bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of transoral laser microsurgical management of T1bstage glottic cancer
Authors: Song J A , Rigby M H , Trites J , Hart R D , Taylor S M
Published: February 2017

Objective:

This study aimed to evaluate the oncological and voice outcomes of transoral laser microsurgery for tumour stage T1bstage glottic cancer patients.

Methods:

A prospective cohort study in a tertiary care head and neck cancer centre included tumour–node–metastasis stage T1bN0M0glottic cancer patients scheduled to undergo transoral laser microsurgery from January 2002 until June 2014. Kaplan–Meier five-year analyses of local control, overall survival, disease-specific survival and laryngeal preservation were performed. Voice Handicap Index-10 scores and maximum phonation times were also recorded.

Results:

Twenty-one participants with a mean age of 66.8 years were enrolled. The mean follow up was 56.5 months. Kaplan–Meier 5-year survival analysis illustrated a local control rate of 82 per cent, overall survival of 88 per cent, disease-specific survival of 100 per cent, and laryngeal preservation of 100 per cent. The pre-operative Voice Handicap Index-10 score was 19.1 ± 9.47 (mean ± standard deviation (SD)) and the post-operative scores were 13.5 ± 9.29 at three months, 10.44 ± 9.70 at one year and 5.83 ± 4.91 at two years. The pre-operative maximum phonation time was 16.23 ± 5.46 seconds (mean ± SD) and the post-operative values were 14.44 ± 6.73 seconds at three months, 15.27 ± 5.71 seconds at one year and 14.33 ± 6.44 seconds at two years.

Conclusion:

Transoral laser microsurgery yields relatively high rates of oncological control and acceptable voice outcomes, and thus shows utility as a primary treatment modality for T1bglottic cancer.
Sustainable diets within sustainable food systems
Authors: Meybeck Alexandre , Gitz Vincent
Published: February 2017

Sustainable diets and sustainable food systems are increasingly explored by diverse scientific disciplines. They are also recognised by the international community and called upon to orient action towards the eradication of hunger and malnutrition and the fulfilment of sustainable development goals. The aim of the present paper is to briefly consider some of the links between these two notions in order to facilitate the operationalisation of the concept of sustainable diet. The concept of sustainable diet was defined in 2010 combining two totally different perspectives: a nutrition perspective, focused on individuals, and a global sustainability perspective, in all its dimensions: environmental, economic and social. The nutrition perspective can be easily related to health outcomes. The global sustainability perspective is more difficult to analyse directly. We propose that it be measured as the contribution of a diet to the sustainability of food systems. Such an approach, covering the three dimensions of sustainability, enables identification of interactions and interrelations between food systems and diets. It provides opportunities to find levers of change towards sustainability. Diets are both the results and the drivers of food systems. The drivers of change for those variously involved, consumers and private individuals, are different, and can be triggered by different dimensions (heath, environment, social and cultural). Combining different dimensions and reasons for change can help facilitate the transition to sustainable diets, recognising the food system's specificities. The adoption of sustainable diets can be facilitated and enabled by food systems, and by appropriate policies and incentives.
Introduction
Authors: Coorlawala Uttara Asha
Published: February 2017

It is my pleasure and honor here to introduce three articles by prominent scholars and practitioners of Indian dance to celebrate a set of profound, meticulous acts of devotion—the writings of Kapila Vatsyayan. These essays, originally presented at an honorary panel for Kapila Vatsyayan at the 1998 CORD Conference, offer diverse perspectives and conceptual frames that significantly enrich our appreciation of Vatsyayan's outstanding contribution to dance scholarship. The first frame, that of Janet O'shea, focuses on the interactions between body, subjectivity, a system of dancing, and their combined implications for dance studies. Joan Erdman's frame draws attention to the ways in which Vatsyayan's vision of dance interacts with Indian culture and becomes expressed as thought, art, architecture, and poetry. Mohd Anis Nor considers the impact of Vatsyayan's scholarship on the works of East Asian scholars. Finally, Vatsyayan herself speaks in an informal interview about formative influences on her writings. Her spontaneous responses reflect and confirm issues that the set of papers have raised concerning her postcolonial experience of scholarly research.

Janet O'shea, a performer of Bharatanatyam, explores how Vatsyayan's understanding of the bodily experience of dancing informs her organization of the components of dance structures. She observes that Vatsyayan's concept of dance demonstrates how the various Indian dance forms groom the body to reflect the concepts of body-shape, posture, and of articulation of movement that are listed in the theoretical texts. O'shea notes that “this methodological framework situates dance as an active cultural participant in relation to other systems of thought” and offers a model for exploring dance as a system.
The Politics of Quadrille Performance in Nineteenth-Century Martinique
Authors: Cyrille Dominique O.
Published: February 2017

Much has been said of the tradition of quadrille dancing that exists in the Caribbean. This dance and music repertory was first introduced there in the late eighteenth century by European colonists who wanted to recreate some of the aristocratic lifestyle they would have enjoyed in their country of origin. But soon after its introduction, people of African descent whom the Europeans had forcibly introduced in the Caribbean appropriated the dance and transformed it to fit the new environment.

In his overview of Caribbean music, Kenneth Bilby noted that the most ubiquitous music traditions of the Caribbean seem to be the ones that grew out of the European social dances and music genres of an earlier era (1985, 195). Establishing a parallel with the Creole music of the Seychelles, which bears strong resemblance to Caribbean forms, John Szwed and Morton Marks (1988) suggested that the French contredanse and quadrille were instrumental to the emergence of the Creole repertories, primarily because, just like many of the Caribbean islands, the Seychelles were French colonies in the eighteenth century.
Still Moving: The Revelation or Representation of Dance in Still Photography
Authors: Reason Matthew
Published: February 2017

Arnold Genthe's 1915 photograph of Anna Pavlova, taken as she leaps into the air, is perhaps the earliest photograph of free movement in dance (Fig. 1). Unlike many other early images, with long exposure times necessitating static poses or wires to hold up the dancers, this photograph depicts actual movement. This claim to authenticity and actuality is a powerful part of its appeal; looking at the image, viewers are sure that they are witnesses to a faithful reproduction of Pavlova dancing, that they are seeing the dance of the past. Considered in this manner, the photograph is an example of the revelatory power of the camera to show us what has been.

However, Genthe's photograph is not a powerful image simply because it is, authentically, of a dancer in motion. It might have mechanically frozen its subject in time, but the photograph communicates movement beyond the moment it depicts—beyond, in a sense, what it reveals photographically to what it evokes in the mind of the viewer. Viewers are able to see movement in details indicative of motion: the flowing fabric of the costume, Pavlova's bodily posture with raised and powerfully muscled thigh, the elevated arm gestures, and the sharply bent and thrusting toes. Additionally, the degree of blur in the photograph provides an indistinctness that is suggestive of something in motion; oddly, the partial obscurity of the picture prompts viewers to imagine more than they can see. All of these elements are evocative indications of movement; they are neither documentary nor part of what can be called photographic revelation, but are instead representational.
Dance and Interactivity
Authors: Birringer Johannes
Published: February 2017

A growing number of practitioners in the international community of choreographers and performers has begun to experiment with computer-assisted work linking dance and new technologies. This hardly comes as a surprise, since dance-on-film and videodance had already attracted considerable attention, at least since the 1980s. Earlier experiments, such as the astonishing films by Maya Deren, take us back to the 1940s, and today's motion capture-based animations find their historical roots in late nineteenth century motion studies in chronophotography and early cinema (Muybridge, Marey, Méliès). Furthermore, dancemakers, researchers, and teachers have used film or video as a vital means of documenting or analyzing existing choreographies. Some scholars and software programmers published tools (LabanWriter, LifeForms) that attracted attention in the field of dance notation and preservation as well as among choreographers (e.g., Merce Cunningham) who wanted to utilize the computer for the invention and visualization of new movement possibilities.
“Arabian Coffee” in the Land of the Sweets
Authors: Fisher Jennifer
Published: February 2017

Onstage, a nineteenth-century German girl waits for her first encounter with the Middle East, which will come courtesy of Tchaikovsky and the many years of choreographic evolution that have preceded the current version of The Nutcracker in which she is performing. The girl's name is Clara (or sometimes Marie), and she has come to a fantasy land, where a lively Spanish dance has been given in her honor. Now, there is softer, slower music with a steady, insistent rhythm and a snaking melody carried by an English horn. Dancers glide onto the stage wearing gauzy harem pants and jeweled headdresses, their faces impassive, their gait deliberate and stately. Who are they? Clara's face seems to ask, and what will they do? Certainly it will be like nothing she has ever seen before because they are dressed like people from far away, a hot climate perhaps, where no one moves quickly and different customs prevail. There is a woman who walks like a princess, with a cool, internal gaze and limbs that stretch out imperially. A consort picks her up and swirls her arched figure around as if she were in need of a breeze. Then they stand side by side, pausing as if transfixed by a greater power, their hands drifting above them with palms facing the sky. When they disappear, Clara stares after them, wondering, no doubt, where they came from and what on earth that was all about.
Against Expectations: Trisha Brown and the Avant-garde
Authors: Burt Ramsay
Published: February 2017

This essay gives an overview of recurring themes and concerns in Trisha Brown's work through close readings of three dance pieces from three very different periods in her career: Trillium (1962), from the early stages of Judson Dance Theatre; Roof Piece (1973), when Brown was working in close proximity with visual artists in SoHo; and Newark (1987), from the period when the Trisha Brown Company had begun performing in major international theaters and arts festivals. Throughout the successive phases or cycles of her choreographic career, Brown has continually pushed the boundaries of her work as if never satisfied but always restlessly needing to move on. Nevertheless, looking back from the first decade of the twenty-first century, two artistic concerns emerge that have remained in constant, productive tension throughout Brown's long career as a dancer and choreographer. On the one hand, she has searched for new ways of moving by working with improvisation and by investigating through body images the neuro-skeleto-muscular sources of movement. But the ways in which she has set innovative new movement nevertheless exemplify a radical, often conceptual approach to choreographic structure. Her work thus forecloses safe, known, predictable aesthetic experiences and pushes the spectator to find and appreciate new, previously unknown qualities.
Moving Out of the Black and Into the Blue: The Cross-referencing of Performative Metaphor in Dancing, Psychotherapy, and Writing
Authors: Edsall Mary E.
Published: February 2017

Introduction: This article cross-references metaphors in therapy, performance, and writing. It is an exploration of the power of metaphor and image in a path of personal discovery. Utilizing interpretive and aesthetical modes of inquiry, I investigate my lived experience in these three activities as applied and manifested in a concert performance, “No Two Alike and Other Dances by Alan Good and Philip Grosser” (Grosser 2001a), within which I was a featured dancer. Through meta-analysis of my clinical work in therapy, deconstruction of certain sections of the dance work as it was created and performed, and a review of personal journals, text and drawings, I examine the transverse effects of the dance, psychotherapeutic processes, and writing, as well as the aesthetical concern of discovering and conveying personal voice in performance.
Reading the Ballerina's Body: Susan Bordo Sheds Light on Anastasia Volochkova and Heidi Guenther
Authors: Oliver Wendy
Published: February 2017

In September of 2003, Bolshoi Ballet dancer and media star Anastasia Volochkova, 27, was fired from her job. The main reason given was that at 5′7″ and 110 lbs., she was too tall and too heavy for her partners to lift. Yekaterina Norikova, spokeswoman for the Bolshoi, said: “The problem is that male dancers complained of her height and weight and refused to dance with her” (quoted in Isachenkov 2003). Yevgeny Ivanchenko, her former partner, publicly declared her too heavy to lift, saying that he risked injury in working with her. The Russian newspaper Vremya Novostei used the headline “Not even bears could hold [her]” (Kishkovsky, 2003, A1).

In her interviews with the press, she said that she is in excellent shape and follows a strict diet. “I don't eat ice cream now,” said Ms. Volochkova, who once told a Russian interviewer that she adores it. “I eat spinach leaves and vegetables.” She also declared that “Height and weight are not the test of a great ballerina” (2003, A1).
In the Presence of the Body: Theorizing Training, Injuries and Pain in Ballet
Authors: Aalten Anna
Published: February 2017

After an injury; a dancer learns, at least for a short time, to heed his [sic] body if only because pain speaks a language almost anyone can understand. This heightened awareness should not disappear once the dancer returns to form; rather it should help him continue to learn about the ways his body moves and reacts (Ashley 1984, 217–218).

In this statement the American dancer Merrill Ashley, who had a memorable 30-year career with the New York City Ballet, expresses a view on injuries that goes against the grain of dominant thinking within the world of ballet. According to Ashley, who suffered from several injuries in her first two years with the company, an injury can be a positive experience for a dancer, because it heightens her awareness of her body and teaches her about its possibilities and limitations. This is a rather exceptional view in a world where the vast majority of professionals commonly see injuries as a disaster (Wulff 1998; Wainwright, Williams and Turner 2005). The dominant realization that a dancer's career is short makes dancers fear an injury, because it will prevent them from dancing and cause them to lose roles. Because “there is a rule in the ballet world against casting or promoting dancers who are injured” (Wulff 1998, 106), dancers who suffer from an injury will wait as long as possible before letting others know, because they are afraid it will stop them dancing (Mainwaring, Krasnow and Kerr 2001).
Belly Dance: Orientalism—Exoticism—Self-Exoticism
Authors: Shay Anthony , Sellers-Young Barbara
Published: February 2017

The Orient was almost a European invention, and had been since antiquity a place of romance, exotic beings, haunting memories and landscapes, remarkable experiences. (Said 1978,1)

The past century has witnessed the phenomenon of belly dancing becoming a key icon of the Middle East in the West. This iconic representation often causes outrage, resentment, and even protest among Arabs who resent Westerners (mis)representing them by focusing on cabaret-style belly dance, a low-class and disreputable symbol for many in the Arab world, as a primary media image of the Middle East. Since the 1970s, millions of women and some men in the West have been attracted to belly dancing, investing millions of dollars and enormous time acquiring the basic skill of the dance in order to perform it. This essay will address several issues that are raised by the phenomenon of belly dancing and its transformation, globalization, and acculturation in the West; it is designed to develop a newly emerging area of performance/cultural research, drawing from the fields of dance and transnational studies.
Modern Dance Alla Turca: Transforming Ottoman Dance in Early Republican Turkey
Authors: Öztürkmen Arzu
Published: February 2017

This essay looks at the works of Selma Selim Sırrı (b. 1906) and her father Selim Sırrı Tarcan (1874–1956), who wrote on dance in the 1920s, a period that marked the transition from the Ottoman Empire to modern Turkey. The Ottoman Empire ruled across the Mediterranean world between the thirteenth and twentieth centuries, collapsing after World War I. The Republic of Turkey was declared in 1923, distancing itself from the Ottoman tradition to adopt a westernization reform program. Written in the early Republican era, the works of Selma Selim Sırrı and Selim Sırrı Tarcan mark the shift from Ottoman dance traditions to a more Western approach to dance. Inspired by Isadora Duncan, Selma Selim Sırrı (1926) explored the idea of modern dance for Ottoman women in a booklet entitled Selma Selim Sırrı Hanım'ın Bedii Raksları (The Aesthetic Dances of Miss Selma Selim Sırrı, see Fig. 1). Her father was the author of Halk Dansları ve Tarcan Zeybeği (Folk Dances and the Tarcan Zeybek, see Fig. 2), a book that focused on the process of refining folk dances, in particular the zeybek genre, to suit the tastes of an educated, urban audience.
Afterword
Authors: Dils Ann
Published: February 2017

The discussion that followed the original presentation of these papers at the 1989 conference speculated on the possibilities of radically reconstructing Tudor's work, somehow re-arranging the gender roles he assigns in order to comment on his covert construction of gender. Reactions varied: some conference participants asserted it was an interesting idea, but felt they wouldn't want to violate Tudor's intentions; others thought this was perfectly acceptable, that the definition of the work needed to be open-ended and include many possibilities. One audience member felt our panel might be considered an instance of the work, especially because Giffin and Maletic performed motifs from the dance.

These diverse opinions reflect alternate understandings of what our panel accomplished. On the one hand, our search for constitutive properties is a way of documenting and preserving Dark Elegies. The search for constitutive properties details what has happened in various performances and the content of the score, and also tries to recapture Tudor's thinking. Through his analysis of the score, Giffin discusses Tudor's choreographic constructions and distinctive ways of using the body.
Note on the Papers by J. Holtan and By J. Lemaire & H. Zi
Authors: Holtan Jon
Published: February 2017

According to the editorial rules of treating discussion situations in the ASTIN Bulletin the paper by J. Lemaire & H. Zi being somewhat a discussion on Holtan's paper was sent to the author of the original paper, who was given the opportunity to make an additional comment. The editors then received the following note by Jon Holtan:

In this note I want to give some general comments on the papers by Lemaire & Zi (1994) and Holtan (1994).

Interpret henceforth a bonus-malus (BM) principle as consisting of two basic components:

(a) The BM design.

(b) The BM tariff parameters.

Traditional actuarial literature has basically been preoccupied with component (b). Or more precisely, the tariff parameters of an initial accepted BM design have usually been mathematically optimalized within different criteria of succes like e.g. high efficiency and financial balance. In my opinion, however, this strategy seems to be too narrow if the aim is to construct a BM principle which is totally optimalized in favour of both the insurer and the insured. In our strive for maximizing BM advantages and minimizing BM disadvantages, actuarial BM research should instead simultaneously focus on both components (a) and (b). The construction of the High-Deductible System (HDS) in Holtan (1994) is an example of this strategy. However, as pointed out in Lemaire & Zi (1994) (see Section 1 and 4) and Holtan (1994) (see Section 3, 5 and 6), a HDS compared with existing BM systems both eliminates and generates important disadvantages which are linked to component (a). Based on some mathematical model assumptions, Lemaire & Zi moreover concludes (see Section 3 and 5) that this two-sided conclusion is in principle also valid within some mathematical criteria of success linked to component (b). These complex, and perhaps confusing, conclusions make it difficult for us to decide whether to prefer the existing BM systems or the HDS. However, the solution to this problem of decision seems to be naturally dependent on some strategic questions like: What kind of BM advantages and what kind of BM disadvantages will be the most important to focus on in the future automobile insurance market?
The Use of Microsatellites in Zygosity Diagnosis of Twins
Authors: Erdmann J. , Nöthen M.M. , Stratmann M. , Fimmers R. , Franzek E. , Propping P.
Published: February 2017

Although numerous genetic and anthropological markers are available for determining zygosity of twins, there is still a need for a more practical and informative method in zygosity diagnosis. Dinucleotide repeats or other short repeats (microsatellites) are highly variable between individuals and offer a simple, fast, cheap, and exact approach for zygosity determination. The feasibility of a set of microsatellites to be used for this purpose is demonstrated.
Recovery and germination of seeds after passage through the gut of Kazakh sheep on the north slope of the Tianshan Mountains
Authors: Wang Shulin , Lu Weihua , Waly Narkes , Ma Chunhui , Zhang Qianbing , Wang Chuanjian
Published: February 2017

Endozoochorous dispersal of seeds by livestock has long attracted the attention of grassland scientists. However, little is known about seed dispersal after ingestion by Kazakh sheep on dry grasslands in the Tianshan Mountains. The objective of this experiment was to learn more about the recovery and germinability of seeds from 17 plant species after either actual or simulated ingestion (i.e. insertion through a rumen fistula) by Kazakh sheep. The passage time of seeds through the sheep gut ranged from 12 to 96 h. More than 80% of all recovered seeds were defecated 24–48 h after ingestion. The mean retention time of seeds in the gut ranged from 27.3 to 42.2 h. Seed recovery percentage ranged between 12.6 and 17.6% for leguminous species and between 0.8 and 3.2% for gramineous species. Seed recovery percentage was positively correlated with seed mass, but negatively correlated with seed shape. The germination percentages of the gramineous species were greater in the non-ingested treatment (66–98%) than in the simulated ingestion treatment (3–10%). In contrast, for leguminous species, seed germination percentages were greater in the simulated ingestion treatment (23–70%) than in the non-ingested one (5–12%). Seed germination percentage after simulated ingestion was positively correlated with seed mass, but negatively correlated with seed shape. In conclusion, leguminous seeds were more likely than gramineous ones to pass through the gut of Kazakh sheep and then germinate. Free-ranging Kazakh sheep can contribute to the spread of plant species, especially leguminous species, in the Tianshan Mountains.
Habitat-correlated seed germination and morphology in populations of Phillyrea angustifolia L. (Oleaceae)
Authors: Mira Sara , Arnal Alberto , Pérez-García Félix
Published: February 2017

The broad aim of this work was to study intraspecific variation of seed germination in Phillyrea angustifolia L. (Oleaceae), a species with a hard (water-permeable) endocarp. Germination of seeds from six different wild populations was correlated with traits related either to seed morphology or to environmental parameters. Germination of naked seeds (seeds without endocarp) at the optimum germination conditions was similar among populations and individuals, but great differences could be detected regarding the germination of seeds with endocarp both at inter- and intra-populational levels. Differences among populations could be related to climatic parameters and to morphometric variables of seeds with endocarp. A higher germination was associated with populations growing in habitats with more severe summer (higher temperature, lower precipitation and a longer drought period) and producing elongated seeds (lower Feret ratio and roundness). Moreover, seeds from eight different individuals within a population were tested independently, and great differences regarding the germination of seeds with endocarp could be detected among individuals. Our results suggest that the morphological variation found in P. angustifolia endocarp is both under strong maternal genetic control as well as influenced by environmental factors, as indicated by the high variability among individuals within one population and the significant correlation between climate variables and seed germination among populations. Finally, it is emphasized that standardization of plant propagation protocols should take into account the degree of intraspecific variation of Mediterranean species.
Heterogeneity of the Jealousy Phenomenon in the General Population: An Italian Study
Authors: Marazziti Donatella , Sbrana Alfredo , Rucci Paola , Cherici Luca , Mungai Francesco , Gonnelli Chiara , Massimetti Enrico , Raimondi Francesca , Doria Maria Rosaria , Spagnolli Sabrina , Ravani Laura , Consoli Giorgio , Osso Mario Catena Dell
Published: February 2017

Introduction: Despite the general agreement that normal jealousy is heterogenous, little is known about this specific topic.

Methods: In the present study, we explored the possibility of distinguishing between four subtypes of “normal” jealousy (depressive, anxious, obsessive, and paranoid) amongst a cohort of 500 healthy university students by means of a specifically designed questionnaire, “Questionario della gelosia” (QUEGE). QUEGE is a self-report instrument of 30 items which explores the presence, frequency, and duration of feelings and behaviors related to jealousy. It was devised to investigate four hypothetical psychopathological profiles: depressive, paranoid, obsessive, and anxious.

Results: The factor analysis identified five rather than four clear-cut factors: self-esteem, paranoia, interpersonal sensitivity, fear of being abandoned, and obsessionality. Women showed statistically significant lower levels of self-esteem and higher levels of obsessionality than men. Younger age (<25 years) was associated with lower self-esteem and higher levels of paranoia and obsessionality, while being single was associated with lower self-esteem and higher levels of obsessionality.

Conclusion: The present study provides evidence of the reliability and validity of the QUEGE instrument, which seems to identify the presence of five psychopathological dimensions within the jealousy phenomenon in the general population.
Play it Again: The Master Psychopharmacology Program as an Example of Interval Learning in Bite-Sized Portions
Authors: Stahl Stephen M. , Davis Richard L. , Kim Dennis H. , Lowe Nicole Gellings , Carlson Richard E. , Fountain Karen , Grady Meghan M.
Published: February 2017

Medical education often presents new material as large data dumps at a single live event (lecture or symposium), in part because it is traditional, and also because this structure can be perceived as the most time efficient for busy clinicians and their teachers. However, modern learning theory and new insights from the neurobiological basis of long-term memory formation show that the format of single-event presentation of materials is not very effective. Rather, seeing the presentation of new materials over time, in bite-sized chunks, and then seeing them again at a later time, particularly as a test, leads to more retention of information than does learning the same amount of material as a large bolus in a single setting. This notion of learning over time, also called “interval learning” or “spaced learning,” is particularly well adapted to the Internet era. Here we describe an application of this concept to the learning of psychopharmacology over time in bite-sized and repeated portions structured as an “online fellowship” called the Master Psychopharmacology Program (www.neiglobal.com/mpptour).
The Clinical Future of Repetitive Transcranial Magnetic Stimulation and Depression: Separating Hope From Hype
Authors: Pallanti Stefano , Schlaepfer Thomas E. , Lisanby Sarah H.
Published: February 2017

One of the key messages of the Sequenced Treatment Alternatives to Relieve Depression study was that only one third of patients with a diagnosis of major depressive disorder (MDD) achieve remission after the first treatment with an antidepressant. Management of most patients after one or more failed trials moves beyond the currently available evidence base and therefore represents a significant clinical challenge. Over the course of the four treatment steps, the cumulative remission rate was 67% and remission was more likely to occur during the first two treatment levels (20% to 30%) rather than during levels 3 and 4 (10% to 20%). These finding suggest that after two consecutive unsuccessful antidepressant trials a change in pharmacologic mode of action has a low probability to affect the likelihood of remission from MDD. The switch to a third antidepressant treatment resulted in an even lower remission rate than the one achieved in the first two levels. Furthermore, the discontinuation rates due to treatment intolerance was shown to rise across sequenced levels. At this point, the search for effective and tolerable alternative options to pharmacotherapy is essential.
Cerebral Ventricular Asymmetry and Ventriculomegaly Interact to Increase Risk for Schizophrenia: A Case Report and Recommendation for Routine Fetal Sonography
Authors: Katz Elionora , Burket Jessica A. , Rosse Stephanie M. , Rosse Richard B. , Schwartz Barbara L. , Deutsch Stephen I.
Published: February 2017

A 60-year-old patient with a clinical diagnosis of schizophrenia underwent a magnetic resonance imaging (MRI) scan related to the evaluation of isolated seizures that emerged while medicated with clozapine. Unexpectedly, the MRI scan revealed evidence of asymmetric and enlarged cerebral ventricles that were interpreted as congenital in origin. The presence of both congenital lateral ventricular asymmetry and ventriculomegaly may interact to increase risk of schizophrenia. The history and clinical features, including cognitive testing, of the illustrative patient are presented.
Use of SSRIs May Impact Bone Density in Adolescent and Young Women With Anorexia Nervosa
Authors: Misra Madhusmita , Le Clair Marie , Mendes Nara , Miller Karen K. , Lawson Elizabeth , Meenaghan Erinne , Weigel Thomas , Ebrahimi Seda , Herzog David B. , Klibanski Anne
Published: February 2017

Objectives: Alterations in serotonin impact bone metabolism in animal models, and selective serotonin reuptake inhibitors (SSRIs) have been associated with increased fracture risk in older adults. SSRIs are commonly used in anorexia nervosa (AN), a condition that predisposes to low bone mineral density (BMD). Our objective was to determine whether SSRI use is associated with low BMD in AN.

Methods: We examined Z-scores for spine, hip, and whole body (WB) BMD, spine bone mineral apparent density, and WB bone mineral content/height (BMC/Ht) in females 12–21 years of age with AN who had never been on SSRIs, had been on SSRIs for <6 months (<6M), or had been on SSRIs for >6 months (>6M).

Results: Subjects on SSRIs for >6M had lower spine, femoral-neck, and WBBMD Z-scores than those on SSRIs for <6M. Hip BMD and WBBMC/Ht Z-scores were lowest in subjects on SSRIs for >6M. Duration of SSRI use, duration since AN diagnosis and duration of amenorrhea inversely predicted BMD, whereas BMI was a positive predictor. In a regression model, duration of SSRI use remained an independent negative predictor of BMD.

Discussion: Duration of SSRI use >6M is associated with low BMD in AN.

Conclusion: It may be necessary to monitor BMD more rigorously when duration of SSRI use exceeds 6M.
Cerebrospinal Fluid Tau and Amyloid β Proteins Do Not Correlate With Cognitive Functioning in Cognitively Impaired Memory Clinic Patients
Authors: Spies Petra E. , Claassen Jurgen A.H.R. , Slats Diane , Rikkert Marcel G.M. Olde , Verbeek Marcel M. , Kessels Roy P.C.
Published: February 2017

Objective: The aim of this study was to investigate the influence of cerebrospinal fluid (CSF), amyloid β42(Aβ42), phosphorylated tau181 (p-tau), and total tau (t-tau) on cognitive functioning.

Methods: We analyzed the ability of the CSF biomarkers Aβ42, p-tau, and t-tau to predict the results on the Cambridge Cognitive Examination–Revised (CAMCOG-R), a cognitive screening test that assesses multiple cognitive domains, in 65 memory clinic patients (73.1±8.2 years) (n=30 probable Alzheimer's disease [AD], n=7 possible AD, n=12 non-AD dementia, n=16 mild cognitive impairment).

Results: We found no correlations between CSF biomarkers and CAMCOG-R performance in the whole group, nor in subgroups based on aberrant biomarker concentrations.

Discussion: Changed concentrations of CSF amyloid β42, p-tau, and t-tau cannot be directly linked to cognitive function in our sample of patients with cognitive impairment. Possibly, compensatory mechanisms such as cognitive reserve determine cognitive performance, rather than the absolute amount of damage caused by Aβ deposition and tangle formation. In addition, abnormal CSF biomarker concentrations may not be a direct reflection of the amount of neuronal damage, but merely serve as an indicator of AD pathology.

Conclusion: While CSF biomarkers are valuable in establishing AD pathology, they cannot be used to predict severity of cognitive impairment.
Comorbid Depressive Disorders in Epilepsy
Authors: Kanner Andres M. , Cole Andrew J.
Published: February 2017

A 27-year-old woman presented to the emergency room after having witnessed generalized tonic clonic seizure while asleep. Birth and development were normal. She had suffered a single febrile seizure at 13 months of age, but had no other seizure risk factors. She was otherwise well except for a history of depression for which she was taking sertraline. Depressive symptoms had been well controlled over the past 3 months, but she had been under increased stress working to finish a doctoral thesis. Neurological examination was normal. Magnetic resonance imaging (MRI) showed modest asymmetry of the hippocampi, slightly smaller on the right, but no abnormal signal and well-preserved laminar anatomy. An electroencephalogram was negative. She was discharged from the emergency room with no treatment. Three weeks later, the patient's boyfriend witnessed an episode of behavioral arrest with lip smacking and swallowing automatisms lasting 45 seconds, after which the patient was confused for 20–30 minutes. The next morning she and her boyfriend kept a previously scheduled appointment with a neurologist.
Targeted Care Plans for Schizophrenia
Authors: Freudenreich Oliver
Published: February 2017

Thomas was a 40-year-old, white male, with a 16-year history of schizoaffective disorder (Slide 1). He first became ill at 24 years of age and had an unstable course for ∼10 years, characterized by frequent hospitalizations and partial adherence. Unfortunately, during episodes of psychosis, he was also extremely violent. During his first hospitalization, risperidone was initiated, which he used intermittently for ∼10 years. There are no records documenting his weight and metabolic parameters at 24 years of age prior to receiving psychiatric medications. During his last psychiatric hospitalization at 34 years of age, olanzapine was prescribed and he stabilized. He entered a period of stable outpatient treatment and had not had a psychiatric hospitalization for 6 years.

When Thomas began taking olanzapine, his weight was 200 lbs, which, given his height, corresponds to a body mass index (BMI) of 28, putting him in the overweight category. However, he had no metabolic monitoring for 3 years. After 3 years of treatment with olanzapine, he had gained substantial weight, increasing to 258 lbs, which corresponds to a BMI of 36 and class 2 obesity.
Understanding Therapeutic Equivalence in Epilepsy
Authors: Sankar Raman , Glauser Tracy A.
Published: February 2017

The issues surrounding generic drug substitution in patients with epilepsy are complex.The substitution of one formulation of an antiepileptic drug (AED) for another is controversial. Well-reasoned and defensible cases can be made both for and against such substitution. Although regulatory agencies require that generic and proprietary drugs have similar pharmacokinetic bioequivalence data, their therapeutic efficacy may not necessarily be identical. The paroxysmal nature of epilepsy, the narrow therapeutic index of some AEDs, the need to. individualize therapy to achieve seizure control, and the negative consequences of uncontrolled epilepsy distinguishes epilepsy from other clinical conditions. Epilepsy management with AEDs requires careful dose titration and consistent drug exposure at the optimal level for each patient, which can be altered if a different formulation of the AED is substituted. Unexpected variability in plasma concentrations could occur when a patient who has been receiving one formulation of an AED (generic or brand) receives an alternate formulation.Thus, no substitutions should be made for people with epilepsy without the knowledge and approval of the prescribing physician. Patients should be consulted about the substitution, with all risks and benefits carefully explained.
Separating Hope from Hype:Some Ethical Implications of the Development of Deep Brain Stimulation in Psychiatric Research and Treatment
Authors: Schlaepfer Thomas E. , Lisanby S.H. , Pallanti Stefano
Published: February 2017

Major depression is the most common serious brain disorder with a lifetime prevalence of up to 17%. Despite numerous options currently available for the treatment of depression, ~2 million people in the United States may experience an inadequate response to treatment (treatment-resistant depression [TRD]) at some point in their lives. The definition of TRD is variable, ranging from a failure to respond to two or more trials of antidepressant monotherapy to a failure to respond to four or more trials of different antidepressant therapies, including augmentation, combination therapy, and electroconvulsive therapy. It has been reported that as many as one-third of patients experience only a partial response to initial therapy, while nearly one-fifth are considered nonresponders. In addition to the obvious quality of life issues for the patient with TRD, the economic cost of TRD is significant. Annual healthcare costs increase significantly for patients with TRD with each successive change in antidepressant medication. Early in treatment (two medication changes), the annual costs are <$7,000/Year. By the eighth medication change, annual costs double to nearly $14,000/year.

There is a well-documented need for better long-term treatments for TRD, as witnessed by multiple efforts to establish treatment algorithms and best treatment steps when first and subsequent treatment measures prove inadequate. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which analyzed outcome following several standardized antidepressive treatment steps, reported that 33% of patients did not respond even after four evidence-based treatment steps. A substantial proportion of patients are inadequately treated and some of these will go on to suffer from chronic, debilitating, and life-threatening symptoms.
Evaluation of the Effects of Severe Depression on Global Cognitive Function and Memory
Authors: McClintock Shawn M. , Cullum C. Munro , Husain Mustafa M. , Rush A. John , Knapp Rebedca G. , Mueller Martina , Petrides Georgios , Sampson Shirlene , Kellner Charles H.
Published: February 2017

Introduction: Major depressive disorder (MDD) is thought to negatively impact cognitive function; however, the relationship has not been well explored.

Objective: This study examined the association between depression severity and global cognitive function and memory in subjects with severe, treatment-resistant MDD.

Methods: We enrolled 66 subjects with Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosed unipolar MDD in a multicenter trial to assess the efficacy and neurocognitive effects of electroconvulsive therapy (ECT). We measured depression severity with the 24 item Hamilton Rating Scale for Depression (HRSD24). Neuropsychologic measures included the Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), and the Complex Figure Test (CFT). Correlational and regression analyses were conducted to explore associations between depression severity and cognitive function.

Results: The mean age of the subjects was 53.6 years (SD=15.8), 65% were female, and mean HRSD24 was 33.9 (SD=6.7). Mean demographic-corrected T-scores for each neurocognitive measure were in the average to borderline range, and HRSD24 values were unrelated to performance on the MMSE, RAVLT immediate and delayed recall, and CFT immediate and delayed recall.

Conclusion: In this sample of severely depressed subjects referred for ECT, depression severity was unrelated to global cognitive function or memory. Future research should examine the interactions between other depressive characteristics and neurocognitive function.
Adherence to Treatment and Therapeutic Strategies in Schizophrenic Patients: The ADHERE Study
Authors: Gutiérrez-Casares José Ramón , Cañas Fernando , Alonso-Escolano David , Hidalgo-Borrajo Rebeca , Rodríguez-Morales Alexander
Published: February 2017

Aim: To assess the degree of compliance and adherence to treatment during the follow-up of schizophrenic outpatients after a new therapeutic strategy had been initiated.

Methods: A multicenter, retrospective, prospective, observational study of 1,848 outpatients with schizophrenia or schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) was conducted. Patients were treated either with oral or injectable conventional or second generation antipsychotics, and were followed up for 3 months at mental health centers. Patient compliance with the pharmacological treatment was assessed by the use of questionnaires, scales, medication accountability, and the Medication Event Monitoring System. Patients were considered compliant if they reported a high compliance rate (≥80%).

Results: At baseline only 29% of patients on oral medication were compliant compared with 79% of patients on injectable medication (injection counting) (OR= 9.11; 95% CI 6.02-13.77; P<.0001). At the 3 month visit, 84% of patients had changed their treatment and in these, the compliance rate of those on injectable medication was 94% versus 87% of patients taking oral medication (OR= 2.47; 95% CI 1.21-5.05; P=.022).

Conclusion: The use of long-acting injectable antipsychotics, which improves compliance rates and patient follow-up, should facilitate the management of Spanish patients with schizophrenia in mental health centers.
Comorbidities with Bipolar Disorders: Significance, Recognition, and Management
Authors: Bowden Charles L.
Published: February 2017

Bipolar disorder, particularly bipolar type I disorder, is at least as highly comorbid with other psychiatric and behavioral disorders as any Axis I medical disorder (Slide 1). Two iterations of the National Comorbidity Survey study, which is epidemio-logic-based and not anecdotal evidence from clinical offices and hospital emergency rooms, have shown that these data are reflective of the overall population in the United States and potentially for all other countries across the world.

In particular, if the prevalence rates of all anxiety disorders are grouped together, they are almost as prevalent as bipolar disorder itself, and clinicians rarely see a patient with bipolar disorder who does not have an anxiety disorder. This finding raises the question that anxiety may not be a separate entity, but an additional fundamental component of bipolar symptomatology, at least for a substantial number of patients. Regardless, the role of anxiety in bipolar disorder is unique. Perugi and colleagues studied the time sequence of different anxiety disorders in relation to first presence and clinical recognition of bipolar disorder (Slide 2). In contrast to panic disorder/agoraphobia and obsessive-compulsive disorder (OCD), social anxiety or social phobia was shown to be prevalent in 94.7% of patients prior to onset of hypomania and the clinically recognizable problematic school and home situations before the diagnosis of the bipolar disorder. This finding suggests that there may be some fundamental aspect of social anxiety and other anxiety disorders that is a ties. These patients tend to be more unstable symptomatically and have multiple comorbidities.
Pharmacologic Treatment of Bipolar Disorder
Authors: Baldassano Claudia
Published: February 2017

Regarding the treatment of patients with bipolar disorder, positive findings have shown that patients engaged in treatment may live longer. Angst and Sellaro studied standardized mortality ratios for patients with bipolar disorder and found a significant reduction in mortality ratio in our bipolar patients who were actively in treatment (Slide 1). Data from the Collaborative Depression Study by Judd and colleagues showed that bipolar patients are quite symptomatic. Judd and colleagues followed bipolar patients over a 13-year period and found that these patients were symptomatic ~50% of the study period. What were these patients most likely to be symptomatic with: bipolar depression (Slide 2). Thus, it is important to focus on bipolar depression and examine placebo-controlled trials that were adequately powered in its treatment.

Over the last decade, there have been positive trials studying lamotrigine, quetiapine, olanzapine, and olanzapine-fluoxetine combination. Two of these medications are United States Food and Drug Administration—approved in bipolar disorder treatment: quetiapine and olanzapine-fluoxetine. There are a number of negative trials in bipolar depression, including a number of antidepressant monotherapy trials and antidepressants in combination with mood stabilizers (Slide 3). However, what is the most frequent pharmacotherapy treatment used for bipolar depression? It is the use of antidepressants alone; antidepressant monotherapy is twice as commonly prescribed as mood stabilizers (Slide 4). Thus, it is necessary for clinicians to possess knowledge of the evidence and results from both positive and negative antidepressant trials for bipolar disorder.