously reporting impaired,1unaffected2or heightened3detection of fear. How the amygdala contributes to a spatially specificoculomotorresponse also requires explanation. We aimed to investigate the neural mechanisms underlying this instinctive response.

Methods

We studied six patients with intracranial unilateral amygdala electrodes temporarily implanted for the clinical evaluation of focal epilepsy. We invited them to perform a custom behavioural task designed to dissociate the location of fearful face presentation (sensory) from the direction of the orientation response (motor). We recorded eye-movements with and without focal, transient, unilateral direct electrical disruption of the amygdala in a block design. Saccade latencies and choices were modelled with multi-level Bayesian models.

Results

We analysed 1064 trials. Amygdala disruption delayed gaze shifts towards faces presented in the contralateral hemifield regardless of their emotional expression establishing the functional lateralisation of the human amygdala. Dissociating face location from response direction implicated the amygdala not only in detecting contralateral faces, but also in automatically orienting specifically towards fearful ones. This salience-specific role manifested, within a drift-diffusion model of action, as an orientation bias towards the location of potential threat. Pixel-wise analysis of target facial morphology revealed scleral exposure as its primary driver.

Conclusions

The amygdala is here re-conceptualised as a functionally lateralised instrument of earlyaction, reconciling previous conflicting accounts confined todetection, and revealing a neural organisation analogous to the superior colliculus, with which it is phylogenetically kin. Greater clarity on its role has the potential to guide therapeutic resection, and inform novel focal stimulation techniques for the management of neuropsychiatric conditions.

References

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Gamer M,et al. Curr Biol2013;23:R917–R918.

Terburg D,et al. Transl Psychiatry2012;2:e115–10.
Sensorimotor features in Autism
Authors: Nicholson Tim
Published: November 2023

Tim Nicholson is a Reader in Neuropsychiatry at the Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London where he leads the Neuropsychiatry Research and Education Group. He is an Honorary Consultant Neuropsychiatrist at the South London and Maudsley NHS Foundation Trust and King’s College Hospital NHS Foundation Trust where he currently runs a Long COVID clinic focusing on neuropsychiatric complications.

His clinical work and research covers the full spectrum of neuropsychiatry, but with a particular interest in Functional Neurological Disorder (FND) and immunopsychiatry. More recently he has focused on both the acute and chronic neuropsychiatric sequelae of COVID-19 including leading the psychiatry reporting system of the Coronerve surveillance study, the neuropsychiatry working group of the COVID-CNS project and the PC-COS study developing a Core Outcome Set for Long COVID. At the start of the pandemic he set up a weekly JNNP blog to rapidly collate and summarise the rapidly emerging data on the neuropsychiatric complications of COVID that has developed into Neuropsychiatry.net – a dynamic and expanding group of clinicians and scientists of all levels and backgrounds interested in neuropsychiatry research and education specialising in online distributed teamwork producing large and high impact systematic reviews and meta-analyses as well as increasing education activities such as a trainee led online journal club.

He also has a particular interest in psychopharmacology and wrote 6 editions of the practical prescribing guide Pocket Prescriber. He co-edits the specialist version of this book (Pocket Prescriber Psychiatry, Rogers et al) produced in collaboration with the British Association of Psychopharmacology, the 2ndedition of which is scheduled to be published later this year. He is on the executive committee of the RCPsych Neuropsychiatry Faculty, the BNPA, Chair of the MSc in Clinical Neuropsychiatry at the IoPPN and a council member of the Fellowship of Postgraduate Medicine.

A wide range of complex sensorimotor features are a common yet relatively overlooked aspect of autistic spectrum disorders (ASD). Most clinical and research attention is understandably on social and cognitive function in ASD. I will give an overview of what we know about these sensorimotor features in terms of the range of clinical features and the potential mechanisms underlying them. I will argue that these features deserve more research attention which could not only lead to a greater understanding and better management of the full range of distressing and disabling symptoms experienced by people with ASD, but also potentially provide insights into both broader brain function and dysfunction and the aetiology and management of disorders with which ASD may overlap and/or commonly co-occur with including functional as well as organic disorders.
Frontotemporal dementia and autism spectrum disorder: complex bedfellows
Authors: Hodges John
Published: November 2023

John is Professor Emeritus John Hodges, Brain and Mind centre, University of Sydney.

John qualified in Medicine from London University with honours (1975) and undertook periods of psychiatric and neurological training in Southampton, Oxford and San Diego and obtained his MD in 1988. From 1997 to 2007 he was MRC Professor of Behavioural Neurology with joint appointments in the Department of Clinical Neuroscience at Addenbrooke’s Hospital and the MRC Cognition and Brain Sciences Unit Cambridge. He moved to Sydney in 2007 obtaining an ARC Federation Fellowship and established FRONTIER with the support from the ARC and NHMRC. He has a longstanding interest in many aspects of cognition particularly in the context of neurodegenerative disorders. He is the author of over 450 journal articles and five books including Cognitive Assessment for Clinicians (OUP 2007), Early Onset Dementia (OUP) Frontotemporal Dementia Syndromes (CUP, 2007).

Although the syndrome of behavioural variant Frontotemporal Dementia (bvFTD) was recognised many years ago, the centrality of changes in social cognition became apparent around 20 years ago when it was realised that these features overlap considerably with those seen in people with Autistic Spectrum disorder (ASD). In 2002 we were the first show that patients with bvFTD had impaired performance of a range of theory of mind tasks thus consolidating the clinical overlap between bvFTD and ASD, although those with the former differ in that they progress to full blown dementia and eventual death.

After running a cognitive disorders clinic in Cambridge for a decade, we recognised a subgroup of men presenting with abnormal social cognition who had been initially diagnosed with bvFTD, yet failed to progress over many years of follow up. They have been termed ‘phenocopy cases’. It has been suggested that such men have lifelong ASD presenting in mid- to late-life because of changes in life circumstances (such as a new partner) or the additional effects of brain ageing. The aetiology of the phenocopy syndrome remains, however, contentious.

To complicate the picture, it was recognised that patients with the C9orf72 mutation (identified in 2011 and found to be the commonest genetic cause of FTD) may progress very slowly. A study screening for the mutation in phenocopy cases showed the mutation to be rarely present. In contrast, a study involving 1,400 family members of FTD patients (with and without the mutation) showed that children from C9orf72 families had a significantly higher rate of ASD. Clearly there is much to be leant. Does late life ASD simply mimic bvFTD, could ASD be a risk factor for FTD or are they separate disorders with a shared genetic background? As usual, more studies are needed.
Meaning and role of functional-organic distinction: a study of clinicians in psychiatry and neurology services
Authors: Chesterfield Alice , Harvey Jordan , Hendrie Callum , Wilkinson Sam , Vera San Juan Norha , Bell Vaughan
Published: November 2023

The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and the conditions to which they apply, as well as noting value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semistructured interviews that were analysed applying a constructivist grounded theory approach. The distinction was described as often incongruent with how clinicians conceptualise patients’ problems. Organic factors were considered to be objective, unambiguously identifiable and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors—including cultural assumptions, service demands, patient needs and colleagues’ views—were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision making required it to be used strategically. These uses included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at both individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. There was a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on.
The effects of raw and steam-pressure toasted faba bean seeds on the production performance in high-lactating dairy cows
Authors: Espinosa María E. Rodríguez , Oquendo Víctor H. Guevara , Christensen David A. , Yu Peiqiang
Published: November 2023

Introducing new feeds for feeding options requires reliable information to prove beneficial impacts on animal productivity. The objective of the study was to evaluate the effects of 10% inclusion of raw faba bean seeds (R-FBS) and steam-pressure toasted FBS (SP-FBS) on dairy production performance and metabolism. Snowbird FBS were processed by steam-pressure toasting at 121 °C for 0, 7.5, 15, and 30 min. Total mixed rations (TMRs) were prepared using R-FBS (FBS0) and SP-FBS (FBS7.5, FBS15, and FBS30). The TMRs were fed to cows (second and third lactation, 69 ± 15 days in milk, and 720 kg mean BW) for 120 days (November 2020 to February 2021). Data were analyzed using a repeated 4 × 4 Latin square design model with treatment as the fixed effect and cows as the random effect. Feed efficiency was linearly decreased as processing times increased ( P = 0.02) from 1.63 with FBS0 to 1.52 with FBS30. Milk urea nitrogen decreased from 12.18 mg/dL with FBS0 to 11.10 mg/dL with FBS30 (linear P < 0.01). Heating FBS for 7.5 min could be suitable for increasing milk fat and feed efficiency in dairy cows. We believe that high-lactating dairy cows can be fed locally grown faba beans to support their production performance.