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This study explored regression patterns in 100 children with ASD (3-11 years) using several approaches to enhance the validity of retrospective parent report. Both early development and outcome were examined in regression groups defined by 36 months age cut-off and two underlying empirical patterns based on type and onset age. Results over regression groups were generally consistent. During early development, children with regression showed a similar amount of social atypicalities and stereotyped behaviour as compared to children without regression. However, parents indicated less communication skills which could be a valuable predictor of regression. Development after regression was characterised by early language delay and more restricted and repetitive behaviour. The findings provide insight into the diagnosis and prognosis of regression in ASD.

Machine learning approaches are increasingly used to extract patterns and insights from the ever-increasing stream of geospatial data, but current approaches may not be optimal when system behaviour is dominated by spatial or temporal context. Here, rather than amending classical machine learning, we argue that these contextual cues should be used as part of deep learning (an approach that is able to extract spatio-temporal features automatically) to gain further process understanding of Earth system science problems, improving the predictive ability of seasonal forecasting and modelling of long-range spatial connections across multiple timescales, for example. The next step will be a hybrid modelling approach, coupling physical process models with the versatility of data-driven machine learning.

The concept of regression is schematically reviewed, focusing on the complexities and confusions that have surrounded this contested notion in the course of psychoanalytic history. Clinical illustrations are used to suggest descriptive differences in regressive functioning occurring in the course of psychoanalysis. It is argued that there may be an important distinction between the sense-making (adaptational, maturational, and integrative) aims of therapeutic discourse and the distinctively deconstructive conditions of a psychoanalytic process. In this context, the "regressive" impact of the free-associative method is illustrated, and on this basis, it is suggested that there is a significant and profound difference between "free association" conceived simply as uncensored storytelling and "full-on free association" as closer to the babbling of a stream of consciousness.

As shown in our previous paper ('Regression I. Experimental approaches to regression', JAP, 65, 2, 345-65), the common mechanism of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the proportion of low-differentiated (older) systems in actualized experience. Experimental data show that regression following disease (chronic tension headache) is followed by adaptation and an increase in system differentiation in that experience domain which contains systems responsible for that adaptation. The results of mathematical modelling support the idea that reversible dedifferentiation can be one of the mechanisms for increasing the effectiveness of adaptation through learning. Reversible dedifferentiation, which is phenomenologically described as regression, is a general mechanism for restructuring the organism-environment interactions in situations where behaviours that were effective in the past become ineffective. Reversible dedifferentiation has evolved as a component of adaptation when new behaviours are formed and large-scale modifications in the existing behaviours are required in the face of changes in the external and/or internal environment. Thus, the authors believe that this article provides evidence for Jung's view that regression is not only a 'return' to past forms of thinking, affects and behaviour, but that regressive processes provide a significant impetus for psychological growth and development.Comme nous l’avons montré dans notre article précédent (« Régression I. Les approches expérimentales de la régression »), le mécanisme propre à la régression peut être décrit en tant que dé-différentiation réversible, ce que l’on peut comprendre comme une hausse relative de la proportion de systèmes peu différentiés (plus vieux) dans l’expérience actualisée. Les données expérimentales montrent que la régression suite à une maladie (mal de tête de tension chronique) est suivie par une adaptation et un accroissement dans la différentiation des systèmes dans le domaine d’expérience qui contient les systèmes responsables de cette adaptation. Les résultats de la modélisation mathématique soutiennent l’idée que la dé-différentiation réversible peut être l’un des mécanismes pour accroitre l’efficacité de l’adaptation par l’apprentissage. La dé-différentiation réversible, qui est décrite phénoménologiquement comme régression, est un mécanisme général pour restructurer les interactions organisme-environnement dans des situations où les comportements qui fonctionnaient par le passé sont devenus inefficaces. La dé-différentiation réversible a évolué comme un élément de l’adaptation quand de nouveaux comportements se développent et que des changements dans l’environnement extérieur ou intérieur requièrent des modifications à grande échelle dans les comportements existants. Ainsi, les auteurs pensent que cet article apporte un soutien à la perspective de Jung selon laquelle la régression n’est pas seulement un « retour » à des formes anciennes de fonctionnement, d’affects et de comportement, mais que les processus régressifs fournissent un élan significatif pour la croissance et le développement psychologiques.Wie wir in unserem vorangegangenen Artikel gezeigt haben (‘Regression I. Experimentelle Ansätze zur Regression’), kann der gewöhnliche Regressionsmechanismus als reversible Entdifferenzierung beschrieben werden, die als relative Zunahme des Anteils niedrig differenzierter (älterer) Systeme innerhalb aktualisierten Erlebens verstanden wird. Experimentelle Daten zeigen, daß auf die nach einer Krankheit (chronischer Spannungskopfschmerz) auftretende Regression eine Anpassung und eine Zunahme der Systemdifferenzierung in jenem Erfahrungsbereich folgt, der Systeme enthält, die für diese Anpassung verantwortlich sind. Die mit Hilfe eines mathematischen Modells gewonnenen Ergebnisse stützen die Idee, daß reversible Entdifferenzierung einer der Mechanismen zur Steigerung der Wirksamkeit der Anpassung durch Lernen sein kann. Reversible Entdifferenzierung, die phänomenologisch als Regression bezeichnet wird, ist ein allgemeiner Mechanismus zur Restrukturierung der Wechselwirkungen zwischen Organismus und Umwelt in Situationen, in denen Verhaltensweisen, die in der Vergangenheit wirksam waren, unwirksam werden. Reversible Entdifferenzierung hat sich als Bestandteil der Anpassung entwickelt, wenn neue Verhaltensweisen gebildet werden und umfangreiche Änderungen an den vorhandenen Verhaltensweisen angesichts von Änderungen in der externen und/oder internen Umgebung erforderlich sind. Die Autoren gehen daher davon aus, daß dieser Artikel die Ansicht von Jung belegt, daß Regression nicht nur eine 'Rückkehr' zu früheren Formen des Denkens, von Affekten und Verhalten ist, sondern daß regressive Prozesse einen signifikanten Impuls für psychologisches Wachstum und Entwicklung liefern.Come abbiamo mostrato nel nostro precedente articolo ('Regressione I. Approcci sperimentali alla regressione'), il comune meccanismo di regressione può essere descritto come una de-differenziazione reversibile, che è intesa come un aumento dei sistemi poco differenziati (vecchi) nell'esperienza concreta. I dati sperimentali mostrano che la regressione successiva ad un disturbo (come il mal di testa da tensione cronica) è seguita dall'adattamento e da un aumento della differenziazione del sistema in quel settore di esperienza che contiene i sistemi responsabili di tale adattamento. I risultati della modellazione matematica supportano l'idea che la de-differenziazione reversibile possa essere uno dei meccanismi che aumentano l'efficacia dell'adattamento attraverso l'apprendimento. La de-differenziazione reversibile, che è fenomenologicamente descritta come regressione, è un meccanismo generale per la riorganizzazione delle interazioni organismo-ambiente in situazioni in cui comportamenti che erano efficaci in passato diventano inefficaci. La de-differenziazione reversibile si è evoluta in una componente dell’adattamento rispetto a nuovi comportamenti o modifiche su larga scala nei comportamenti esistenti, a fronte di cambiamenti nell'ambiente esterno e/o interno. Pertanto, gli Autori ritengono che questo articolo offra sostegno all’idea di Jung secondo cui la regressione non è solo un “ritorno” a forme passate di pensiero, affetti e comportamento, ma fornisca anche un impulso significativo per la crescita e lo sviluppo psicologico.Как мы показали в нашей предыдущей статье («Регрессия I. Экспериментальные подходы к регрессии»), общий механизм регрессии можно описать как обратимую дедифференциацию, которая понимается как относительное увеличение доли низкодифференцированных (более старых) систем в актуализированном опыте. Экспериментальные данные показывают, что возникающая после заболевания (например, после хронической головной боли напряжения) регрессия сопровождается адаптацией и увеличением системной дифференциации в то м домене опыта, которыйсодержит системы, ответственные за эту адаптацию. Результаты математического моделирования подтверждают идею о том, что обратимая дедифференциация может быть одним из механизмов повышения эффективности адаптации посредством обучения. Обратимая дедифференциация, которая феноменологически описывается как регрессия, является общим механизмом реструктуризации взаимодействий организм-среда в ситуациях, когда поведение, которое было эффективным в прошлом, становится неэффективным. Обратимая дедифференциация развивается как компонент адаптации, когда формируется новое поведение и требуются крупномасштабные изменения в существующем поведении перед лицом изменений во внешней и/или внутренней среде. Таким образом, авторы полагают, что в этой статье подтверждается мнение Юнга о том, что регрессия - это не только «возврат» к прошлым формам мышления, аффектов и поведения, но и то, что регрессивные процессы дают значительный импульс для психологического роста и развития.Como hemos mostrado en nuestros trabajos previos (‘Regresión I. Abordajes experimentales hacia la regresión’), el mecanismo común de la regresión puede ser descripto como desdiferenciación reversible, el cual es comprendido como un relativo incremento en la proporción de sistemas de baja-diferenciación en la experiencia actual. Data experimental muestra que la regresión luego de una enfermedad (tensión de cabeza crónica) es seguida por la adaptación y por un incremento en la diferenciación de sistemas en aquel dominio de la experiencia, que contiene sistemas responsables para tal adaptación. Los resultados del modelo matemático sostienen la idea de que la desdiferenciación reversible puede ser uno de los mecanismos para incrementar la efectividad de la adaptación a través del aprendizaje. La desdiferenciación reversible, la cual fenomenológicamente se describe como regresión, es un mecanismo general para restructurar las interacciones entre el organismo y el medio ambiente, en situaciones en las que las conductas que eran efectivas en el pasado se vuelven ineficaces. La desdiferenciación reversible ha evolucionado como un componente de la adaptación cuando se forman nuevas conductas y se requieren modificaciones a gran escala en las conductas existentes frente a los cambios en el medio ambiente externo y/o interno. Así, los autores consideran que el artículo proporciona evidencia a la perspectiva de Jung sobre la regresión, no solamente como un ‘retorno’ a formas de pensar, sentir y actuar del pasado sino que los procesos regresivos proveen un estímulo significativo para el desarrollo y el crecimiento psicológico.退行II:通过退行得以发展 在第一篇文章中 (退行I:退行的实证取向), 退行的一般机制可以被描述为一种可逆的去分化, 这可以理解为, 低分化的 (旧的)系统在实际经验中所占比例的相对增长。实验数据显示, 与退行相随的疾病 (慢性紧张性头痛)之后, 会发生适应, 以及系统分化的增长, 因为这一经验领域包含了作用于适应的系统。数学建模的研究结果也支持这一观念, 即可逆的去分化是一种通过学习来增进适应效率的机制。可逆的去分化在现象学上被描述为退行, 它是一种普遍的机制, 用以重建有机环境中的互动, 在这些情境中, 以往有效的行为开始失效。当新的行为形成, 个体为了面对内外环境的变化, 对已有行为进行必要的大尺度调整时, 可逆的去分化便进化为适应的一个组成部分。于是, 作者相信这篇文章为荣格的退行观点提供了支持, 即退行不仅仅是“回归”过往的思维方式、情感和行为, 而是说, 退行还为心理成长与发展提供了重要的动力。.

The Nicholas Young phenomenon involves an immediate shift in dreams to more regressive mental functioning whenever, in the manifest ideational content, the dreamer or protagonist crosses a topographical boundary or threshold (spatial translation). This phenomenon thus furthers the regression typical in dreams. Eight examples of the Young phenomenon are presented. An attempt to explain this highly specialized phenomenon addresses dreams in series, or dream sections in series, and refers to Scherner’s Law, which covers their sequential trend toward regression. Referring to the mind’s self-observing capacity, Silberer’s “symbolism of the threshold” is invoked to explain the spatial translation of the Young phenomenon.

Objective The present study was performed to identify factors associated with a Bacille Calmette–Guérin (BCG) inoculation site change in patients with Kawasaki disease (KD). Methods Among patients who had received BCG vaccination and treatment for KD at our hospital from 2005 through 2016, 177 patients born in 2005 through 2016 were enrolled. The patients were divided into those with (n = 83, change group) and without (n = 94, no-change group) a BCG site change, and the patient demographics, clinical severity, blood examination results, and echocardiographic findings were compared between the two groups. Results The change group was younger at onset and had a shorter interval from vaccination to onset. A BCG site change was observed in patients who developed the onset of KD symptoms from 31 to 806 days after BCG vaccination. Multivariate analysis showed that the interval from vaccination was closely and positively associated with the BCG site change (hazard ratio = 0.995, 95% confidence interval = 0.993–0.997). Conclusion A BCG site change in patients with KD is most closely associated with the interval from BCG vaccination to onset.

OBJECTIVETo identify the factors associated with first Clostridium difficile infection (CDI) that predict fecal microbiota transplantation (FMT) for recurrent CDIDESIGNWe carried out a retrospective single-center cohort study to compare the clinical characteristics of 200 patients who underwent FMT for recurrent CDI to 75 patients who did not.SETTINGA single academic hospital in the United StatesPATIENTSAdult patientsRESULTSThe time from first to second CDI correlated to subsequent FMT use. Concomitant inflammatory bowel disease (IBD; P=.002), use of immunosuppressive therapy (P=.04), and use of metronidazole within 2 months before the first CDI (P=.02) correlated positively to subsequent FMT in univariate analysis. The use of oral vancomycin for first CDI was more common in those who required FMT than those who did not in univariate (P=.02) and multivariate (P=.03) analyses. In contrast, intravenous vancomycin use within 2 months before the first CDI reduced the risk for FMT in univariate P=.000003) and multivariate (P=.0001) analyses. Black patients with recurrent CDI were less likely to receive FMT than white patients (P=.00005). Patients who received FMT were also less likely to have comorbidities.CONCLUSIONSThis study provides important insights into the factors predictive for FMT in patients with recurrent CDI and highlights the potential racial and medical characteristics that affect the access of the patients to FMT.Infect Control Hosp Epidemiol 2018;39:302–306

The partial-filling affinity capillary electrophoresis (pf-ACE) works with a ligand present in a background electrolyte that forms a weak complex with an analyte. In contrast to a more popular mobility-shift affinity capillary electrophoresis, only a short plug of the ligand is introduced into a capillary in the pf-ACE. Both methods can serve for determining apparent stability constants of the formed complexes but this task is hindered in the pf-ACE by the fact that the analyte spends only a part of its migration time in a contact with the ligand. In 1998, Amini and Westerlund published a linearization strategy that allows for extracting an effective mobility of an analyte in the presence of a neutral ligand out of the pf-ACE data. The main purpose of this paper is to show that the original formula is only approximate. We derive a new formula and demonstrate its applicability by means of computer simulations. We further inspect several strategies of data processing in the pf-ACE regarding a risk of an error propagation. This establishes a good practice of determining apparent stability constants of analyte-ligand complexes by means of the pf-ACE.

In an eye-tracking experiment, we examined how readers comprehend indirect replies when they are uttered in reply to a direct question. Participants read vignettes that described two characters engaged in dialogue. Each dialogue contained a direct question (e.g., How are you doing in Chemistry?) answered with an excuse (e.g., The exams are not fair). In response to direct questions, such indirect replies are typically used to avoid a face-threatening disclosure (e.g., doing badly on the Chemistry course). Our goal was to determine whether readers are sensitive during reading to the indirect meaning communicated by such replies. Of the three contexts we examined, the first described a negative, face-threatening situation and the second a positive, non-face threatening situation, while the third was neutral. Analysis of reading times to the replies provides strong evidence that readers are sensitive online to the face-saving function of indirect replies.

Traditional psychoanalytic theories of development hold that the adult neurotic can regress, or has already regressed, to the childhood arrests and/or fixations in which his pathology originated. More recent critiques have called this possibility into question. It is unlikely that anyone can roll back the additions and modifications of lifespan development in a full-fledged return to the needs, wishes, and anxieties of childhood. By regression, though, some analysts mean not a full-fledged return to an earlier developmental phase, but a non–phase-specific slip into primitive fantasies and defenses. The operational term, in this particular variation, is not regression but primitive. The shift from the depressive to the paranoid-schizoid position is, for instance, considered not a phase-specific regression but a regression to primitive forms of mentation. The psychoanalytic conception of the primitive originated in Freud’s reading of late nineteenth and early twentieth century anthropology. Freud and later Klein believed that the neurotic regresses to a psychological childhood, which in turn preserves the thought patterns of our prehistoric ancestors. Although this proposition and the underlying principle of recapitulation have been disproven, its traces are nonetheless preserved in what are termed the primary processes and primitive defenses. A tradition of theoretical critique and developmental research, however, shows that the primary processes and primitive defenses are not in fact primitive. That is, they are neither evolutionarily nor developmentally primary in human life. By implication, psychoanalysis should discard the term primitive and adopt a lifespan approach to the processes it describes.

A hybrid model based on Positive Matrix Factorization (PMF) and Health Risk Assessment Model for assessing risks associated with sources of perfluoroalkyl substances (PFASs) in water was for the first time established, and applied at Dianchi Lake to test its applicability. The new method contains two stages: (1) The sources to PFASs were apportioned by PMF model and (2) the contribution of health risks from each source was calculated by the new hybrid model. Two factors were extracted by PMF, with Factor 1 identified as aqueous fire-fighting foams (AFFFs) source, and Factor 2 as fluoropolymer (FP) manufacturing and processing & perfluorooctanoic acid production source. Health risk of PFASs in the water assessed by Health Risk Assessment Model was 9.54 × 10−7 a−1 on average, showing no obvious adverse effects to human health. The two sources' risks estimated by the new hybrid model ranged from 2.95 × 10−10 to 6.60 × 10−6 a−1 and from 1.64 × 10−7 to 1.62 × 10−6 a−1 respectively. The new hybrid model can provide useful information on the health risks of PFASs sources, which is helpful for pollution control and environmental management. This article is protected by copyright. All rights reserved

Background Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract‐based socioeconomic determinants beyond the effect of individual factors. Objective To evaluate whether census tract‐based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual‐level determinants. Methods We analyzed 33 515 laboratory‐confirmed influenza‐associated hospitalizations that occurred during the 2009‐2010 through 2013‐2014 influenza seasons using a population‐based surveillance system at 14 sites across the United States. Results Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72‐9.70) for those ≥65 vs 5‐17 years old. African Americans had an AOR of 1.67 (95% CI 1.60‐1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16‐1.26) compared to non‐Hispanics. Among census tract‐based determinants, those living in a tract with ≥20% vs

Purpose To describe the frequency and characteristics of developmental regression in a sample of 50 patients with Phelan McDermid Syndrome (PMS) and investigate the possibility of association between regression, epilepsy, and electroencephalogram (EEG) abnormalities and deletion size. Methods The Autism Diagnostic Interview-Revised (ADI-R) was used to evaluate regression in patients with a confirmed diagnosis of PMS. Information on seizure history and EEGs was obtained from medical record review. Deletion size was determined by DNA microarray. Results A history of regression at any age was present in 43% of all patients. Among those exhibiting regression, 67% had onset after the age of 30 months, affecting primarily motor and self-help skills. In 63% of all patients there was a history of seizures and a history of abnormal EEG was also present in 71%. No significant associations were found between regression and seizures or EEG abnormalities. Deletion size was significantly associated with EEG abnormalities, but not with regression or seizures. Conclusion This study found a high rate of regression in PMS. In contrast to regression in autism, that often occurs earlier in development and affects language and social skills, we found regression in PMS most frequently has an onset in mid-childhood, affecting motor and self-help skills. We also found high rates of seizures and abnormal EEGs in patients with PMS. However, a history of abnormal EEG and seizures was not associated with an increased risk of regression. Larger deletion sizes were found to be significantly associated with a history of abnormal EEG.

Objectives. To examine the health-related quality of life among workers in 22 standard occupation groups using data from the 2013–2014 US Behavioral Risk Factor Surveillance System. Methods. We examined the health-related quality of life measures of self-rated health, frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days by occupation group for 155 839 currently employed adults among 17 states. We performed multiple logistic regression analyses that accounted for the Behavioral Risk Factor Surveillance System’s complex survey design to obtain prevalence estimates adjusted for potential confounders. Results. Among all occupation groups, the arts, design, entertainment, sports, and media occupation group reported the highest adjusted prevalence of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. The personal care and service occupation group had the highest adjusted prevalence for fair or poor self-rated health. Conclusions. Workers’ jobs affect their health-related quality of life.

Supportive-expressive (SE) psychodynamic treatment has been receiving much empirical support. It is based on conceptualizing and working through the patients' Core Conflictual Relationship Theme, which includes their main wish (W) in the context of an interpersonal relationship, an actual or anticipated subjective response from the other (RO) in relation to the W, and the subsequent emotional and behavioral response from the self (RS) to the RO. Studies suggest that the RO and RS components show the greatest change as a result of effective SE treatment. Clinical experience, however, suggests that in the last phase of treatment, when termination is anticipated, at least some patients regress to their original RS. This process is part of a separation conflict, which includes unconsciously renouncing their RS gains. In the present article we make recommendations regarding the timing and manner of initiating the termination discussion (the "clock-like reminder" and the "symbolic listening to termination cues"), integrating both supportive and expressive techniques. The article contains practice-based guidelines on how to work through the potential RS regression. We pay specific attention to what to do and not to do in the very last session and use examples from the pilot phase of a randomized controlled trial to demonstrate each recommended technique. Lastly, we suggest paths for future research to examine the proposed framework for working through termination. (PsycINFO Database Record

Author(s): Zhang, Dajie; Bedogni, Francesco; Boterberg, Sofie; Camfield, Carol; Camfield, Peter; Charman, Tony; Curfs, Leopold; Einspieler, Christa; Esposito, Gianluca; De Filippis, Bianca; Goin-Kochel, Robin P; Hoglinger, Gunter U; Holzinger, Daniel; Iosif, Ana-Maria; Lancioni, Giulio E; Landsberger, Nicoletta; Laviola, Giovanni; Marco, Eva M; Muller, Michael; Neul, Jeffrey L; Nielsen-Saines, Karin; Nordahl-Hansen, Anders; O'Reilly, Mark F; Ozonoff, Sally; Poustka, Luise; Roeyers, Herbert; Rankovic, Marija; Sigafoos, Jeff; Tammimies, Kristiina; Townend, Gillian S; Zwaigenbaum, Lonnie; Zweckstetter, Markus; Bolte, Sven; Marschik, Peter B

Two community-based cohorts of children with autism spectrum disorder, examined using similar assessment protocols, were pooled (n = 301) and subdivided according to history of regression. Those with regression (n = 62), 20.5% of the combined cohort, were contrasted with those without regression (n = 241) at first assessment (age range 19-60 months) and at 2-year follow-up on a range of measures. The regression group was significantly more functionally impaired, with regard to intellectual function (p

The term regression refers to the idea that a person can return to earlier phases of mental development and the primitive modes of functioning associated with them. A core concept in both conflict and deficit models of development, the idea has nonetheless come under increasing scrutiny from critics who argue that it misleads us into a genetic fallacy whereby we reduce the issues of adolescent and adult development to their childhood precursors. Inderbitzen and Levy (2000) suggest that we focus on transformations, or shifts, in mental organization, instead of on regressions. But discarding the concept of regression has theoretical implications: to adopt instead a focus on shifts in mental organization we must (1) consider our object of study to be the meaning-making person, not isolated instincts or needs; (2) understand conscious and unconscious mental life to be embedded in the here-and-now relational field; and (3) adopt a lifespan model of development. The aim here is to outline a theoretical framework in which we can more fully explore the possibility of discarding “regression” in favor of a focus on transformations in the developmental present.

Early developmental trauma is imprinted in the psyche by survival fragmentation and dissociation. Traumatized patients need the analyst to be actively involved and allow for regression to dependence in order to strengthen, create and construct their psychic functioning and structure so that environmental failures will be contained and not rupture continuity of being. I suggest that Ferenczi's and Winnicott's ideas about regression to dependence in analysis are fundamental contributions to these quests, and that Ferenczi set the foundation, which Winnicott further explored and developed. I would like to focus on their clinical theory of treating early developmental trauma of the psyche, describing it in the less known language of Ferenczi, reviving his concept of Orpha and its functions. The complementarities of the two approaches can enrich and broaden our understanding of the clinical complications that arise in the analysis of such states.

Kristen is a 13-year-old girl with Down syndrome (DS) who was seen urgently with concerns of cognitive and developmental regression including loss of language, social, and toileting skills. The evaluation in the DS clinic focused on potential medical diagnoses including atlantoaxial joint instability, vitamin deficiency, obstructive sleep apnea (OSA), and seizures. A comprehensive medical evaluation yielded only a finding of moderate OSA. A reactive depression was considered in association with several psychosocial factors including moving homes, entering puberty/onset of menses, and classroom change from an integrated setting to a self- contained classroom comprising unfamiliar peers with behavior challenges.Urgent referrals for psychological and psychiatric evaluations were initiated. Neuropsychological testing did not suggest true regression in cognitive, language, and academic skills, although decreases in motivation and performance were noted with a reaction to stress and multiple environmental changes as a potential causative factor. Psychiatry consultation supported this finding in that psychosocial stress temporally correlated with Kristen's regression in skills.Working collaboratively, the team determined that Kristen's presentation was consistent with a reactive form of depression (DSM-IV-TR: depressive disorder, not otherwise specified). Kristen's presentation was exacerbated by salient environmental stress and sleep apnea, rather than a cognitive regression associated with a medical cause. Treatment consisted of an antidepressant medication, continuous positive airway pressure for OSA, and increased psychosocial supports. Her school initiated a change in classroom placement. With this multimodal approach to evaluation and intervention, Kristen steadily improved and she returned to her baseline function.

As one of the most lethal malignancies worldwide, hepatocellular carcinoma (HCC) has a high mortality rate, which is mainly due to the complex and multi‑step aberrations in gene expression associated with it. Small nucleolar RNAs (snoRNAs), non‑coding RNAs that are 60‑300 nucleotides in length, have been proposed to be closely associated with numerous human diseases, including HCC. However, the current knowledge regarding their clinical significance and mechanistic roles in HCC is limited. The present study comprehensively analyzed the snoRNA expression profiles in HCC and identified several ones that were dysregulated. The potential regulatory mechanisms of these snoRNAs were assessed via gene functional enrichment analyses. Univariate and multivariate Cox regression analyses were performed to identify snoRNAs that are independently associated with the risk of mortality. Subsequently, a prognostic index (PI) for survival prediction was established, which may serve as a prognostic biomarker for patients with HCC (hazard ratio, 3.023; 95% confidence interval: 1.785‑5.119; P

The way in which the behavioral manifestations of autism spectrum disorder (ASD) emerge in infancy is variable. Regression-loss of previously acquired skills-occurs in a subset of children. However, the etiology and significance of regression remains unclear. Until recently, investigation of regression relied on retrospective report by parents or examination of home videos from early in life. However, home videos and retrospective report of the nature and timing of regression, and association with factors such as illness or immunization, is potentially subject to bias. The advent of prospective studies of infant siblings at familial high-risk of ASD has the potential to document regression as it occurs. Recent research has suggested that subtle loss of skills occurs in a larger proportion of children with ASD than previously assumed; however, there are few reports of clear-cut regressions, such as that involving dramatic loss of language and other established skills, in the prospective literature. This could be because of the following: clear-cut regression occurs less commonly than parent report suggests, study design limits the potential to detect regression, or there are differences between multiplex and simplex families in the rate of de novo genetic mutations and therefore regression risk. This review will bring together literature from retrospective and prospective research and attempt to reconcile diverging findings, with a specific focus on methodological issues. Changing conceptualizations of regression will be discussed, as well as etiological factors that may be associated with regression. The main challenges that need to be addressed to measure regression in prospective studies will be set out. Autism Research 2018, 11: 1602-1620. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Regression-a loss of previously established skills-occurs in a subset of children with ASD. Parental recall is not always accurate but studying younger siblings of children with ASD, 10-20% of whom will develop ASD, should make it possible to measure regression as it occurs. Clear-cut regression, like loss of language, has not often been reported in infant sibling studies, but recent research suggests that gradual loss of social engagement might be more common. This review looks at the evidence for regression from infant sibling studies and asks how study design affects the likelihood of capturing regression.

The present study combined air sampling with pulmonary function tests (PFTs) to determine both the extent of air pollution proximal to an electric arc furnace (EAF) and its impact on human health. The mass concentrations of particulate matter with aerodynamic diameters less than 2.5 µm (PM

The objective of the present study was to compare a random regression model, usually used in genetic analyses of longitudinal data, with the structured antedependence (SAD) model to study the longitudinal feed conversion ratio (FCR) in growing Large White pigs and to propose criteria for animal selection when used for genetic evaluation. The study was based on data from 11,790 weekly FCR measures collected on 1,186 Large White male growing pigs. Random regression (RR) using orthogonal polynomial Legendre and SAD models was used to estimate genetic parameters and predict FCR-based EBV for each of the 10 wk of the test. The results demonstrated that the best SAD model (1 order of antedependence of degree 2 and a polynomial of degree 2 for the innovation variance for the genetic and permanent environmental effects, i.e., 12 parameters) provided a better fit for the data than RR with a quadratic function for the genetic and permanent environmental effects (13 parameters), with Bayesian information criteria values of −10,060 and −9,838, respectively. Heritabilities with the SAD model were higher than those of RR over the first 7 wk of the test. Genetic correlations between weeks were higher than 0.68 for short intervals between weeks and decreased to 0.08 for the SAD model and −0.39 for RR for the longest intervals. These differences in genetic parameters showed that, contrary to the RR approach, the SAD model does not suffer from border effect problems and can handle genetic correlations that tend to 0. Summarized breeding values were proposed for each approach as linear combinations of the individual weekly EBV weighted by the coefficients of the first or second eigenvector computed from the genetic covariance matrix of the additive genetic effects. These summarized breeding values isolated EBV trajectories over time, capturing either the average general value or the slope of the trajectory. Finally, applying the SAD model over a reduced period of time suggested that similar selection choices would result from the use of the records from the first 8 wk of the test. To conclude, the SAD model performed well for the genetic evaluation of longitudinal phenotypes.

PURPOSE: This study evaluates initial validity and reliability of the "Galker test of speech reception in noise" developed for Danish preschool children suspected to have problems with hearing or understanding speech against strict psychometric standards and assesses acceptance by the children.METHODS: The Galker test is an audio-visual, computerised, word discrimination test in background noise, originally comprised of 50 word pairs. Three hundred and eighty eight children attending ordinary day care centres and aged 3-5 years were included. With multiple regression and the Rasch item response model it was examined whether the total score of the Galker test validly reflected item responses across subgroups defined by sex, age, bilingualism, tympanometry, audiometry and verbal comprehension.RESULTS: A total of 370 children (95%) accepted testing and 339 (87%) completed all 50 items. The analysis showed that 35 items fitted the Rasch model. Reliability was 0.75 before and after exclusion of the 15 non-fitting items. In the stepwise linear regression model age group of children could explain 20% of the variation in Galker-35-score, sex 1%, second language at home 4%, tympanometry in best ear 2%, and parental education another 2%. Other variable did not reach significance.CONCLUSION: The Galker-35 was well accepted by children down to the age of 3 years and results indicate that the scale represents construct valid and reliable measurement.

The claim that nature delivers health benefits rests on a thin empirical evidence base. Even less evidence exists on how specific conservation policies affect multiple health outcomes. We address these gaps in knowledge by combining municipal-level panel data on diseases, public health services, climatic factors, demographics, conservation policies, and other drivers of land-use change in the Brazilian Amazon. To fully exploit this dataset, we estimate random-effects and quantile regression models of disease incidence. We find that malaria, acute respiratory infection (ARI), and diarrhea incidence are significantly and negatively correlated with the area under strict environmental protection. Results vary by disease for other types of protected areas (PAs), roads, and mining. The relationships between diseases and land-use change drivers also vary by quantile of the disease distribution. Conservation scenarios based on estimated regression results suggest that malaria, ARI, and diarrhea incidence would be reduced by expanding strict PAs, and malaria could be further reduced by restricting roads and mining. Although these relationships are complex, we conclude that interventions to preserve natural capital can deliver cobenefits by also increasing human (health) capital.

Objectives The relationship between glycated hemoglobin A 1c (HbA 1c ) and average glucose has been described by the empirically derived estimated average glucose (eAG) equation in the A1c-Derived Average Glucose (ADAG) study, with extensive calibration efforts in four secondary reference HbA 1c methods. It is not known if this relationship is preserved when HbA 1c is measured by routine laboratory methods under routine conditions. Design and methods We measured average glucose (mAG) by six days of continuous glucose monitoring in 45 adults with stable HbA 1c ( 1c change in the preceding two months). Subjects with medical conditions that may confound HbA 1c measurement, including anemia and hemoglobinopathy, were excluded. HbA 1c was measured using Bio-Rad Variant II (cation-exchange HPLC), Bio-Rad in2it (boronate affinity HPLC) and Roche Tina-quant (immunoassay) methods. Results The average differences between eAG derived from the routine HbA 1c methods and mAG were 10.4% (Variant II), 6.0% (Tina-quant) and 1.0% (in2it). The regression coefficients between the mAG and HbA 1c are different between in2it (mAG, mmol/L = 0.58 × %HbA 1c + 2.3), Tina-quant and Variant II (both mAG, mmol/L = 0.66 × %HbA 1c + 1.9). However, the 95% confidence intervals of the slope and bias of these methods overlap. The correlation between mAG and HbA 1c was greatest when measured using the Variant II ( r 2 = 0.84), followed by Tina-quant ( r 2 = 0.82) and in2it ( r 2 = 0.71). Conclusions The relationship between HbA 1c and measured average glucose is method-dependent despite improved HbA 1c standardization. The differences in relationship may reflect as discrepant eAG and home glucose monitoring results.

We consider the regression or retrogenesis hypothesis, which argues that order of acquisition in development is reversed in neurodegeneration or pathology. Originally proposed as a regression hypothesis for the study of memory disorders, specifically retrograde amnesia, by Ribot (1881), it has been extended to the study of brain aging and pathology and to language. We investigate this hypothesis in a new study of language development, aging, and pathology. Through interuniversity collaboration using a matched experimental design and task, we compare production of complex sentences containing relative clauses by normal monolingual children during normal development, healthy young adults, healthy aging adults, and aging adults diagnosed with mild cognitive impairment, a recognized potential harbinger of Alzheimer's disease. Our results refute the regression hypothesis in this area and lead to potential syntactic markers for prodromal Alzheimer's disease and predictions for future brain imaging analyses.

The International Parkinson and Movement Disorder Society-sponsored UPDRS (MDS-UPDRS) is a powerful clinical outcome measure.To evaluate the feasibility of various MDS-UPDRS-based composite scores and determine their minimal clinically important difference threshold values.Overall, 1,113 paired investigations of 452 patients were reviewed implementing three different techniques simultaneously.Based on the ordinal regression modeling, the MDS-UPDRS II+III, MDS-UPDRS I+II+III, and the total score of MDS-UPDRS are clinically applicable outcome measures. Any improvement greater than 4.9 points or any worsening more than 4.2 points on MDS-UPDRS II+III represent a minimal, yet clinically meaningful, change. In reference to MDS-UPDRS I+II+III, the smallest changes considered clinically relevant were 6.7 and 5.2 points for improvement and deterioration, respectively. The thresholds for the total score of MDS-UPDRS were 7.1 points for improvement and 6.3 points for worsening.Our findings support the application of various MDS-UPDRS-based composite scores. © 2018 International Parkinson and Movement Disorder Society.

Objectives. To determine the generalizability of crowdsourced, electronic health data from self-selected individuals using a national survey as a reference. Methods. Using the world’s largest crowdsourcing platform in 2015, we collected data on characteristics known to influence cardiovascular disease risk and identified comparable data from the 2013 Behavioral Risk Factor Surveillance System. We used age-stratified logistic regression models to identify differences among groups. Results. Crowdsourced respondents were younger, more likely to be non-Hispanic and White, and had higher educational attainment. Those aged 40 to 59 years were similar to US adults in the rates of smoking, diabetes, hypertension, and hyperlipidemia. Those aged 18 to 39 years were less similar, whereas those aged 60 to 75 years were underrepresented among crowdsourced respondents. Conclusions. Crowdsourced health data might be most generalizable to adults aged 40 to 59 years, but studies of younger or older populations, racial and ethnic minorities, or those with lower educational attainment should approach crowdsourced data with caution. Public Health Implications. Policymakers, the national Precision Medicine Initiative, and others planning to use crowdsourced data should take explicit steps to define and address anticipated underrepresentation by important population subgroups.

Purpose Many biological objects, including neuronal dendrites, blood vasculature, airways, phylogenetic trees, produce tree structured data. Current methods of analysis either ignore the complex structure of trees or use distance-based methods which limit the scope of multivariate modeling. Methods We propose a branching process model which enables analysis of both the branching structure and associated properties. Our novel parametrization preserves an important aspect of tree structure, namely its branch order. The model is amenable to standard methods of analysis, like generalized linear/additive models. Results The model fit the distribution of the observed data quite well when applied to a collection of 98 brain artery systems. The estimated probability of branching decreases log linearly with branch order. Likewise, the average diameter of arteries decreases, while average length increases with branch order. Frontal arterial branches are on average longer and thinner than those in the back at equivalent branch orders. A mechanistic arterial branching model based on Poiseuille's blood flow law, which uses vessel length and diameter information, fit the observed branching structure significantly better. This model is further improved by including branch order, suggesting viscoelastic flow impacts branching in narrower vessels. Conclusion After adjustment for branch order, brain arterial branching probabilities decreased significantly with age and length, but increased with diameter. Arteries become thicker and branch less frequently with increasing age, but the age effect decreases with branch order.

An exploratory analysis is carried out to investigate the feasibility of using BioImpedance Spectroscopy (BIS) parameters, measured on scalp, as real-time feedback during Transcranial Direct Current Stimulation (tDCS). TDCS is shown to be a potential treatment for neurological disorders. However, this technique is not considered as a reliable clinical treatment, due to the lack of a measurable indicator of treatment efficacy. Although the voltage that is applied on the head is very simple to measure during a tDCS session, changes of voltage are difficult to interpret in terms of variables that affect clinical outcome. BIS parameters are considered as potential feedback parameters, because: 1) they are shown to be associated with the DC voltage applied on the head, 2) they are interpretable in terms of conductive and capacitive properties of head tissues, 3) physical interpretation of BIS measurements makes them prone to be adjusted by clinically controllable variables, 4) BIS parameters are measurable in a cost-effective and safe way and do not interfere with DC stimulation. This research indicates that a quadratic regression model can predict the DC voltage between anode and cathode based on parameters extracted from BIS measurements. These parameters are extracted by fitting the measured BIS spectra to an equivalent electrical circuit model. The effect of clinical tDCS variables on BIS parameters needs to be investigated in future works. This work suggests that BIS is a potential method to be used for monitoring a tDCS session in order to adjust, tailor, or personalize tDCS treatment protocols.

Examined the psychiatric and clinical correlates of loss of previously acquired skills (regression) as reported by parents of youth with autism spectrum disorder (ASD). Study sample comprised 6- to 18-year old (N = 213) children and adolescents with ASD. Parents reported regression in 77 (36%) youth. A more homogeneous subgroup with regression between 18 and 36 months (n = 48) had higher rates of intellectual disability, epilepsy, and special education, more socially restrictive educational settings, and more severe ASD communication deficits and schizophrenia spectrum symptoms than non-regressed youth (n = 136). Similar results were obtained for a more inclusive definition of regression (n = 77). A brief parent report of developmental regression may be a useful clinical indicator of later general functioning.

Diabetic neuropathy, nephropathy, and retinopathy cause significant morbidity in patients with type 1 diabetes, even though improvements in treatment modalities delay the appearance and reduce the severity of these complications. To prevent or further delay the onset, it is necessary to better understand common underlying pathogenesis and to discover preclinical biomarkers of these complications. Retinal vessel calibers have been associated with the presence of microvascular complications, but their long-term predictive value has only been sparsely investigated. We examined retinal vessel calibers as 16-year predictors of diabetic nephropathy, neuropathy, and proliferative retinopathy in a young population-based Danish cohort with type 1 diabetes. We used semiautomated computer software to analyze vessel diameters on baseline retinal photos. Calibers of all vessels coursing through a zone 0.5–1 disc diameter from the disc margin were measured and summarized as the central artery and vein equivalents. In multiple regression analyses, we found wider venular diameters and smaller arteriolar diameters were both predictive of the 16-year development of nephropathy, neuropathy, and proliferative retinopathy. Early retinal vessel caliber changes are seemingly early markers of microvascular processes, precede the development of microvascular complications, and are a potential noninvasive predictive test on future risk of diabetic retinopathy, neuropathy, and nephropathy.

Research on the link between APOEε4 and neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) has been inconsistent. Previous work has shown a relationship between serum biomarkers of vascular risk and inflammation and NPS in AD. The current study investigated the impact of APOEε4 status on the relationship between biomarkers of cardiovascular risk, systemic inflammation, and NPS. The sample was drawn from the TARCC Longitudinal Research Cohort; the final sample of 190 consisted of 124 females and 66 males meeting the diagnostic criteria for mild to moderate AD. 115 individuals were APOEε4 carriers and 75 were non-carriers. Serum-based clinical biomarkers of vascular risk and biomarkers of inflammation related to AD were analyzed. NPS data was gathered from caretakers/family members using the Neuropsychiatric Inventory. The significant biomarkers differed for carriers and non-carriers with IL15 being a negative biomarker of total NPS accounting for 12% of the variance for carriers and IL18 and TNFα negative predictors for non-carriers (18% of variance). Patterns related to specific symptoms were similar. Stratification by gender revealed significant biomarkers of total NPS for female carriers were negative IL15 and IL1ra (18% of variance) and for female non-carriers were negative IL18 and positive homocysteine. Total cholesterol was a positive biomarker of total NPS for both male carriers (36% of variance) and non-carriers (negative TNFα and total cholesterol, 32% of variance). These findings suggest that dysregulation of inflammatory activity is related to NPS, that cholesterol is a significant factor in the occurrence of NPS, and that gender and APOE status need to be considered.

Recent Web apps have spurred excitement around the prospect of achieving speed reading by eliminating eye movements (i.e., with rapid serial visual presentation, or RSVP, in which words are presented briefly one at a time and sequentially). Our experiment using a novel trailing-mask paradigm contradicts these claims. Subjects read normally or while the display of text was manipulated such that each word was masked once the reader’s eyes moved past it. This manipulation created a scenario similar to RSVP: The reader could read each word only once; regressions (i.e., rereadings of words), which are a natural part of the reading process, were functionally eliminated. Crucially, the inability to regress affected comprehension negatively. Furthermore, this effect was not confined to ambiguous sentences. These data suggest that regressions contribute to the ability to understand what one has read and call into question the viability of speed-reading apps that eliminate eye movements (e.g., those that use RSVP).

This paper explores dissociative phenomena as disruptions of dialogue between persons, and disruptions of internal narratives. A dissociating patient temporarily loses ability to convey his or her inner experience to the therapist. The disconnection between dialogue and internal experience can mislead both participants, or distract them from underlying connotations. Dissociation also disrupts the patient's sense of internal coherence and internal conversation. Dissociation represents a regression to an early, preverbal mode of (internal and external) communication. The challenge for the dyad is to restore dialogue and then to discern the multiply determined meanings of the dissociative communication. This therapeutic work allows the patient to achieve a more coherent sense of self and of his or her life course.

It is well known that people who read print or braille sometimes make eye or finger movements against the reading direction. The way these regressions are elicited has been studied in detail by manipulating linguistic aspects of the reading material. Actually, it has been shown that reducing the physical intensity or clarity of the visual input signal can also lead to increased regressions during reading. We asked whether the same might be true in the haptic realm while reading braille. We set the height of braille dots at three different levels (high, medium, and low) and asked adult blind, practiced braille readers to read standardized texts without any repetition of content. The results show that setting the braille dot height near the tactile threshold significantly increased the frequency of regressive finger movements. Additionally, at the lowest braille dot height, braille reading speed significantly diminished. These effects did not occur at braille dot heights that were closer to the height of standard braille (medium and high). We tentatively conclude that this effect may be due to a heightened sense of uncertainty elicited by perception near the threshold that seems to be common to the reading process, independent of the sensory input modality. Furthermore, the described effect may be a feature of a brain area that contributes to the reading process mediated by vision as well as touch.

Freud’s “Group Psychology and Analysis of the Ego” is the starting point for all investigations concerning the psychology of leadership. The phenomenon of hypnosis is the model of all “authority,” and hypnosis is a regressive phenomenon; an old pattern is remobilized: the relationship of the child to his parents whom he believes to be omnipotent (after having lost the belief in his own omnipotence). Through the feeling of being loved and protected by the parents, the child enjoys sexual and narcissistic (security) satisfaction simultaneously. The deep memory traces of this experience form in later situations of danger, anxiety, insecurity or frustration, a temptation to long for a “hypnotist” who magically brings all that is missing, in the same unconditioned and oral way as the mother once brought the food. This longing can be misused by different “hypnotists,” under different conditions in very different ways. The hypnotist offers magical reparticipation in the lost and projected omnipotence. This narcissistic satisfaction once had been identical with an (archaic) sexual satisfaction; nor should it be forgotten that also mature sexual satisfaction brings an experience of undoing of individualization, of “flowing together,” of “oceanic feelings.” Hunger and satiety govern the rhythm of the infant’s life; “sexual longing” and “sexual satisfaction” as well as “narcissistic need” and “narcissistic satisfaction” are two different derivatives of this very same root.1 Normally those two types of derivatives have a different development. To get sexual

Regressive behavior is a known sequela after severe traumatic brain injury (TBI). However, prolonged "infantile-like" behavior has received little attention in the literature, suggesting that this is a rare phenomenon. It is typically characterized by long-lasting childish, extremely dependent, and sometimes aggressive behavior, which is distinguished from the expected recovery process. The relevant theoretical framework lies in the field of disorders called "Neuropathologies of the self" (NPS). We report three cases of young adults who, following a severe TBI, developed continual regressive behavior. The Disability Rating Scale (DRS) was used to assess possible change in their condition. First, while admitted, which was performed in retrospect, and again 6 years later at the time stated. Inter-rater reliability for the scale items showed adequate correlation. Results showed no significant difference in patients' scores, indicating persistent functional difficulties. We conclude that this "regressive syndrome" presents an unusual form of behavior that is stable over time. It seems to be in line with other NPS disorders, and may stem from an interaction of organic factors and primary mental complexity. Nevertheless, further research is required to examine the factors affecting the emergence and recovery from this phenomenon.

The concept of Granger causality can be used to examine putative causal relations between two series of scores. Based on regression models, it is asked whether one series can be considered the cause for the second series. In this article, we propose extending the pool of methods available for testing hypotheses that are compatible with Granger causation by adopting a configural perspective. This perspective allows researchers to assume that effects exist for specific categories only or for specific sectors of the data space, but not for other categories or sectors. Configural Frequency Analysis (CFA) is proposed as the method of analysis from a configural perspective. CFA base models are derived for the exploratory analysis of Granger causation. These models are specified so that they parallel the regression models used for variable-oriented analysis of hypotheses of Granger causation. An example from the development of aggression in adolescence is used. The example shows that only one pattern of change in aggressive impulses over time Granger-causes change in physical aggression against peers.

We assessed various aspects of speech-language and communicative functions of an individual with the preserved speech variant of Rett syndrome (RTT) to describe her developmental profile over a period of 11 years.For this study, we incorporated the following data resources and methods to assess speech-language and communicative functions during pre-, peri- and post-regressional development: retrospective video analyses, medical history data, parental checklists and diaries, standardized tests on vocabulary and grammar, spontaneous speech samples and picture stories to elicit narrative competences.Despite achieving speech-language milestones, atypical behaviours were present at all times. We observed a unique developmental speech-language trajectory (including the RTT typical regression) affecting all linguistic and socio-communicative sub-domains in the receptive as well as the expressive modality.Future research should take into consideration a potentially considerable discordance between formal and functional language use by interpreting communicative acts on a more cautionary note.

Objectives To investigate frequency of and reasons for readmission to acute care (RTAC) during inpatient rehabilitation after traumatic spinal cord injury (SCI), and to identify factors associated with RTAC. Design Prospective observational cohort. Setting Inpatient rehabilitation. Participants Individuals with SCI (N=1376) consecutively admitted for inpatient rehabilitation; 1032 randomly selected for model development; 344 selected for model cross-validation. Interventions Not applicable. Main Outcome Measures RTAC, RTAC reasons, rehabilitation length of stay (LOS), discharge location and FIM, rehospitalization between discharge and year 1, and 1-year outcomes: FIM, Craig Handicap Assessment and Reporting Technique, and Patient Health Questionnaire-9. Results Participants (n=116; 11%) experienced RTAC with a total 143 episodes—96 patients experienced only 1 RTAC, while 14 had 2 RTACs, 5 had 3 RTACs, and 1 had 4 RTACs. The most common RTAC reasons were surgery (36%), infection (22%), noninfectious respiratory (14%), and gastrointestinal (8%). Mean days ± SD from rehabilitation admission to first RTAC was 27±30 days. Seventy-four (7%) patients had at least 1 RTAC for medical reasons and 46 (4%) for surgical reasons. Regression analyses indicated several variables were associated with RTACs: greater admission medical severity, lower admission cognitive FIM, pressure ulcer acquired in acute care, and study site. Medical RTACs were associated with higher body mass index, lower admission cognitive and motor FIM, payer, and study site. Predictors of surgical RTAC were longer time from injury to rehabilitation admission and study site. After controlling for the other variables, the only outcome RTAC influenced was longer rehabilitation LOS. Conclusions Approximately 11% of SCI patients experience RTAC during the course of rehabilitation for a variety of medical and surgical reasons. RTACs are associated with longer rehabilitation LOS.

A 38-year-old right-handed man was referred for investigation of a 20-year history of progressive behavior change and involuntary movements. Symptom onset was in his late teens. Up until that time he had achieved age-appropriate motor and cognitive milestones and had completed normal schooling. There was no family history of dementia or movement disorders.

The aim of this study was to determine the frequency, timing, and associated features of developmental regression in MECP2 duplication syndrome. We also examined whether duplication size was associated with regression. Comprehensive psychological evaluations were used to assess 17 boys with MECP2 duplication syndrome. Information about regression was gathered via parent report. Eight of 17 boys exhibited regression in language skills, while seven of 17 exhibited regression in other skill areas. Regression in "other skill" areas coincided with seizure onset and with a prior autism diagnosis in six of seven participants. Regression was not associated with duplication size. Questions remain as to why some boys regress, and future work is necessary to understand the underlying mechanism(s) that causes regression.

Examination and comparison of the current DSM-IV-TR and the proposed revisions for the forthcoming DSM-5, with regard to neuropsychiatric aspects of critical illness, identified five important issues. These remain to be addressed in order to improve the care of critically ill patients. These are 1) sickness behavior, as part of the organic reaction types of the brain; 2) delirium in children and the "Differential Diagnosis of Mental Disorders Due to a General Medical Condition" in children; 3) catatonia; 4) regressive disorders in childhood in relation to somatic disorders (e.g., anti-NMDAR encephalitis); 5) age-related diagnostic criteria in relation to neuro-psychiatric disorders.

The authors tested the hypothesis that hypnotic age regression produces a shift from secondary- to primary-thought processing in hypnotizable participants. Thirty participants were tested for hypnotizability using the Elkins Scale of Hypnotizability (EHS). Participants were exposed to a tailored hypnotic arm-levitation induction and a hypnotic suggestion to age regress to 5 years of age and to have a dream. Primary-process thinking was assessed using the Primary-Process Thinking Scale. An independent t test with 2 levels of hypnotizability (middle and high) showed high hypnotizables demonstrated higher ratings of primary thought processing than those in the middle group.

Over five years, from 1919 to 1924, Freud dealt with masochism in three texts written in close proximity: “A Child Is Being Beaten,” Beyond the Pleasure Principle, and “The Economic Problem of Masochism.” Initially Freud explains masochism as incestuous fixation on the father and regression to pregenital, sadistic ways of loving. Subsequently he considers it primarily as subservient to the death drive. This paper starts from an idea present in two of the three texts, but not developed by Freud, in which he refers to the role that the “qualitative” element of rhythm could play in the occurrence of pleasure in masochism. By means of this element traumatic aspects of the primary relationship with the object could be stored as fantasies in the body. In any staged masochistic fantasies of being beaten or in masochistic perversion, the pleasure of pain would lie in the attempt to “dream” the trauma not only in the imagination but also, “aesthetically,” in the body.

Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.

I describe the analytic treatment of Mr. C, a highly intelligent man who began therapy claiming to have schizophrenia. He entered treatment on the verge of suicide, convinced of his utter isolation, and gradually, he confronted his lifelong paranoia, and learned to trust his analyst and the therapeutic process. Among his embodied realizations was the remarkable insight that paranoia kept him anchored to the world, attached to others, and thus, offset schizophrenic detachment. Paranoia also helped him maintain an optimal distance from others who could hurt him or discover his "true nature." Then, after six years and much hard work, Mr. C faced a confluence of factors that initiated the reactivation of childhood trauma and a regressive psychosis that threatened his life, his relationships, and all he had built in therapy. The journey through his six-month long psychosis was one of the greatest challenges he and I ever faced together.