bluuebunny/crossref_metadata_2025 huggingface dataset:
Intergenerational transmission of delay discounting: The mediating role of household chaos
Authors: Peviani Kristin M. , Kahn Rachel E. , Maciejewski Dominique , Bickel Warren K. , Deater‐Deckard Kirby , King‐Casas Brooks , Kim‐Spoon Jungmeen
Published: March 2019

Introduction

Adolescence is a period when impulsive decision making may be especially vulnerable to environmental influences. Impulsive decision making is often assessed using a delay discounting paradigm, which measures the preference for smaller rewards sooner over larger rewards with a delay. Research is needed to clarify the relationship between parents' and adolescents' delay discounting and to identify related environmental processes that might facilitate the intergenerational transmission of delay discounting. The current prospective longitudinal study examined the competing mediating processes of household chaos and harsh parenting in the intergenerational transmission of delay discounting between parents and adolescents.

Methods

Participants included 167 adolescents (mean age = 14.07 years at Time 1; 53% male) and their parents (mean age = 41.98 years at Time 1; 87% female) recruited from the southeast United States. Parents' delay discounting was collected at Time 1, and adolescents' delay discounting was collected both at Time 1 and at Time 3 via a computerized delay discounting task. Parents and adolescents reported household chaos and harsh parenting at Time 2.

Results

A parallel mediation model indicated that parents' delay discounting at Time 1 indirectly predicted adolescents' delay discounting Time 3 residualized change scores (regressing Time 3 delay discounting onto baseline delay discounting) through household chaos but not through harsh parenting at Time 2.

Conclusions

These results underline the importance of household chaos in facilitating the intergenerational transmission of delay discounting between parents and adolescents. Furthermore, our findings point to household chaos as a potential environmental target for interrupting intergenerational impulsivity.
GL-EQUIVARIANT MODULES OVER POLYNOMIAL RINGS IN INFINITELY MANY VARIABLES. II
Authors: SAM STEVEN V , SNOWDEN ANDREW
Published: March 2019

Twisted commutative algebras (tca’s) have played an important role in the nascent field of representation stability. Let $A_{d}$ be the tca freely generated by $d$ indeterminates of degree 1. In a previous paper, we determined the structure of the category of $A_{1}$-modules (which is equivalent to the category of $\mathbf{FI}$-modules). In this paper, we establish analogous results for the category of $A_{d}$-modules, for any $d$. Modules over $A_{d}$ are closely related to the structures used by the authors in previous works studying syzygies of Segre and Veronese embeddings, and we hope the results of this paper will eventually lead to improvements on those works. Our results also have implications in asymptotic commutative algebra.
Motion-capture system to assess intraoperative staff movements and door openings: Impact on surrogates of the infectious risk in surgery
Authors: Birgand Gabriel , Azevedo Christine , Rukly Stephane , Pissard-Gibollet Roger , Toupet Gaëlle , Timsit Jean-François , Lucet Jean-Christophe ,   the ARIBO Study Group
Published: March 2019

Objectives:

We longitudinally observed and assessed the impact of the operating room (OR) staff movements and door openings on surrogates of the exogenous infectious risk using a new technology system.

Design and setting:

This multicenter observational study included 13 ORs from 10 hospitals, performing planned cardiac and orthopedic surgery (total hip or knee replacement). Door openings during the surgical procedure were obtained from data collected by inertial sensors fixed on the doors. Intraoperative staff movements were captured by a network of 8 infrared cameras. For each surgical procedure, 3 microbiological air counts, longitudinal particles counts, and 1 bacteriological sample of the wound before skin closure were performed. Statistics were performed using a linear mixed model for longitudinal data.

Results:

We included 34 orthopedic and 25 cardiac procedures. The median frequency of door openings from incision to closure was independently associated with an increased log10 0.3 µm particle (ß, 0.03; standard deviation [SD], 0.01; P = .01) and air microbial count (ß, 0.07; SD, 0.03; P = .03) but was not significantly correlated with the wound contamination before closure (r = 0.13; P = .32). The number of persons (ß, −0.08; SD, 0.03; P < .01), and the cumulated movements by the surgical team (ß, 0.0004; SD, 0.0005; P < .01) were associated with log10 0.3 µm particle counts.

Conclusions:

This study has demonstrated a previously missing association between intraoperative staff movements and surrogates of the exogenous risk of surgical site infection. Restriction of staff movements and door openings should be considered for the control of the intraoperative exogenous infectious risk.
Drag force on an accelerating submerged plate
Authors: Grift E. J. , Vijayaragavan N. B. , Tummers M. J. , Westerweel J.
Published: March 2019

We present results on the drag on, and the flow field around, a submerged rectangular normal flat plate, which is uniformly accelerated to a constant target velocity along a straight path. The plate aspect ratio is chosen to be$AR=2$to resemble an oar blade in (competitive) rowing, the sport which inspired this study. The plate depth, i.e. the distance from the top of the plate to the air–water interface, the plate acceleration and the plate target velocity are varied, resulting in a plate width based Reynolds number of$4\times 10^{4}\lesssim Re\lesssim 8\times 10^{4}$. In our analysis we distinguish three phases; (i) the acceleration phase during which the plate drag is enhanced, (ii) the transition phase during which the plate drag decreases to a constant steady value upon which (iii) the steady phase is reached. The plate drag force is measured as function of time which showed that the steady-phase plate drag at a depth of$1/5$plate height (20 mm depth for a plate height of 100 mm) increased by 45 % compared to the plate top at the surface (0 mm). Also, it is shown that the drag force during acceleration of the plate increases over time and is not captured by a single added mass coefficient for prolonged accelerations. Instead, an entrainment rate is defined that captures this behaviour. The formation of starting vortices and the wake development during the time of acceleration and transition towards a steady wake are studied using hydrogen bubble flow visualisations and particle image velocimetry. The formation time, as proposed by Gharibet al.(J. Fluid Mech., vol. 360, 1998, pp. 121–140), appears to be a universal time scale for the vortex formation during the transition phase.
Multidimensional regular C-fraction with independent variables corresponding to formal multiple power series
Authors: Dmytryshyn R. I.
Published: March 2019

In the paper the correspondence between a formal multiple power series and a special type of branched continued fractions, the so-called ‘multidimensional regular C-fractions with independent variables’ is analysed providing with an algorithm based upon the classical algorithm and that enables us to compute from the coefficients of the given formal multiple power series, the coefficients of the corresponding multidimensional regular C-fraction with independent variables. A few numerical experiments show, on the one hand, the efficiency of the proposed algorithm and, on the other, the power and feasibility of the method in order to numerically approximate certain multivariable functions from their formal multiple power series.
Regularity results for the 2D critical Oldroyd-B model in the corotational case
Authors: Ye Zhuan
Published: March 2019

This paper studies the regularity results of classical solutions to the two-dimensional critical Oldroyd-B model in the corotational case. The critical case refers to the full Laplacian dissipation in the velocity or the full Laplacian dissipation in the non-Newtonian part of the stress tensor. Whether or not their classical solutions develop finite time singularities is a difficult problem and remains open. The object of this paper is two-fold. Firstly, we establish the global regularity result to the case when the critical case occurs in the velocity and a logarithmic dissipation occurs in the non-Newtonian part of the stress tensor. Secondly, when the critical case occurs in the non-Newtonian part of the stress tensor, we first present many interesting global a priori bounds, then establish a conditional global regularity in terms of the non-Newtonian part of the stress tensor. This criterion comes naturally from our approach to obtain a global L∞-bound for the vorticity ω.
Violence Exposure and Ethnic Identification: Evidence from Kashmir
Authors: Nair Gautam , Sambanis Nicholas
Published: March 2019

This article studies the conditions that lead peripheral minorities to identify with the state, their ethnic group, or neighboring countries. We contribute to research on separatism and irredentism by examining how violence, psychological distance, and national status determine identification. The analysis uses data from a novel experiment that randomized videos of actual violence in a large, representative survey of the Kashmir Valley region in the Indian state of Jammu and Kashmir, an enduring site of separatist and irredentist conflict. We find that a strong regional identity is a counterweight to irredentism, but violent repression by the state can push members of the minority to identify with an irredentist neighbor. Violence increases perceived distance from the nation and reduces national identification. There is suggestive evidence that these effects are concentrated among individuals with attributes that otherwise predict higher levels of identification with the state. Information about integrative institutions and increased national status brought about by economic growth is insufficient to induce national identification in a context where psychological distance from the nation is large.
For the Future Viewer: Salvage Ethnography and Edward Curtis's “The Oath – Apsaroke”
Authors: YABLON NICK
Published: March 2019

Since its reclamation in the 1970s, Edward S. Curtis's project to exhaustively photograph and describe American Indian cultures in the early twentieth century has invited shifting critical assessments. Complicating earlier arguments that it represents a nostalgic and inauthentic drama of a “vanishing” race, in which Indians functioned merely as props, recent scholars seek to recover his sitters’ agency or contemporary artists’ acts of reclamation. This article contributes to those efforts, but by exploring the temporal ambiguities inherent in the notion – then common among ethnographic photographers – of “preserving” a people for future viewers. It thus examines a photograph that Curtis contributed in 1913 to the Modern Historic Records Association, a short-lived organization that intended to assemble time capsules and archival vaults for historians in the distant future. Focussing on this single photograph – “The Oath – Apsaroke” (1908) – also allows us to track the way that Curtis's images could break free from his book project and resonate unpredictably across multiple domains, such as debates over the existence and meaning of Indian oaths.
Oriental Taste in Imperial Japan: The Exhibition and Sale of Asian Art and Artifacts by Japanese Department Stores from the 1920s through the Early 1940s
Authors: Oh Younjung
Published: March 2019

From the 1920s to the early 1940s, Japanese department stores provided Japanese urban middle-class households with art and artifacts from China, Korea, Taiwan, and Southeast Asia. The department stores not merely sold art and artifacts from Japan's Asian neighbors but also promoted the cultural confidence to appreciate and collect them. At the same time, aspiring middle-class customers satisfied their desire to emulate the historical elite's taste for Chinese and other Asian objects by shopping at the department stores. The aesthetic consumption of Asian art and artifacts formulated a privileged position for Japan in the imperial order and presented the new middle class with the cultural capital vital to the negotiation of its social status. This article examines the ways in which department stores marketed “tōyō shumi” (Oriental taste), which played a significant role in the formation of identity for both the imperial state and the new middle class in 1920s and 1930s Japan.
Consuming Capitalist Modernity in the Media Cultures of 1930s and 1960s Manila's Commercial Streets
Authors: Gonzaga Elmo
Published: March 2019

Tracing the entangled genealogies of spaces of media spectatorship, modes of visual perception, and practices of capitalist consumption, this article explores how the shift in Manila's main commercial street from Calle Escolta in the 1930s to Avenida Rizal in the 1960s reveals changes in the imagination and experience of capitalism and modernity. Previously embodied in the infrastructure, architecture, and technology of the cityscape, which only government and business were perceived as having the capacity to produce, modernity became reconfigured as a dynamic force that ordinary residents came to believe they could harness. The article comparatively analyzes variations and dissonances in the print and audiovisual media of the two periods, particularly in the contrasting representations of awkward vaudeville comedians and youthful movie antiheroes. Instead of treating consumer and media culture as a source of docility and atomization, it sees the collective spectatorship of mass entertainment as generating the potential for self-transcendence and revolution.
The Sovereign Trickster
Authors: Rafael Vicente L.
Published: March 2019

In our current moment, authoritarian figures loom large. One of them is Philippine President Rodrigo Duterte. He seems to embody two notions of sovereignty. One is related to law, the other to norms: on the one hand, the power of taking exception to the former, deciding who will live and who will die; on the other hand, the freedom from the limits of the latter by way of dissipation, irresponsibility, and excess. This article explores the double sources of his power with reference to the works of Michel Foucault and Achille Mbembe. While most of Foucault's work has focused on Europe, Mbembe has written about postcolonial conditions in ways that make critical use of Foucault. Drawing from their writings, this article situates Duterte as a “sovereign trickster” who seeks to dominate death while monopolizing laughter. Finally, this article speculates on the comparative usefulness of this figure of the sovereign trickster with regard to President Donald Trump, whose form of tricksterism derives, the author argues, from the tradition of blackface minstrelsy.
Malacosporean myxozoans exploit a diversity of fish hosts
Authors: Naldoni Juliana , Adriano Edson A. , Hartigan Ashlie , Sayer Carl , Okamura Beth
Published: March 2019

Myxozoans are widespread and common endoparasites of fish with complex life cycles, infecting vertebrate and invertebrate hosts. There are two classes: Myxosporea and Malacosporea. To date about 2500 myxosporean species have been described. By comparison, there are only five described malacosporean species. Malacosporean development in the invertebrate hosts (freshwater bryozoans) has been relatively well studied but is poorly known in fish hosts. Our aim was to investigate the presence and development of malacosporeans infecting a diversity of fish from Brazil, Europe and the USA. We examined kidney from 256 fish belonging variously to the Salmonidae, Cyprinidae, Nemacheilidae, Esocidae, Percidae, Polyodontidae, Serrasalmidae, Cichlidae and Pimelodidae. Malacosporean infections were detected and identified by polymerase chain reaction and small subunit ribosomal DNA sequencing, and the presence of sporogonic stages was evaluated by ultrastructural examination. We found five malacosporean infections in populations of seven European fish species (brown trout, rainbow trout, white fish, dace, roach, gudgeon and stone loach). Ultrastructural analyses revealed sporogonic stages in kidney tubules of three fish species (brown trout, roach and stone loach), providing evidence that fish belonging to at least three families are true hosts. These results expand the range of fish hosts exploited by malacosporeans to complete their life cycle.
Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis
Authors: Karatzias Thanos , Murphy Philip , Cloitre Marylene , Bisson Jonathan , Roberts Neil , Shevlin Mark , Hyland Philip , Maercker Andreas , Ben-Ezra Menachem , Coventry Peter , Mason-Roberts Susan , Bradley Aoife , Hutton Paul
Published: March 2019

Background

The 11th revision to the WHO International Classification of Diseases (ICD-11) identified complex post-traumatic stress disorder (CPTSD) as a new condition. There is a pressing need to identify effective CPTSD interventions.

Methods

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of psychological interventions for post-traumatic stress disorder (PTSD), where participants were likely to have clinically significant baseline levels of one or more CPTSD symptom clusters (affect dysregulation, negative self-concept and/or disturbed relationships). We searched MEDLINE, PsycINFO, EMBASE and PILOTS databases (January 2018), and examined study and outcome quality.

Results

Fifty-one RCTs met inclusion criteria. Cognitive behavioural therapy (CBT), exposure alone (EA) and eye movement desensitisation and reprocessing (EMDR) were superior to usual care for PTSD symptoms, with effects ranging from g = −0.90 (CBT; k = 27, 95% CI −1.11 to −0.68; moderate quality) to g = −1.26 (EMDR; k = 4, 95% CI −2.01 to −0.51; low quality). CBT and EA each had moderate–large or large effects on negative self-concept, but only one trial of EMDR provided useable data. CBT, EA and EMDR each had moderate or moderate–large effects on disturbed relationships. Few RCTs reported affect dysregulation data. The benefits of all interventions were smaller when compared with non-specific interventions (e.g. befriending). Multivariate meta-regression suggested childhood-onset trauma was associated with a poorer outcome.

Conclusions

The development of effective interventions for CPTSD can build upon the success of PTSD interventions. Further research should assess the benefits of flexibility in intervention selection, sequencing and delivery, based on clinical need and patient preferences.
Strategic Violence during Democratization: Evidence from Myanmar
Authors: Christensen Darin , Nguyen Mai , Sexton Renard
Published: March 2019

abstract

Democratic transitions are often followed by conflict. This article explores one explanation: the military’s strategic use of violence to retain control of economically valuable regions. The authors uncover this dynamic in Myanmar, a country transitioning from four decades of military rule. Fearing that the new civilian government will assert authority over jade mining, the military initiated violence in mining townships. Using geocoded data on conflict and jade mines, the authors find evidence for this strategic use of violence. As Myanmar started to transition in 2011, conflicts instigated by the military in jademining areas sharply rose. The article also addresses alternative explanations, including a shift in the military’s strategy, colocation of mines and military headquarters, commodity prices, opposition to a controversial dam, and trends specific to Kachin State. With implications beyond Myanmar, the authors argue that outgoing generals can use instability to retain rents where plausible challengers to state authority provide a pretense for violence.
Path to Centralization and Development: Evidence from Siam
Authors: Paik Christopher , Vechbanyongratana Jessica
Published: March 2019

This article investigates the role of colonial pressure on state centralization and its relationship to subsequent development by analyzing the influence of Western colonial threats on Siam’s internal political reform. Unlike other countries in the region, Siam remained independent by adopting geographical administrative boundaries and incorporating its traditional governance structures into a new, centralized governance system. The authors find that the order in which areas were integrated into the centralized system depended on the interaction between precentralization political structures and proximity to British and French territorial claims. The authors show that areas centralized early in the process had higher levels of infrastructure investment and public goods provision at the time the centralization process was completed in 1915 than those centralized later in the process. They also show that early centralization during the Western colonial era continued to be strongly associated with higher levels of public goods provision and economic development, and that this relationship persists today.
A Novel Robust Model Reference Adaptive Impedance Control Scheme for an Active Transtibial Prosthesis
Authors: Heidarzadeh Siamak , Sharifi Mojtaba , Salarieh Hassan , Alasty Aria
Published: March 2019

In this paper, a novel robust model reference adaptive impedance control (RMRAIC) scheme is presented for an active transtibial ankle prosthesis. The controller makes the closed loop dynamics of the prosthesis similar to a reference impedance model and provides asymptotic tracking of the response trajectory of this impedance model. The interactions between human and prosthesis are taken into account by designing a second-order reference impedance model. The proposed controller is robust against parametric uncertainties in the nonlinear dynamic model of the prosthesis. Also, the controller has robustness against bounded uncertainties due to unavailable ground reaction forces and unmeasurable feedbacks of accelerations at the socket place. Moreover, an appropriate Series Elastic Actuator (SEA) mechanism for the prosthetic ankle is included in this work and its effects are discussed. Tracking performance and stability of the closed-loop system are proven via the Lyapunov stability analysis. Using simulations on an overall amputee prosthetic foot system, the effectiveness of the proposed RMRAIC controller is investigated for the task of level ground walking.
Two Steps Forward, One Step Back: Chinese State Reactions to Labour Unrest
Authors: Elfstrom Manfred
Published: March 2019

What impact is the current rise in workplace conflict having on governance in China? This article argues that, over time, protests are driving the state in two directions at once: towards greater repression and greater responsiveness. Using an original dataset of strikes, protests and riots by Chinese workers between 2003 and 2012, along with government budgetary and judicial statistics, the article demonstrates that significant, positive correlations exist at the provincial level between increased unrest on the one hand and both increased spending on the People's Armed Police (repression) and increasing numbers of pro-worker and split decisions in mediation, arbitration and court cases (responsiveness) on the other. Feedback effects exist with regard to responsiveness, though: more cases in which workers win something in turn seem to spur greater unrest. The article closes by noting the changes since Xi Jinping took office and examining the implications of the findings for China's political development.
Producing the Morally Captive Guest: Discourse and Power in Gratitude Education of Migrant Children in Beijing
Authors: Li Miao , Xiong Yihan
Published: March 2019

To promote a prosocial conscience and behaviour, gratitude education has long been perceived as an effective intervention in formal schooling. Built upon the Foucauldian account of the mutually constitutive relationship between knowledge and power, this paper investigates how an urban school for largely poor and low-income children of migrant workers in Beijing constructed and transmitted knowledge and discourses on gratitude. The authors argue that the students are positioned as what we term “morally captive guests”1 who possess an inferior position in the moral life compared to urbanites, and who are perceived as an instrument for attracting resources and attention to the lower-ranked school. This schooling reproduces extant class relations, whereas the student resistance questions practices of graduating citizenship and educational inequalities.
Epidemiology and genotypic characterisation of dissemination patterns of uropathogenicEscherichia coliin a community
Authors: Matsukawa M. , Igarashi M. , Watanabe H. , Qin L. , Ohnishi M. , Terajima J. , Iyoda S. , Morita-Ishihara T. , Tateda K. , Ishii Y. , Saga T. , Aoki K. , Bonomo R. A.
Published: March 2019

To characterise the dissemination patterns of uropathogenicEscherichia coli(UPEC) in a community, we conducted a study utilising molecular and fundamental descriptive epidemiology. The subjects, consisted of women having community-acquired acute urinary tract infection (UTI), were enrolled in the study from 2011 to 2012. UPEC isolates were subjected to antibacterial-susceptibility testing, O serogrouping, phylotyping, multilocus-sequence typing with phylogenetic-tree analysis and pulsed-field-gel electrophoresis (PFGE). From the 209 unique positive urinary samples 166 UPEC were isolated, of which 129 were fully susceptible to the tested antibiotics. Of the 53 sequence types (STs), the four most prevalent STs (ST95, ST131, ST73 and ST357) accounted for 60% of all UPEC strains. Antimicrobial resistance was less frequently observed for ST95 and ST73 than for the others. A majority of rare STs and a few common STs constituted the diversity pattern within the population structure, which was composed of the two phylogenetically distinct clades. Eleven genetically closely related groups were determined by PFGE, which accounted for 42 of the 166 UPEC isolates, without overt geo-temporal clustering. Our results indicate that a few major lineages of UPEC, selected by unidentified factors, are disseminated in this community and contribute to a large fraction of acute UTIs.
A One Health investigation of Salmonella enterica serovar Wangata in north-eastern New South Wales, Australia, 2016–2017
Authors: Collins J. , Simpson K. M. J. , Bell G. , Durrheim D. N. , Hill-Cawthorne G. A. , Hope K. , Howard P. , Kohlenberg T. , Lawrence K. , Lilly K. , Porigneaux P. , Sintchenko V. , Wang Q. , Ward M. P. , Wiethoelter A. , Mor S. M. , Flint J.
Published: March 2019

Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
Screening and measurement of cognitive impairment in psychiatry
Authors: Harrison John E.
Published: March 2019

A key message from the review of cognitive dysfunction in psychiatry published by Millanet al(2012) was not just that cognitive skills are often compromised in patients with psychiatric disorders, but that deficits in specific domains are common to a number of conditions. The review also highlighted that the magnitude of the observed deficits varied across disorders. A helpful element of the Millanet alstudy was the inclusion of a table in which the authors sought to convey the domains of cognition and a categorization of the magnitude of the observed deficits.

In previous articles, we have considered best practice for the assessment of cognition. In these contributions, we have argued not for the use of specific tests, but instead for measures that meet acceptable standards of reliability, validity, and sensitivity. In the course of our discussions, we have included reference to test validity in the context of considering whether selected measures index appropriate domains of cognition. In this article, we begin with a brief discussion of the requirements for good test selection, especially with respect to issues of sensitivity, reliability, and validity. Thereafter the focus of this article is on the issue of domain validity. We will critically review the specification of the cognitive domains proposed by Millanet al, as well as those selected by authors of meta-analyses characterizing cognitive deficits in major depressive disorders. This focus is solely to make the discussion tractable, though we propose that the issues raised will be applicable across all psychiatric and neurological disorders.
6 Presence and Impact of Possible Tardive Dyskinesia in Patients Prescribed Antipsychotics: Results from the RE-KINECT Study
Authors: Cutler Andrew J. , Caroff Stanley N. , Tanner Caroline M. , Shalhoub Huda , Lenderking William R. , Chen Jun , Yeomans Karen , Anthony Ericha , Yonan Chuck
Published: March 2019

Objective

Tardive dyskinesia (TD) is a hyperkinetic movement disorder associated with antipsychotic treatment. RE KINECT (NCT03062033), a real-world study of outpatients prescribed antipsychotics, was designed to identify the presence of possible TD and characterize the impact of involuntary movements on functioning and quality of life. Data from RE-KINECT were used to compare the impact of possible TD in patients with schizophrenia/schizoaffective disorder [SZD] versus mood/other psychiatric disorders [Mood].

Methods

Adults with ≥3months of lifetime exposure to antipsychotics and ≥1 psychiatric disorder were recruited. The presence of possible TD was based on clinicians’ observation of involuntary movements in 4 body regions (head, trunk, upper extremities, and lower extremities). Baseline outcomes included demographics, medication history, location/severity of abnormal movements, impact of abnormal movements on daily activities, the Sheehan Disability Scale (SDS), and the EuroQoL 5-Dimensional questionnaire (EQ-5D-5L).

Results

Of 204 patients with clinician-confirmed possible TD, 111 (54.4%) had a SZD diagnosis and 93 (45.6%) had a mood/other psychiatric diagnosis. Significant differences found between groups (Mood vs SZD) included: mean age (56.9 vs 52.7 years; P=0.0263); male sex (33.3% vs 62.2%; P<0.0001); African-American race (7.5% vs 26.1%; P=0.0005); mean lifetime exposure to antipsychotics (9.5 vs 19.5 years; P<0.0001); and percentage of patients currently taking ≥2 psychiatric medications (93.5% vs 79.3%; P=0.0093). Based on clinician observation, there were no significant differences between diagnosis groups in the number of body regions impacted by abnormal movements, maximum severity score across all 4 regions, or patient awareness of possible TD. Over 30% of patients in both groups reported that involuntary movements had “some” or “a lot” of impact on their ability to continue usual activities, be productive, and socialize. No significant differences between the diagnosis groups (Mood vs SZD) were found for mean SDS total score (12.8 vs 10.8), SDS domain scores (work/school [4.1 vs 4.2], social life [4.3 vs 3.7], family life [4.1 vs 3.5]), EQ-5D-5L utility score (0.68 vs 0.74), or EQ-5D-5L health state VAS (64.8 vs 68.5).

Conclusions

In this cohort of outpatients with possible TD, those with Mood disorders were more likely to be older, female, and white than patients with SZD. The ability to function and quality of life were equally impaired in both groups. Further studies on the impact of TD are needed.

Funding Acknowledgements: Neurocrine Biosciences, Inc.
32 Early-Onset Efficacy and Safety Pilot Study of Amphetamine Extended-Release Oral Suspension (AMPH EROS) in the Treatment of Children with Attention-Deficit/Hyperactivity Disorder
Authors: Childress Ann C. , Pardo Antonio , King Thomas R. , Kando Judith C. , Herman Barry K.
Published: March 2019

Objective

To determine whether amphetamine extended-release oralsuspension (AMPH EROS) has an onset of effect at 30minutes postdose inchildren with ADHD.

Methods

This randomized, double-blind, 2-treatment, 2-sequence, placebo-controlled crossover pilot study enrolled subjects aged 6 to 12 years withattention-deficit/hyperactivity disorder (ADHD) and ADHD-Rating Scale-5 scores of ≥90th percentile for sex and age. A dose of 5 to 20mg/day of AMPH EROS was determined during a 1-week open-label phase based on medication history, symptom control, and tolerability. Subjects completed a practice laboratory classroom then received one day of double-blind active drug or placebo each in random sequence during 2 double-blind laboratory classroom days. Subjects completed the first double-blind laboratory classroom session, returned to open label drug for 5days then crossed over on day 6 during a second double-blind laboratory classroom session. DB dose was fixed at AMPH EROS 15, 17.5, or 20mg . The primary endpoint was change from predose in the Swanson, Kotkin, Agler, M-Flynn, Pelham rating scale-combined score (SKAMP-C) at 30minutes postdose on two DB days. The key secondary endpoint was change from predose in the SKAMP-C score at 3hours postdose for AMPH EROS compared with placebo. Safety assessments included vital signs and adverse events.

Results

Eighteen subjects were enrolled in the study (14 males and 4 females) with a mean age of 9 years. At both 30minutes and 3hours postdose, changes from baseline in SKAMP-C for AMPH EROS vs. placebo were statistically significant (p<0.01 and p=0.0002, respectively) with corresponding effect sizes of 0.96 and 1.57. Adverse events (>10%) during the open-label phase included upper respiratory tract infection, fatigue, upper abdominal pain, headache, decreased appetite, and affect lability.

Conclusions

AMPH EROS was effective in reducing ADHD symptoms at 30minutes postdose. AEs were mild or moderate and consistent with those of other extended-release amphetamines.

Funding Acknowledgements: Support was provided by Tris Pharma, Inc.
46 Confirmed Safety of Deutetrabenazine for Tardive Dyskinesia in a 2-Year Open-label Extension Study
Authors: Fernandez Hubert H. , Stamler David , Davis Mat D. , Factor Stewart A. , Hauser Robert A. , Jimenez-Shahed Joohi , Ondo William G. , Jarskog L. Fredrik , Woods Scott W. , LeDoux Mark S. , Shprecher David R. , Anderson Karen E.
Published: March 2019

Study Objective

To evaluate the long-term safety and tolerability of deutetrabenazine in patients with tardive dyskinesia (TD) at 2years.

Background

In the 12-week ARM-TD and AIM-TD studies, deutetrabenazine showed clinically significant improvements in Abnormal Involuntary Movement Scale scores compared with placebo, and there were low rates of overall adverse events (AEs) and discontinuations associated with deutetrabenazine.

Method

Patients who completed ARM-TD or AIM-TD were included in this open-label, single-arm extension study, in which all patients restarted/started deutetrabenazine 12mg/day, titrating up to a maximum total daily dose of 48mg/day based on dyskinesia control and tolerability. The study comprised a 6-week titration period and a long-term maintenance phase. Safety measures included incidence of AEs, serious AEs (SAEs), and AEs leading to withdrawal, dose reduction, or dose suspension. Exposure-adjusted incidence rates (EAIRs; incidence/patient-years) were used to compare AE frequencies for long-term treatment with those for short-term treatment (ARM-TD and AIM-TD). This analysis reports results up to 2 years (Week106).

Results

343 patients were enrolled (111 patients received placebo in the parent study and 232 received deutetrabenazine). There were 331.4 patient-years of exposure in this analysis. Through Week 106, EAIRs of AEs were comparable to or lower than those observed with short-term deutetrabenazine and placebo, including AEs of interest (akathisia/restlessness [long-term EAIR: 0.02; short-term EAIR range: 0–0.25], anxiety [0.09; 0.13–0.21], depression [0.09; 0.04–0.13], diarrhea [0.06; 0.06–0.34], parkinsonism [0.01; 0–0.08], somnolence/sedation [0.09; 0.06–0.81], and suicidality [0.02; 0–0.13]). The frequency of SAEs (EAIR 0.15) was similar to those observed with short-term placebo (0.33) and deutetrabenazine (range 0.06–0.33) treatment. AEs leading to withdrawal (0.08), dose reduction (0.17), and dose suspension (0.06) were uncommon.

Conclusions

These results confirm the safety outcomes seen in the ARM-TD and AIM-TD parent studies, demonstrating that deutetrabenazine is well tolerated for long-term use in TD patients.

Presented at: American Academy of Neurology Annual Meeting; April 21–27, 2018, Los Angeles, California,USA

Funding Acknowledgements: Funding: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel
79 Failure to Do Maintenance Therapy After Completion of Transcranial Magnetic Stimulation Treatment Is a Cause of Relapse of Depression in MDD Patient
Authors: Malik Sitwat , Malik Azfar , Mercille Kimberly
Published: March 2019

Objective

The purpose of this case report is to provide information regarding the importance and effectiveness of monthly maintenance therapy (if required) after completing full course of 36 TMS (Transcranial magnetic stimulation) sessions. (Most patients do not require the maintenance after full course of treatment.)

This is the first study to evaluate the cause of relapse of depression after TMS treatment can be due to failure to do maintenance therapy, no related studies are found in the literature.

Method

The participant is a 57-year-old female with chronic history of treatment resistant MDD since her teenage years. She has been treated 3 times with full course of TMS treatment in 2 years with excellent results, and she went in remission from depression after every treatment. However, due to lack of her attendance for maintenance therapy, despite suggestions by the psychiatrist, her depression relapsed each time within 2–3 months. She was unable to follow-up with maintenance therapy due to her financial situation and lack of coverage of maintenance therapy cost through insurance.

Result

Patient was monitored from initiation of therapy each day until end with clinical rating scale PHQ9& GAD7 for depression & anxiety (in all 3 therapies in 2 years). Marked improvement was observed in her symptoms as shown with range during 3 therapies in the chart below. During each therapy, her remission started anytime from10th-14th treatment and after completion of treatment, she was in remission, fully functional & back to normal life.

Clinical rating    Baseline score in 3    Outcome score in

                           therapies (Before       3 therapies (End

                           TMS treatment of      36 TMS)

PHQ-9                Range: 18-26             Range: 5-9

GAD-7               Range: 14-21             Range: 6-7

Conclusion

Regardless of the limitations of the study (such as case study on one patient), our findings highly suggest that lack of maintenance therapy when needed after completing TMS treatment with full remission may be a cause of relapse of depression in MDD patients. Following through with proper maintenance therapy will prevent relapse of MDD and may have lead to more successful outcomes in subsequent patients. Randomized clinical trial is warranted on large patient population for further evaluation.
84 Assessment of Current Clinical Practices in Recognizing and Treating Bipolar Disorder
Authors: Correll Christoph U. , Chatterjee Piyali , Gitzinger Susan H. , Lubarda Jovana , Morgan Marcello
Published: March 2019

Background

Among adults in the US, bipolar disorder affects 2.6% or 5.7 million individuals; 83% of cases are considered to be severe. Even when an accurate diagnosis of bipolar disorder is established, its treatment remains suboptimal, and those with the disorder often fail to receive any care or evidence‐based care.

Introduction

A continuing medical education (CME)-certified 25-item, multiple choice clinical practice assessment survey was developed to assess recognition and treatment of bipolar disorder, specifically, the use of LAIs in these patients.

Methods

The survey included knowledge- and case-based multiple-choice questions completed confidentially online. The survey was launched on December 20, 2017 and hosted on the Medscape Education website. Participant responses were collected through January 31, 2018. Confidentiality was maintained, and responses were de-identified and aggregated before analyses.

Results

(n=1123 psychiatrists; 305 primary care physicians [PCPs]):

- When asked about assessment tools in bipolar disorder, only 43% of psychiatrists and 36% of PCPs could identify the correct use of the MDQ screening instrument, while only 64% of psychiatrists and 51% of PCPs knew that the use of the MDQ can improve recognition of bipolar disorder in patients with depression;

- Psychiatrists were more likely to correctly identify the symptoms that most strongly support a diagnosis of bipolar disorder compared to PCPs (76% vs 43%, respectively);

- When asked about laboratory testing in mood disorders, 52% of psychiatrists and 46% of PCPs knew that laboratory testing can help exclude alternative causes for mood symptoms;

- The majority of both healthcare professionals (73%–75%) did not know that diagnosis of bipolar I disorder relies heavily on changes in activity, energy, and mood;

- 87% of psychiatrists and 76% of PCPs did not identify oral aripiprazole as the only SGA not approved by the FDA for the maintenance treatment of bipolar I disorder;

- 49% of PCPs did not recognize lithium as the first choice for maintenance monotherapy for bipolar I disorder according to the guidelines;

- Only 19% of psychiatrists and 20% of PCPs correctly chose aripiprazole monohydrate and risperidone microspheres as the LAI SGAs indicated for use as monotherapy for patients with bipolar I disorder;

- When asked what is the most common barrier to prescribing LAI antipsychotics in patients with bipolar disorder, 34% of psychiatrists selected “Patients fear of injectables”

Conclusions

This educational research identified psychiatrists and PCPs’ current real-world clinical practices and gaps in the knowledge and competence in the diagnosis and assessment of bipolar disorder, and the treatment options for this condition. Further educational efforts tailored to address identified gaps for each audience are warranted.

Funding Acknowledgements:Otsuka
Do Europeans consider sustainability when making food choices? A survey of Polish city-dwellers
Authors: Rejman Krystyna , Kaczorowska Joanna , Halicka Ewa , Laskowski Wacław
Published: March 2019

Objective

To obtain a better insight into the conceptualization of sustainable consumption among consumers with special focus on food choice determinants. Previous studies show that people present positive attitude towards sustainable diet while their everyday food choices do not follow sustainable diet rules.

Design

A structured questionnaire was designed and data were collected via computer-assisted telephone interview among a random group (n600) of city-dwellers. Quota sampling was used in proportion to the city population. Cluster analysis (k-means method) was applied to identify consumer segments according to the determinants of food choices. Consumer segments were identified using one-way ANOVA withpost hocDuncan comparison of mean scores and cross-tabulation withχ2. The Friedman test was applied to identify enablers and barriers of sustainable food choices.

Setting

Cities in Mazovia, the best developed, central region of Poland.

Participants

Adults (21–70 years old).

Results

Consumers are not familiar with the concept of sustainability and are not able to define it adequately. Only 6 % of the studied population indicated that sustainable consumption is connected with nutrition which has possibly less impact on the environment. Three segments of consumers were distinguished regarding their attitude to food choice determinants adequate to sustainable diet: Non-Adopters (17 %), Emergents (32 %), Adopters (51 %). Desire to improve health by decreasing body weight was the main driver for sustainable food choices, while prices were the main limitation.

Conclusions

Knowledge dissemination on sustainability issues is needed to empower consumers to make more sustainable food choices and to make public health and food policy measures more effective.
Socio-economic and demographic characteristics associated with risk behaviour patterns for chronic non-communicable diseases in Brazil: data from the National Health Survey, 2013
Authors: Duarte Ana Paula P , Rodrigues Paulo Rogério Melo , Ferreira Márcia Gonçalves , Cunha Diana Barbosa , Moreira Naiara Ferraz , Sichieri Rosely , Muraro Ana Paula
Published: March 2019

Objective

To identify risk behaviour patterns for chronic non-communicable diseases (NCD) in the Brazilian population and to investigate associated socio-economic and demographic factors.

Design

Factor analysis was used to identify patterns considering the following risk behaviours: consumption of soft drinks/artificial juice, sweet foods, red meat with apparent fat, chicken skin; inadequate consumption of fruits and vegetables; alcohol abuse; smoking; absence of physical activity during leisure time; and time spent watching television. The χ2 test was used to compare ratios. All analyses accounted for weighting factors and the study’s complex sampling design effect. The socio-economic and demographic variables evaluated were gender, age, schooling level and macro region of residence.

Setting

National Health Survey, a household survey with national representation, conducted in 2013 in Brazil.

Participants

Individuals (n 60202) aged 18 years or over.

Results

Four risk behaviour patterns were identified: ‘Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables’, ‘Saturated fat’, ‘Alcohol and Smoking’ and ‘Sedentary behaviour and Sugar’, explaining 52·01 % of the total variance. Overall, greater adherence to ‘Saturated fat’ and ‘Alcohol and Smoking’ patterns was observed among men and those with lower education level. The ‘Sedentary behaviour and Sugar’ and ‘Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables’ patterns had greater adherence among younger individuals, and the first was associated with higher education whereas the second with less education among individuals residing in the North and Northeast regions.

Conclusions

Risk behaviour patterns for NCD were heterogeneous, reflecting the socio-economic and demographic differences in Brazil.