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Background: Ipsilesional motor impairments of the arm are common after stroke. Previous studies have suggested that severity of contralesional arm impairment and/or hemisphere of lesion may predict the severity of ipsilesional arm impairments. Historically, these impairments have been assessed using clinical scales, which are less sensitive than robot-based measures of sensorimotor performance. Therefore, the objective of this study was to characterize progression of ipsilesional arm motor impairments using a robot-based assessment of motor function over the first 6-months post-stroke and quantify their relationship to (1) contralesional arm impairment severity and (2) stroke-lesioned hemisphere. Methods: A total of 106 participants with first-time, unilateral stroke completed a unilateral assessment of arm motor impairment (visually guided reaching task) using the Kinarm Exoskeleton. Participants completed the assessment along with a battery of clinical measures with both ipsilesional and contralesional arms at 1-, 6-, 12-, and 26-weeks post-stroke. Results: Robotic assessment of arm motor function revealed a higher incidence of ipsilesional arm impairment than clinical measures immediately post-stroke. The incidence of ipsilesional arm impairments decreased from 47 to 14% across the study period. Kolmogorov–Smirnov tests revealed that ipsilesional arm impairment severity, as measured by our task, was not related to which hemisphere was lesioned. The severity of ipsilesional arm impairments was variable but displayed moderate significant relationships to contralesional arm impairment severity with some robot-based parameters. Conclusions: Ipsilesional arm impairments were variable. They displayed relationships of varying strength with contralesional impairments and were not well predicted by lesioned hemisphere. With standard clinical care, 86% of ipsilesional impairments recovered by 6-months post-stroke. [ABSTRACT FROM AUTHOR]

Author Correction: Quantifying changes over 1 year in motor and cognitive skill after transient ischemic attack (TIA) using robotics Graph: Figure 4 Line plots of task scores over time in the TIA cohort at all 4 assessments with significant changes corrected for the false discovery rate (FDR). Graph: Figure 2 Scatterplots of one-sided Task Scores at first- and second assessments in TIA (a-c) and migraine (d-f) cohorts. [Extracted from the article]

Background: Robots can generate rich kinematic datasets that have the potential to provide far more insight into impairments than standard clinical ordinal scales. Determining how to define the presence or absence of impairment in individuals using kinematic data, however, can be challenging. Machine learning techniques offer a potential solution to this problem. In the present manuscript we examine proprioception in stroke survivors using a robotic arm position matching task. Proprioception is impaired in 50–60% of stroke survivors and has been associated with poorer motor recovery and longer lengths of hospital stay. We present a simple cut-off score technique for individual kinematic parameters and an overall task score to determine impairment. We then compare the ability of different machine learning (ML) techniques and the above-mentioned task score to correctly classify individuals with or without stroke based on kinematic data. Methods: Participants performed an Arm Position Matching (APM) task in an exoskeleton robot. The task produced 12 kinematic parameters that quantify multiple attributes of position sense. We first quantified impairment in individual parameters and an overall task score by determining if participants with stroke fell outside of the 95% cut-off score of control (normative) values. Then, we applied five machine learning algorithms (i.e., Logistic Regression, Decision Tree, Random Forest, Random Forest with Hyperparameters Tuning, and Support Vector Machine), and a deep learning algorithm (i.e., Deep Neural Network) to classify individual participants as to whether or not they had a stroke based only on kinematic parameters using a tenfold cross-validation approach. Results: We recruited 429 participants with neuroimaging-confirmed stroke (< 35 days post-stroke) and 465 healthy controls. Depending on the APM parameter, we observed that 10.9–48.4% of stroke participants were impaired, while 44% were impaired based on their overall task score. The mean performance metrics of machine learning and deep learning models were: accuracy 82.4%, precision 85.6%, recall 76.5%, and F1 score 80.6%. All machine learning and deep learning models displayed similar classification accuracy; however, the Random Forest model had the highest numerical accuracy (83%). Our models showed higher sensitivity and specificity (AUC = 0.89) in classifying individual participants than the overall task score (AUC = 0.85) based on their performance in the APM task. We also found that variability was the most important feature in classifying performance in the APM task. Conclusion: Our ML models displayed similar classification performance. ML models were able to integrate more kinematic information and relationships between variables into decision making and displayed better classification performance than the overall task score. ML may help to provide insight into individual kinematic features that have previously been overlooked with respect to clinical importance. [ABSTRACT FROM AUTHOR]

Bipolar disorder (BD) largely begins in adolescence, but diagnosis lags for years, causing significant morbidity and mortality, and demonstrating the need for better diagnostic tools. Suggesting an association between BD and immune activity, elevated levels of peripheral inflammatory markers, including C-reactive protein (CRP), have been found in adults with BD. As similar data are extremely limited in adolescents, this study examined CRP levels in adolescents with BD (n = 37) compared to those with anxiety disorders (ADs, n = 157) and healthy controls with no psychiatric diagnoses (HCs, n = 2760). CRP blood levels for patients aged 12–17 years were retrieved from a nationwide repository of deidentified clinical data. After excluding patients with inflammatory conditions, differences in CRP were examined using multivariate and weighted regressions (covariates: demographics and BMI). Mean CRP levels were significantly elevated in adolescents with BD relative to those with ADs and HCs. Mean CRP levels were lower in the ADs cohort versus HCs. Although CRP levels were significantly higher in males and younger patients, the significant between-cohort differences in CRP remained after controlling for multiple confounders. To our knowledge, our study is the first to compare CRP levels between adolescent BD, ADs, and HCs, comprising a novel and essential contribution. Our results suggest the presence of a unique immune process in adolescents with BD and indicate that CRP may represent a biomarker with a crucial role in the diagnostic assessment of adolescent BD. • CRP levels were higher in adolescents with bipolar disorder vs. healthy controls. • CRP levels were higher in adolescents with bipolar disorder vs. anxiety disorders. • Differences in CRP levels were not driven by demographic variables or BMI. • CRP may be a candidate biomarker for adolescent bipolar disorder. [ABSTRACT FROM AUTHOR]

Background: Nonsexually acquired genital ulcers have been described among girls who are prepubertal after various viral illnesses due to mucosal inflammation from an immunologic response. Until recently, nonsexually acquired genital ulcers have only been associated with viral infections.Case: We present a case of an adolescent girl developing nonsexually acquired genital ulcers after both her first and second coronavirus disease 2019 (COVID-19) vaccine doses. Her course followed an expected timeline for severity and resolution of ulcers.Conclusions: Aphthous ulcers may arise from inflammatory effects of COVID-19 vaccination. Clinical monitoring after COVID-19 vaccination from all formulations should include assessment for nonsexually acquired genital ulcers if vaginal pain is reported. [ABSTRACT FROM AUTHOR]

In addition to motor symptoms such as difficulty in movement initiation and bradykinesia, patients with Parkinson's disease (PD) display nonmotor executive cognitive dysfunction with deficits in inhibitory control. Preoperative psychological assessments are used to screen for impulsivity that may be worsened by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it is unclear whether anti-Parkinson's therapy, such as dopamine replacement therapy (DRT) or DBS, which has beneficial effects on motor function, adversely affects inhibitory control or its domains. The detrimental effects of STN-DBS are more apparent when tasks test the inhibition of habitual prepotent responses or involve complex cognitive loads. Our goal was to use a reverse visually guided reaching (RVGR) task, a hand-based version of the antisaccade task, to simultaneously measure motor performance and response inhibition in subjects with PD. We recruited 55 healthy control subjects, 26 PD subjects receiving treatment with DRTs, and 7 PD subjects receiving treatment with STN-DBS and DRTs. In the RVGR task, a cursor moved opposite to the subject's hand movement. This was compared to visually guided reaching (VGR) where the cursor moved in the same direction as the subject's hand movement. Reaction time, mean speed, and direction errors (in RVGR) were assessed. Reaction times were longer, and mean speeds were slower during RVGR compared to VGR in all three groups but worse in untreated subjects with PD. Treatment with DRTs, DBS, or DBS + DRT improved the reaction time and speed on the RVGR task to a greater extent than VGR. Additionally, DBS or DBS + DRT demonstrated an increase in direction errors, which was correlated with decreased reaction time. These results show that the RVGR task quantifies the benefit of STN-DBS on bradykinesia and the concomitant reduction of proactive inhibitory control. The RVGR task has the potential to be used to rapidly screen for preoperative deficits in inhibitory control and to titrate STN-DBS, to maximize the therapeutic benefits on movement, and minimize impaired inhibitory control. [ABSTRACT FROM AUTHOR]

Integrated perinatal behavioral healthcare provides opportunities to support women and their babies as part of their primary care medical home. The COVID‐19 pandemic required significant changes to be made to medical practices to enhance safety and reduce risk, particularly for vulnerable populations, including pregnant women. Previously established modes of mental health service delivery in the HEART program, an integrated behavioral health program embedded in a primary care clinic for adolescent mothers and their babies, and the PROMISE Clinic, an integrated obstetric behavioral health program that serves pregnant women, quickly pivoted to telehealth services because of the pandemic. HEART serves a racially and ethnically diverse patient population, with over 85% of patients publicly insured. The PROMISE Clinic serves a socioeconomically, racially, and ethnically diverse patient population. Behavioral health clinicians implemented a variety of technology‐based services including telephone interventions and support, virtual visits using iPads during medical visits, and video visits that patients accessed from their homes. In HEART, behavioral health visits continued at pre‐COVID rates during telehealth adaptations. In the PROMISE clinic, the number of perinatal women seen doubled, the total number of patient contacts tripled, and the missed appointment rate significantly decreased during COVID. In the PROMISE clinic, significantly more White and Hispanic perinatal women were seen during COVID and telehealth adaptations, while significantly fewer Black perinatal women were seen during this period. Further research is indicated to examine patient attitudes towards telehealth services, barriers to treatment for Black women, and outcome data. [ABSTRACT FROM AUTHOR]

Recent work has highlighted that people who have had TIA may have abnormal motor and cognitive function. We aimed to quantify deficits in a cohort of individuals who had TIA and measured changes in their abilities to perform behavioural tasks over 1 year of follow-up using the Kinarm Exoskeleton robot. We additionally considered performance and change over time in an active control cohort of migraineurs. Individuals who had TIA or migraine completed 8 behavioural tasks that assessed cognition as well as motor and sensory functionality in the arm. Participants in the TIA cohort were assessed at 2, 6, 12, and 52 weeks after symptom resolution. Migraineurs were assessed at 2 and 52 weeks after symptom resolution. We measured overall performance on each task using an aggregate metric called Task Score and quantified any significant change in performance including the potential influence of learning. We recruited 48 individuals to the TIA cohort and 28 individuals to the migraine cohort. Individuals in both groups displayed impairments on robotic tasks within 2 weeks of symptom cessation and also at approximately 1 year after symptom cessation, most commonly in tests of cognitive-motor integration. Up to 51.3% of people in the TIA cohort demonstrated an impairment on a given task within 2-weeks of symptom resolution, and up to 27.3% had an impairment after 1 year. In the migraine group, these numbers were 37.5% and 31.6%, respectively. We identified that up to 18% of participants in the TIA group, and up to 10% in the migraine group, displayed impairments that persisted for up to 1 year after symptom resolution. Finally, we determined that a subset of both cohorts (25–30%) experienced statistically significant deteriorations in performance after 1 year. People who have experienced transient neurological symptoms, such as those that arise from TIA or migraine, may continue to experience lasting neurological impairments. Most individuals had relatively stable task performance over time, with some impairments persisting for up to 1 year. However, some individuals demonstrated substantial changes in performance, which highlights the heterogeneity of these neurological disorders. These findings demonstrate the need to consider factors that contribute to lasting neurological impairment, approaches that could be developed to alleviate the lasting effects of TIA or migraine, and the need to consider individual neurological status, even following transient neurological symptoms. [ABSTRACT FROM AUTHOR]

Perinatal mental health is recognized as a priority component of obstetrical care. Perinatal patients often turn to their obstetrician for help with mental health concerns as they view them as their primary health care provider. Unfortunately, obstetricians face challenges in providing adequate support due to time constraints and limited expertise. Integrated behavioral health care offers a collaborative and cost-effective solution to enhance patient care and clinician satisfaction. Integrated behavioral health clinicians possess fundamental skills to care for patients throughout the reproductive lifespan and assist obstetricians in identifying and managing common mood concerns. [ABSTRACT FROM AUTHOR]

Objective: There is concern whether established parenting programs for children's conduct problems meet the needs of families with severe and complex mental health problems. For example, many children with conduct problems show comorbid attention-deficit/hyperactivity disorder (ADHD) or emotional problems, or have parents who are depressed, but families with such complex mental health problems typically seen in real life are often underrepresented in evaluation trials. We tested whether children with more severe conduct problems, and those with more complex mental health problems, benefit less from the Incredible Years parenting program, using individual participant data meta-analysis of randomized trials in Europe.Method: In 1,696 families from 13 children aged (child age 2-11 years; 37% girls; 58% low income; 30% ethnic minority; 98% mothers), we used moderator analysis within a multilevel model to test whether initial conduct problem severity, comorbid ADHD or emotional problems, and maternal depression would diminish intervention effects for children's conduct problems.Results: The Incredible Years program reduced children's conduct problems overall (Cohen's d = -0.35), but more so in children with more severe conduct problems. There was no evidence that children's comorbid ADHD and emotional problems changed the intervention benefits. Children of mothers with more depressive symptoms benefited more.Conclusion: Children with more severe conduct problems derive greater, rather than lesser, benefits from a high-quality group parenting program, and comorbid ADHD and emotional problems do not reduce effects; maternal depression, rather than being linked to less child change, was associated with greater reductions in children's conduct problems. [ABSTRACT FROM AUTHOR]

Introduction: The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations.Materials and Methods: This is a quality improvement pre-post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants' self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard.Results: A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = -11.29, p < 0.001. A paired t-test revealed a significant increase in exam scores from pre (M = 70.22, SD = 9.43) to post (M = 87.78, SD = 7.19), t (17) = -7.31, p < 0.001. There was no pre-intervention skills assessment, however, all participants (n = 18, 100%) passed the tourniquet application, needle chest compression, and insertion of nasopharyngeal airway.Conclusion: TCCC for Army Aviators is easily implemented, demonstrates an increase in knowledge and confidence in providing prehospital care, and provides effective scenario-based training of necessary psychomotor skills needed to reduce preventable death on the battlefield. TCCC for Army Aviators effectively takes the TCCC for All Combatants curriculum and modifies it to address the unique considerations in treating wounded aviators and passengers, both in flight and after crashes. This project demonstrates on a small scale how TCCC can be tailored to specific military jobs in order to successfully meet the intent of the upcoming All Service Member TCCC course mandated in DoD 1322.24. Beyond Army aviation, this program is easily modifiable for aviators throughout the military and civilian sector. [ABSTRACT FROM AUTHOR]

We aimed to retrospectively determine if initial staging18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can predict overall survival (OS) in oral cavity squamous cell carcinoma (OCSCC), which is currently a source of ongoing controversy in the literature. Forty-six consecutive patients with nonmetastatic (Stage M0) OCSCC had18F-FDG PET/CT prior to definitive surgical treatment followed by observation or adjuvant treatment at our institution between 2006 and 2012. The median follow-up time was 18 months (range 0.1–76 months). Univariate and multivariate analysis were used to determine the ability of imaging, pathologic, and demographic factors to predict OS.18F-FDG PET/CT parameters were standardized uptake value (SUV) maximum and mean, metabolic tumor volume, and total lesional glycolysis (TLG) of primary tumor and regional nodes. Significant predictors of OS in the multivariate analysis were primary tumor SUV mean, nodal TLG, and age. Two-year OS of patients with primary tumor SUV mean below and above the median of 6.26 was 68% and estimated 28%, respectively. Two-year OS of patients with nodal TLG below and above median of 7.9 was 69% and 34%, respectively. Two-year OS of patients younger and older than median age of 57 was 60% and 43%, respectively. Our results suggest that18F-FDG PET/CT may be a valuable addition to multifactorial models predicting outcome for OCSCC. Thus, continued research aiming to incorporate18F-FDG PET/CT parameters in risk-stratification algorithms for OCSCC is warranted and should be conducted using more standardized prognostic models driven by a specific clinical question. [ABSTRACT FROM AUTHOR]

Current models of motor learning suggest that multiple timescales support adaptation to changes in visual or mechanical properties of the environment. These models capture patterns of learning and memory across a broad range of tasks, yet do not consider the possibility that rapid changes in behavior may occur without adaptation. Such changes in behavior may be desirable when facing transient disturbances, or when unpredictable changes in visual or mechanical properties of the task make it difficult to form an accurate model of the perturbation. Whether humans can modulate control strategies without an accurate model of the perturbation remains unknown. Here we frame this question in the context of robust control (Hx-control), a control strategy that specifically considers unpredictable disturbances by increasing initial movement speed and feedback gains. Correspondingly, we demonstrate in two human reaching experiments including males and females that the occurrence of a single unpredictable disturbance led to an increase in movement speed and in the gain of rapid feedback responses to mechanical disturbances on subsequent movements. This strategy reduced perturbation-related motion regardless of the direction of the perturbation. Furthermore, we found that changes in the control strategy were associated with co-contraction, which amplified the gain of muscle responses to both lengthening and shortening perturbations. These results have important implications for studies on motor adaptation because they highlight that trial-by-trial changes in limb motion also reflected changes in control strategies dissociable from error-based adaptation. [ABSTRACT FROM AUTHOR]

Planar wave fronts in autocatalytic chemical systems propagate with a constant wave form and velocity provided that the reactant and autocatalytic species have similar diffusion coefficients. Such waves are also stable to spatial perturbations. Circular or spherical fronts show a constant wave form and a velocity that increases towards the planar wave velocity as the radius increases with time. These are again stable to spatial perturbation if the reactant and autocatalyst have similar diffusivities. However, if the ratio of the diffusion coefficients δ exceeds some critical value δ*≊2.3 a different situation arises. For cylindrical or spherical geometries, unperturbed waves decelerate as they expand if δ>=δ*. For all geometries, the smooth waves may become unstable to spatial perturbation if δ>=δ* although there are some additional requirements. In Cartesian systems, the width of the reaction zone transverse to the direction of propagation must exceed some minimum value W*≊6 (in dimensionless units) and the wave number of the imposed perturbation must be less than kcr,max≊0.15. For circular or spherical waves, the conditions for the growth of perturbations also involves the radius of the wave at the moment the perturbation is applied. A set of expansions based on small curvature and small departures of δ from unity have been derived allowing the instantaneous wave velocity to be written in the form v(θ,[lowercase_phi_synonym],τ)=c+v1κ+v2Δtrκ, where the coefficients c, v1, and v2 depend on δ and κ is the instantaneous curvature. © 1995 American Institute of Physics. [ABSTRACT FROM AUTHOR]

A prototype model is exploited to reveal the origin of mixed-mode oscillations. The initial oscillatory solution is born at a supercritical Hopf bifurcation and exhibits subsequent period doubling as some parameter is varied. This period-2 solution subsequently loses stability, but continues to exist-regaining stability to form the 11 mixed-mode state (one large plus one small excursion). Other mixed-mode states lie on isolated branches or ‘‘isolas’’ of limit cycles in the one-parameter bifurcation diagram and are separated by regions of chaos. As a second parameter is varied, the number of isola solutions increases and the ‘‘gaps’’ between them become narrower, leading to correspondingly more complete Devil’s staircases. An exactly comparable scenario is shown to arise in the three variable model of the Belousov–Zhabotinsky reaction proposed recently by Györgyi and Field [Nature 335, 808 (1992)]. [ABSTRACT FROM AUTHOR]

Complex oscillations and even aperiodicity can exist as transient phenomena in closed chemical systems. These effects are illustrated through the analysis of a simple, isothermal chemical model based on mass action kinetics for autocatalytic feedback, involving the conversion of a reactant to a final product via three intermediate species. The use of the so-called pool chemical approximation and of pseudo-steady-state analyses for such systems is indicated and discussed, particularly with relevance to ‘‘real’’ chemical situations where small perturbations due to extraneous noise are inevitably present. [ABSTRACT FROM AUTHOR]

Study Objective A rare cause of adolescent abdominal pain includes isolated tubal torsion (ITT). Presentation is nonspecific and few studies have investigated ITT in adolescents. Our study objective was to describe the presentation and management of ITT in a large case series. Design Retrospective observational case series. Setting Tertiary care children's hospital. Participants Participants were female and aged 3-21 years, presenting to Children's Hospital Colorado and diagnosed with ITT between January 2004 and August 2015. Interventions and Main Outcome Measures Clinical presentation, physical exam, laboratory findings, surgical diagnosis, and treatment provided. Results A total of 19 cases were included. Average age was 13.3 (range, 11-18) years. In patients with unilateral abdominal pain (n = 16), there was 100% correlation with side of adnexal pathology. Ultrasound examination in 14 of 18 cases (78%) noted abnormal findings ipsilateral to the ITT. Most cases were managed with laparoscopy (84%; n = 16 of 19) and detorsion with or without cystectomy (74%; n = 14 of 19). Salpingectomy was more common with prolonged pain greater than 24 hours (relative risk 5.6, 95% confidence interval, 0.7-39.0). The most common intraoperative finding was a paratubal cyst (74%; n = 14 of 19). When Doppler flow was performed, it was present in 88% (n = 16 of 18) of the affected adnexa. ITT was more common on the left side (68%; n = 13 of 19). Conclusion The high occurrence of paratubal cysts might suggest pathologic predisposition for ITT. Providers should maintain a high index of suspicion for ITT, particularly if associated with a paratubal cyst. Classic examination findings of surgical abdomen, leukocytosis, fever, and absence of Doppler flow are infrequently present. Laparoscopy and detorsion are appropriate treatments for managing ITT. [ABSTRACT FROM AUTHOR]

Humans are adept at performing an extraordinary breadth of voluntary motor actions that allow us to rapidly move around and interact with the environment. While voluntary motor actions necessarily include top-down intention to generate a motor act, a key to voluntary control is the selective use of bottom-up sensory feedback to select and guide motor actions. This review classifies the many ways in which sensory feedback is used by the motor system and highlights regularities in the timing of each class of motor responses to sensory stimuli, revealing a functional hierarchical organization of motor control. The highly automatic way in which feedback is typically used in goal-directed action blurs the distinction between reflexes and voluntary control. [ABSTRACT FROM AUTHOR]

The article by Ng and Weisz () on how to build a science of personalized intervention for youth mental health is ambitious and wide-ranging, being packed with penetrating analyses and imaginative proposals that set the agenda for psychotherapeutic research for years to come. It is driven by the desire to make therapy more effective, and underpinned by the notion that if therapy can be fitted more closely to individual characteristics, results will be better. [ABSTRACT FROM AUTHOR]

A central problem in motor neuroscience is to understand how we select, plan, and control motor actions. An influential idea is that the motor system computes and implements a desired limb trajectory, an intermediary control process between the behavioral goal (reach a spatial goal) and motor commands to move the limb. The most compelling evidence for trajectory control is that corrective responses are directed back toward the unperturbed trajectory when the limb is disturbed during movement. However, the idea of trajectory control conflicts with optimal control theories that emphasize goal-directed motor corrections. Here we show that corrective responses in human subjects can deviate back toward the unperturbed trajectory, but these reversals were only present when there were explicit limits on movement time. Our second experiment asked whether trajectory control could be generated if the trajectory was made an explicit goal of the task. Participants countered unexpected loads while reaching to a static goal, tracking a moving target, or maintaining their hand within a visually constrained path to a static goal. Corrective responses were directed back toward the constrained path or to intercept the moving target. However, corrections back to the unperturbed path disappeared when reaching to the static target. Long-latency muscle responses paralleled changes in the behavioral goal in both sets of experiments, but goal-directed responses were delayed by 15-25 ms when tracking the moving goal. Our results show the motor system can behave like a trajectory controller but only if a "desired trajectory" is the goal of the task. [ABSTRACT FROM AUTHOR]

Humans possess an impressive ability to generate goal-oriented motor actions to move and interact with the environment. The planning and initiation of these body movements is supported by highly distributed cortical and subcortical circuits. Recent studies, inspired by advanced control theory, highlight similar sophistication when we make online corrections to counter small disturbances of the limb or altered visual feedback. Such goal-directed feedback is likely generated by the same neural circuits associated with motor planning and initiation. These common neural substrates afford a highly responsive system to maintain goal-directed control and rapidly select new motor actions as required to deftly move and interact in a complex world. [ABSTRACT FROM AUTHOR]

A common problem in motor control concerns how to generate patterns of muscle activity when there are redundant solutions to attain a behavioral goal. Optimal feedback control is a theory that has guided many behavioral studies exploring how the motor system incorporates task redundancy. This theory predicts that kinematic errors that deviate the limb should not be corrected if one can still attain the behavioral goal. Studies in humans demonstrate that the motor system can flexibly integrate visual and proprioceptive feedback of the limb with goal redundancy within 90 ms and 70 ms, respectively. Here, we show monkeys (Macaca mulatta) demonstrate similar abilities to exploit goal redundancy. We trained four male monkeys to reach for a goal that was either a narrow square or a wide, spatially redundant rectangle. Monkeys exhibited greater trial-bytrial variability when reaching to the wide goal consistent with exploiting goal redundancy. On random trials we jumped the visual feedback of the hand and found monkeys corrected for the jump when reaching to the narrow goal and largely ignored the jump when reaching for the wide goal. In a separate set of experiments, we applied mechanical loads to the arm of the monkey and found similar corrective responses based on goal shape. Muscle activity reflecting these different corrective responses were detected for the visual and mechanical perturbations starting at ~90 and ~70 ms, respectively. Thus, rapid motor responses in macaques can exploit goal redundancy similar to humans, creating a paradigm to study the neural basis of goal-directed motor action and motor redundancy. [ABSTRACT FROM AUTHOR]

Feedback delays are a major challenge for any controlled process, and yet we are able to easily control limb movements with speed and grace. A popular hypothesis suggests that the brain largely mitigates the impact of feedback delays (∼50 ms) by regulating the limb intrinsic visco-elastic properties (or impedance) with muscle co-contraction, which generates forces proportional to changes in joint angle and velocity with zero delay. Although attractive, this hypothesis is often based on estimates of limb impedance that include neural feedback, and therefore describe the entire motor system. In addition, this approach does not systematically take into account that muscles exhibit high intrinsic impedance only for small perturbations (short-range impedance). As a consequence, it remains unclear how the nervous system handles large perturbations, as well as disturbances encountered during movement when short-range impedance cannot contribute. We address this issue by comparing feedback responses to load pulses applied to the elbow of human subjects with theoretical simulations. After validating the model parameters, we show that the ability of humans to generate fast and accurate corrective movements is compatible with a control strategy based on state estimation. We also highlight the merits of delay-uncompensated robust control, which can mitigate the impact of internal model errors, but at the cost of slowing feedback corrections. We speculate that the puzzling observation of presynaptic inhibition of peripheral afferents in the spinal cord at movement onset helps to counter the destabilizing transition from high muscle impedance during posture to low muscle impedance during movement. [ABSTRACT FROM AUTHOR]

Hair tourniquets are a rare phenomenon effecting potentially any appendage. Male genitalia and digits are the most common locations with female genitalia classified as an "other" site, occurring in less than 6% of reported reviews. The most recent review of female genital hair tourniquets identified 34 patients from 32 reports or series. Pain was reported as a presenting symptom in 30 cases, while the remaining four cases did not comment on pain. We present a case of an asymptomatic labial hair tourniquet presenting as a vulvar mass. The patient is a 5-year 7-month female born at 24 weeks gestation with intraventricular hemorrhage and subsequent cerebral palsy (CP) and lower extremity contractures. The patient was referred by her PCP for possible biopsy due to a recurrent vulvar mass that waxed and waned in size and purple discoloration over two months. The patient was scheduled for exam under anesthesia and noted to have an edematous left labia minora (Fig 1) with tightly wound hair and cotton threads at the base leaving an erosion with an indentation flap in its mid portion (Fig 2). The fibers were released, a 'V" excision was created removing the mid portion (Fig3), and the inferior and superior areas of the labia were approximated restoring symmetry. (Figs 4) The patient's postoperative course was uncomplicated and at 20 months post procedure her parents report normal anatomy without new incidents of labia edema. This case report demonstrates a presentation of chronic painless swelling due to a labia hair tourniquet, which has not yet been described in the literature. Absence of pain may have led to a delay in referral for definitive diagnosis and treatment. It is possible that sensory disruptions in the lower extremities from CP contributed to the lack pain perception by the patient. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionBreastfeeding has a positive impact on child and maternal health outcomes. Black and Latina women and adolescent mothers have lower rates of breastfeeding initiation and continuance in the U.S. Maternal depression and psychosocial stressors may contribute to reduced rates of breastfeeding. The current study aims to better understand behaviours and associated factors related to breastfeeding in a diverse group of adolescent mothers attending a teen-tot clinic for postpartum and infant well care.Participants were 191 mother-infant dyads. Mother’s age ranged from 13 to 25, and 54% of mothers identified as Latina, 22% Black, 11% more than one race and 5% white. Demographic information and breastfeeding behaviour were abstracted from the medical record. Rates of postpartum mood/anxiety symptoms and psychosocial stressors were obtained from screening measures completed at medical visits.Analyses revealed that 87% of adolescent mothers in the sample initiated breastfeeding at birth and the racial/ethnic breakdown of those mothers closely mirrored the overall population (58% Hispanic or Latina, 17% Black, 10% more than one race, 5% white). At 2 months postpartum, only 41% of the population was still breastfeeding. Mothers with significant mood/anxiety symptoms at the newborn visit were more likely to be breastfeeding at the 1- and 2-month visits. Mothers with psychosocial stressors at the newborn visit were less likely to be breastfeeding at the 1- and 2-month visits.Efforts to promote health equity through breastfeeding for at-risk mothers must occur within the first few weeks postpartum and must consider associated factors including postpartum mood/anxiety symptoms and psychosocial stressors. [ABSTRACT FROM AUTHOR]

In this issue of Neuron , Stavisky et al. (2017) demonstrate that visual feedback in M1 during reaching initially reflects a specific pattern of neural activity that does not generate motor output and then is altered to a pattern that does generate motor output. This switch likely provides time for the motor system to consider various behavioral factors when specifying the appropriate motor response during voluntary motor actions. [ABSTRACT FROM AUTHOR]

In many child services across health, education and social care, ‘attachment disorder’ is a popular description and explanation for complex presentations of children who have been neglected or maltreated and is frequently used to describe fostered and adopted children. Very often the use of this term bears little resemblance to the established diagnostic systems, nor indeed to attachment theory as conceptualised by Bowlby. Its misuse can lead professionals to overlook commoner and more treatable conditions, to the detriment of the children. In fact both reactive and disinhibited attachment disorders are rare, but are becoming better characterised by high quality research. Poor understanding about the attachment disorder construct can pose particular problems for clinicians working with adopted children. The current paper briefly reviews the practical difficulties with the attachment disorder diagnosis as applied to adopted children and uses four case studies taken from a specialist Adoption and Fostering Service to highlight some of the problems for services working with adopted children. Finally, we propose some provisional recommendations for the assessment and treatment of adopted children and their families, which aim to be consistent with attachment theory as well as with the existing evidence base on wider child mental health problems. [ABSTRACT FROM PUBLISHER]

Objective: Antisocial personality is a common adult problem that imposes a major public health burden, but for which there is no effective treatment. Affected individuals exhibit persistent antisocial behavior and pervasive antisocial character traits, such as irritability, manipulativeness, and lack of remorse. Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking. Method: The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13. The primary psychiatric outcome measures were the two elements of antisocial personality, namely, antisocial behavior (assessed by a diagnostic interview) and antisocial character traits (assessed by a questionnaire). Also assessed were reading achievement (an important domain of youth functioning at work) and parent-adolescent relationship quality. Results: In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group (antisocial behavior: odds ratio of oppositional defiant disorder= 0.20, 95% CI=0.06, 0.69; antisocial character traits: B=–4.41, 95% CI=–1.12, –8.64). Additionally, reading ability improved (B=9.18, 95% CI=0.58, 18.0). Parental expressed emotion was warmer (B=0.86, 95% CI=0.20, 1.41) and supervision was closer (B=–0.43, 95% CI=–0.11, –0.75), but direct observation of parenting showed no differences. Teacher-rated and self-rated antisocial behavior were unchanged. In contrast, in the selective high-risk sample, early intervention was not associated with improved long-term outcomes. Conclusions: Early intervention with severely antisocial children for whom treatment is indicated may prevent the development of antisocial personality in adolescence and may improve academic performance. In contrast, early intervention with selective high-risk samples may be ineffective. [ABSTRACT FROM AUTHOR]

Background: Our environment is composed of biological components of varying magnitude. The relationships between the different biological elements can be represented as a biological network. The process of mating in S. cerevisiae is initiated by secretion of pheromone by one of the cells. Our interest lies in one particular question: how does a cell dynamically adapt the pathway to continue mating under severe environmental changes or under mutation (which might result in the loss of functionality of some proteins known to participate in the pheromone pathway). Our work attempts to answer this question. To achieve this, we first propose a model to simulate the pheromone pathway using Petri nets. Petri nets are directed graphs that can be used for describing and modeling systems characterized as concurrent, asynchronous, distributed, parallel, non-deterministic, and/or stochastic. We then analyze our Petri net-based model of the pathway to investigate the following: 1) Given the model of the pheromone response pathway, under what conditions does the cell respond positively, i.e., mate? 2) What kinds of perturbations in the cell would result in changing a negative response to a positive one? Method: In our model, we classify proteins into two categories: core component proteins (set ψ) and additional proteins (set λ). We randomly generate our model’s parameters in repeated simulations. To simulate the pathway, we carry out three different experiments. In the experiments, we simply change the concentration of the additional proteins (λ) available to the cell. The concentration of proteins in ψ is varied consistently from 300 to 400. In Experiment 1, the range of values for λ is set to be 100 to 150. In Experiment 2, it is set to be 151 to 200. In Experiment 3, the set λ is further split into σ and ς, with the idea that proteins in σ are more important than those in ς. The range of values for s is set to be between 151 to 200 while that of ς is 100 to 150. Decision trees were derived from each of the first two experiments to allow us to more easily analyze the conditions under which the pheromone is expressed. Conclusion: The simulation results reveal that a cell can overcome the detrimental effects of the conditions by using more concentration of additional proteins in λ. The first two experiments provide evidence that employing more concentration of proteins might be one of the ways that the cell uses to adapt itself in inhibiting conditions to facilitate mating. The results of the third experiment reveal that in some case the protein set σ is sufficient in regulating the response of the cell. Results of Experiments 4 and 5 reveal that there are certain conditions (parameters) in the model that are more important in determining whether a cell will respond positively or not. [ABSTRACT FROM AUTHOR]

Ahallmark of voluntary motor control is the ability to adjust motor patterns for novel mechanical or visuomotor contexts. Recent work has also highlighted the importance of feedback for voluntary control, leading to the hypothesis that feedback responses should adaptwhenwelearnnew motorskills. We tested this prediction with a novelparadigmrequiring thathumansubjects adapt to a viscouselbowload while reaching to three targets. Target 1 required combined shoulder and elbow motion, target 2 required only elbow motion, and target 3 (probe target) required shoulder but no elbow motion. This simple approach controlled muscle activity at the probe target before, during, and after the application of novel elbow loads. Our paradigm allowed us to perturb the elbow during reaching movements to the probe target and identify several key properties of adapted stretch responses. Adapted long-latency responses expressed (de-) adaptation similar to reaching errors observed when we introduced (removed) the elbow load. Moreover, reaching errors during learning correlated with changes in the long-latency response, showing subjects who adapted more to the elbow load displayed greater modulation of their stretch responses. These adapted responses were sensitive to the sizeanddirection of the viscous training load. Our results highlightanimportant link between the adaptation of feedforwardand feedback control and suggest a key part of motor adaptation is to adjust feedback responses to the requirements of novel motor skills. [ABSTRACT FROM AUTHOR]

In every motor task, our brain must handle external forces acting on the body. For example, riding a bike on cobblestones or skating on irregular surface requires us to appropriately respond to external perturbations. In these situations, motor predictions cannot help anticipate the motion of the body induced by external factors, and direct use of delayed sensory feedback will tend to generate instability. Here, we show that to solve this problem the motor system uses a rapid sensory prediction to correct the estimated state of the limb. We used a postural task with mechanical perturbations to address whether sensory predictions were engaged in upper-limb corrective movements. Subjects altered their initial motor response in ∼60 ms, depending on the expected perturbation profile, suggesting the use of an internal model, or prior, in this corrective process. Further, we found trial-to-trial changes in corrective responses indicating a rapid update of these perturbation priors. We used a computational model based on Kalman filtering to show that the response modulation was compatible with a rapid correction of the estimated state engaged in the feedback response. Such a process may allow us to handle external disturbances encountered in virtually every physical activity, which is likely an important feature of skilled motor behaviour. [ABSTRACT FROM AUTHOR]

Agricultural lands are considered to be a major source of nonpoint source pollutants such as sediment, pesticides and nutrients in the United States. Conservation practices have been tested for their effectiveness in reducing agricultural related pollutants on smaller scales, but farm watershed scale assessments of these practices are limited and few of these have evaluated the impacts on downstream ecology. Several projects focused on oxbow lake watersheds in the Mississippi River alluvial plain were designed to utilize working farms to evaluate primary pollutants in water resources and to identify conservation practices that are most effective in reducing the transport of those pollutants in surface and ground water on a watershed scale. Major findings of these studies include: (1) conservation practices reduced sediment in oxbow lakes, resulting in improved water clarity, plankton growth, and fish stocks; (2) total phosphorus in lakes decreased between 39-50% following application of conservation practices; (3) conservation tillage and cover crops reduced NO3-N losses by 73%, sediment losses by 70; and (4) riparian areas mitigated the transport of sediment in runoff and enhanced the degradation of pesticides. [ABSTRACT FROM AUTHOR]

Summary: Neurons in monkey primary motor cortex (M1) tend to be most active for certain directions of hand movement and joint-torque loads applied to the limb. The origin and function of these biases in preference distribution are unclear but may be key to understanding the causal role of M1 in limb control. We demonstrate that these distributions arise naturally in a network model that commands muscle activity and is optimized to control movements and counter applied forces. In the model, movement and load preference distributions matching those observed empirically are only evident when particular features of the musculoskeletal system were included: limb geometry, intersegmental dynamics, and the force-length/velocity properties of muscle were dominant factors in dictating movement preferences, and the presence of biarticular muscles dictated load preferences. Our results suggest a general principle: neural activity in M1 commands muscle activity and is optimized for the physics of the motor effector. [Copyright &y& Elsevier]

Optimal feedback control (OFC) provides a powerful tool to interpret voluntary motor control, highlighting the importance of sensory feedback in the control and planning of movement. Recent studies in the context of OFC have increasingly used mechanical perturbations and visual shifts to probe voluntary control processes. These studies reveal the surprising sophistication of corrective responses, which are goal-directed and exhibit knowledge of the physical properties of the limb and the environment. These complex feedback processes appear to be generated through transcortical feedback pathways. The research reviewed here opens and enhances several lines of discovery, including testing whether feedback corrections share all of the attributes associated with voluntary control, identifying how prediction influences optimal state estimation, and importantly, how these voluntary control processes are generated by the highly distributed circuitry within the brain. [ABSTRACT FROM AUTHOR]

Background: The concept of differential susceptibility has challenged the potential meaning of personal traits such as poor ability to regulate emotions. Under the traditional model of diathesis/stress, personal characteristics such as liability to angry outbursts are seen as essentially disadvantageous, emerging under duress in a way that is maladaptive. In contrast, with differential susceptibility, there is the same poorer functioning under adverse conditions but, under favorable conditions, individuals with the trait function better than those without it. To date, there have been limited studies on response under positive environments. We used the experimental power of an intervention trial to test the differential susceptibility hypothesis that children with emotional dysregulation would show greater response to an experimentally induced improvement in their parenting environment. Methods: Data were from the SPOKES trial (ISRCTN 77566446), a randomized controlled trial of 112 school children who were 5-6-years old, screened for elevated levels of oppositionality, randomized to parenting groups or control; 109 (97%) were followed-up a year later. Using DSM-IV oppositional-defiant symptoms, children were divided into an Emotionally-Dysregulated type (ED, n = 68) and a Headstrong type ( n = 44). The parenting intervention was the Incredible Years program supplemented by positive strategies to use when reading with children. Assessment of conduct problems and parenting was by semistructured interviews. Results: At follow-up, parents of Emotionally-Dysregulated and Headstrong children allocated to the intervention showed significant improvements in their parenting strategies to an equal extent compared to parents in the control group. However, the Emotionally-Dysregulated children showed a significantly greater decrease in conduct problems between intervention and control groups (treatment effect-size 0.84 standard deviations) than the Headstrong (es 0.20 SD), p = 0.04. Conclusions: Using the power of a controlled experiment, this study showed that children who exhibited Emotionally-Dysregulated behavior pretreatment were more responsive to improvements in parental care that were experimentally induced. The findings extend prior work on differential sensitivity in suggesting that children exhibiting irascibility and emotionality may show greater susceptibility to the caregiving environment, and may identify a subset of children who respond better to existing treatments. [ABSTRACT FROM AUTHOR]

There has traditionally been a separation between voluntary control processes and the fast feedback responses which follow mechanical perturbations (i.e., stretch 'reflexes'). However, a recent theory of motor control, based on optimal control, suggests that voluntary motor behavior involves the sophisticated manipulation of sensory feedback. We have recently proposed that one implication of this theory is that the long-latency stretch 'reflex', like voluntary control, should support a rich assortment of behaviors because these two processes are intimately linked through shared neural circuitry including primary motor cortex. In this review, we first describe the basic principles of optimal feedback control related to voluntary motor behavior. We then explore the functional properties of upper-limb stretch responses, with a focus on how the sophistication of the long-latency stretch response rivals voluntary control. And last, we describe the neural circuitry that underlies the long-latency stretch response and detail the evidence that primary motor cortex participates in sophisticated feedback responses to mechanical perturbations. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the risk of misdiagnosis of asthma in obese patients. It identifies factors that increase the risk namely, impaired health-related quality of life (HRQoL) and increased body mass index (BMI). It explores the relationship between HRQoL and BMI and other measures of asthma severity in obese subjects. It concludes that there are instances of misdiagnosis in obese subjects.

Behaviour problems and poor literacy levels are each independently associated with a lower quality of life in childhood, and carry forward to predict much poorer outcomes in adulthood. Longitudinal surveys show that the dimensions of parenting that influence child behaviour and child literacy differ. The aspects of parenting that promote good behaviour concern the quality of the relationship, for example giving warmth and encouragement while calmly enforcing clear limits. In contrast, the aspects that promote literacy are regular reading with the child in a manner that is sensitive to their ability level. To help children with difficulties, there are many evidence-based parenting programmes to improve parent–child relationship quality, but very few address literacy. This paper reviews evidence on these issues, illustrated by our own previous preventive trials that combined a parenting programme addressing relationships (Incredible Years; IY) with a new parenting programme addressing literacy (Supporting Parents on Kids Education; SPOKES). Because this combination improved both child behaviour and literacy, a new randomized controlled trial called Helping Children Achieve is underway to disentangle the mode of action of each component by comparing the effects of: (1) a relationship programme alone (IY); with (2) a literacy programme alone (SPOKES); (3) both combined; and (4) an information helpline (control group). The results are not yet known but should answer whether programmes that target relationships also improve child literacy, and whether programmes that target literacy also improve behaviour. The findings will inform strategies to reduce social inequality and help young children achieve their potential. [ABSTRACT FROM PUBLISHER]

Background. After the safety issues raised by the Salmeterol Multicenter Asthma Research Trial, concerns persist about the safety of agents that cause prolonged β-adrenoceptor stimulation in asthmatic patients. We therefore decided to revisit and review the use of continuous subcutaneous infusions of terbutaline (CSIT)-a treatment often reserved for those with severe and refractory disease. Results. Original studies from the 1980s included 26 patients and showed that CSIT was well tolerated with predominately cutaneous side effects despite maintaining very high serum levels of terbutaline. CSIT led to improved outcomes in approximately 75% of patients which included rises in lowest daily peak expiratory flow rate (PEFR), diminution in diurnal variation, reduction in other medication requirements, and subjective opinion of symptoms. Almost all patients demonstrating an improvement had a wide variation in their pretreatment PEFRs. However, in a retrospective follow-up of 42 patients, the only outcome to be significantly improved by CSIT was that of mean hospital admissions ( p = .031). CSIT is theorized to stimulate a discrete set of β-receptors not accessible by the inhaled route as further increases in Forced expiratory volume in one second (FEV1) occur with concurrent nebulized therapy. Conclusion. Although some findings are encouraging, they are drawn from small observational studies done at a time when the standard management of asthma was quite different from today. No randomized controlled trials exist for the use of CSIT, which remains off-license for the treatment of asthma in the United Kingdom. Clearly, prospective well-powered studies are required to fully ascertain its potential benefits and safety profile-something that is unlikely to occur given that the use of CSIT remains low and appears to be declining. [ABSTRACT FROM AUTHOR]

Background: Children with oppositional defiant disorder/conduct disorder (ODD/CD) have shown deficits in 'cool' abstract-cognitive, and 'hot' reward-related executive function (EF) tasks. However, it is currently unclear to what extent ODD/CD is associated with neuropsychological deficits, independently of attention deficit hyperactivity disorder (ADHD). Methods: Fifty-nine adolescents with a history of early-onset oppositional problems, 28 with pure ODD/CD symptoms and 31 with ADHD with or without ODD/CD, and 34 healthy controls were administered a task battery measuring motor response inhibition, sustained attention, cognitive flexibility and reward-related decision-making. Findings were analysed using dimensional and group analyses. Results: In group analyses both groups with and without ADHD were impaired in EF measures. Dimensional analyses, however, showed that ODD/CD but not ADHD was related to hot EF based on increased risky decision-making in the Iowa Gambling Task. ODD/CD was also independently related to aspects of cool EF independently of ADHD, namely slower speeds of inhibitory responding and increased intra-subject variability. Conclusions: These findings show EF deficits associated with ODD/CD independently of ADHD, and implicate reward-related abnormalities in theories of antisocial behaviour development. [ABSTRACT FROM AUTHOR]

Background: Attachment theory was conceptualized by Bowlby as relevant across the life span, from 'cradle to grave'. The research literature on attachment in infants and preschool-aged children is extensive, but it is limited in adolescence. In particular, it is unclear whether or not attachment security is distinguishable from other qualities of the parent-adolescent relationship and predicts adjustment independently of alternate measures of it. Methods: Data from three parallel studies of adolescents, representing normal- to high-risk status, were combined, n = 248. Attachment was assessed using the Child Attachment Interview, a recently constructed measure designed for older children and adolescents. Parent-adolescent relationship quality was assessed in detail through questionnaires, interviews and observation of a standard problem-solving interaction. Adolescent adjustment was assessed through parental psychiatric interview, teacher questionnaire and adolescent self-report. Results: Bivariate analyses showed that secure attachment representations were modestly associated with diverse measures of the current parent-adolescent relationship such as monitoring, negative expressed emotion, and directly observed parental warmth and anger. In addition, attachment representations were reliably associated with key indicators of psychological adjustment in adolescence, including parent-rated oppositional-defiant disorder symptoms and teacher-reported emotional and behavioural difficulties. Regression analyses revealed that secure attachment representations explained unique variance in these indicators of adjustment, independent of alternative measures of the parent-adolescent relationship. Conclusion: Adolescents' representational models of attachment are related to but distinct from current parenting quality and provide unique insight into the understanding of behavioural adjustment. The findings support a distinct conceptual role of attachment representations in adolescence. Clinical assessment and treatment models should include attachment patterns in this age group. [ABSTRACT FROM AUTHOR]

Robotic technologies have profoundly affected the identification of fundamental properties of brain function. This success is attributable to robots being able to control the position of or forces applied to limbs, and their inherent ability to easily, objectively, and reliably quantify sensorimotor behavior. Our general hypothesis is that these same attributes make robotic technologies ideal for clinically assessing sensory, motor, and cognitive impairments in stroke and other neurological disorders. Further, they provide opportunities for novel therapeutic strategies. The present opinionated review describe show robotic technologies combined with virtual/augmented reality systems can support a broad range of behavioral tasks to objectively quantify brain function. This information could potentially be used to provide more accurate diagnostic and prognostic information than is available from current clinical assessment techniques. The review also highlights the potential benefits of robots to provide upper-limb therapy. Although the capital cost of these technologies is substantial, it pales in comparison with the potential cost reductions to the overall healthcare system that improved assessment and therapeutic interventions offer. [ABSTRACT FROM AUTHOR]

The use of multi-method, multi-informant assessment is a hallmark of research in child development and mental health; however, many research strategies such as population surveys require brief assessment tools. The Alabama Parenting Questionnaire (APQ) is a popular measure of empirically identified aspects of positive and negative parenting styles important to conduct problems in children. A brief version exists, however it does not measure all relevant parenting domains, and it has not been validated for child reports. We evaluated validity of the brief parent and child report version of the complete five subscale version of the APQ in a sample of 208 children aged between 9 and 17, at risk for conduct problems and antisocial behaviour. The results showed that all five dimensions of parenting can be measured using a brief 15 item version; specifically child and parent reports converged as expected and discriminated high from low conduct problem children using parent and teacher reports. Only child reports converged with independent observations of parenting behaviour, supporting previous research showing that child reports of parenting are particularly important. Finally, results did not support the typical methods used for combining child and parent reports into one index. [ABSTRACT FROM AUTHOR]

Parenting programs have been shown to work when delivered to motivated ethnic majority parents in demonstration projects, but comparatively little is known about their impact when delivered to high-risk, multi-ethnic populations by routine local services. The Primary Age Learning Skills (PALS) trial was a randomized controlled trial of an evidence-based parenting-group program that targeted the parent-child relationship and child literacy. Parents of 174 children were selected from a population of 672 5- and 6-year-olds attending four primary schools in a high-risk, ethnically diverse, inner-city area. Eighty-eight children were allocated to the Incredible Years preventive program plus a shortened six-week version of the SPOKES literacy program, delivered by local services; 86 to usual community services; 152/174 (87%) of families were successfully followed up. Parent-child relationship quality and child behavior were measured using direct observation and parent interview; child reading was assessed psychometrically. Two-thirds (58/89) of those offered the parenting program attended at least one session, with similar enrolment rates across the Black African, African-Caribbean, White-British and Other ethnic groups. Mean attendance was four relationship-building sessions and one literacy-development session. Satisfaction questionnaires were completed by 43/58 starters; 93% said they were well or extremely satisfied, with equally high rates across ethnic groups. At follow-up after one year, those allocated to the intervention showed significant improvements in the parent-child relationship on observation and at interview compared to controls; effects were similar across all ethnic groups. However, child behavior problems and reading did not improve. The cost was £1,343 ($2,100) per child. Programs can be organized to be engaging and effective in improving parenting among high-risk, multi-ethnic communities, which is of considerable value. To also be cost-effective in achieving child changes may require a set-up that enables parents to attend more sessions and/or an exclusive focus on children with clinically significant behavior problems. [ABSTRACT FROM AUTHOR]

Background: There is a pressing need for cost-effective population-based interventions to tackle early-onset antisocial behaviour. As this is determined by many factors, it would seem logical to devise interventions that address several influences while using an efficient means of delivery. The aim of this trial was to change four risk factors that predict poor outcome: ineffective parenting, conduct problems, attention deficit/hyperactivity disorder (ADHD) symptoms, and low reading ability. Methods: A randomised controlled trial was carried out in eight schools in London, England. Nine hundred and thirty-six (936) 6-year-old children were screened for antisocial behaviour, then parents of 112 high scorers were randomised to parenting groups held in schools or control; 109 were followed up a year later. The intervention lasted 28 weeks and was novel as it had components to address both child behaviour (through the Incredible Years programme) and child literacy (through a new ‘SPOKES’ programme to help parents read with their children). Fidelity of implementation was emphasised by careful training of therapists and weekly supervision. Controls received an information helpline. Assessment of conduct problems was by parent interview, parenting by direct observation and child reading by psychometric testing. Results: At follow-up parents allocated to the intervention used play, praise and rewards, and time out more often than controls, and harsh discipline less; effect sizes ranged from .31 to .59 sd ( p-values .046 to .005). Compared to control children, whose behaviour didn’t change, intervention children’s conduct problems reduced by .52sd, ( p < .001), dropping from the 80th to the 61st percentile; oppositional-defiant disorder (ODD) halved from 60% to 31% ( p = .003). ADHD symptoms reduced by .44sd ( p = .002), and reading age improved by six months (.36sd, p = .027). Teacher-rated behaviour didn’t change. The programme cost £2,380 ($3,800) per child. Conclusions: Effective population-based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity. [ABSTRACT FROM AUTHOR]

Improving the parent–child relationship by using strategies based on social learning theory has become the cornerstone for the treatment of conduct problems in children. Over the past 40 years, interventions have expanded greatly from small, experimental procedures to substantial, systematic programmes that provide clear guidelines in detailed manuals on how practitioners should implement the standardised treatments. They are now widely disseminated and there is a great deal of empirical support that they are very effective for the majority of cases. However, evaluations of even the best of these evidence-based programmes show that a quarter to a third of families and their children do not benefit. What does the practitioner then do, when a standard social learning approach, diligently applied, doesn’t work? We argue that under these circumstances, some of the major theories of child development, family functioning and individual psychology can help the skilled practitioner think his or her way through complex clinical situations. This paper describes a set of practical strategies that can then be flexibly applied, based on a systematic theoretical analysis. We hold that social learning theory remains the core of effective parent training interventions, but that ideas from attachment theory, structural family systems theory, cognitive-attribution theory, and shared empowerment/motivational interviewing can each, according to the nature of the difficulty, greatly enrich the practitioner’s ability to help bring about change in families who are stuck. We summarise each of these models and present practical examples of when and how they may help the clinician plan treatment. [ABSTRACT FROM AUTHOR]

Abstract: It is well-known that heavy particles in homogeneous isotropic turbulence tend to collect in certain regions of the flow, leading to preferential accumulation. In this study, we investigate different measures of preferential accumulation, some of which show a dependence on Reynolds number. All the measures used in this study confirm that this phenomenon is most pronounced for a Stokes number, St ∼ 1, based on the Kolmogorov time-scale. The variation with Stokes number has been studied over a wider range for all the measures than in previous studies. Though the effect of changing St, for a particular Re, has been well understood, the scaling with Re is not so obvious. The measures used in this study seem to suggest a structure to the particle concentration field which scales with Re. To investigate this structure, we introduce a concentration distribution length scale which shows a dependence on Re, especially at higher St. The results in the present work agree with several previous computational and experimental works and provide a more unified picture of the dependence of preferential accumulation on St and Re. [Copyright &y& Elsevier]

Background: There is a growing quest for anger management techniques especially in underserved populations. Patients with a substance abuse history often have untreated anger problems. Aims: To test a new comprehensive program for prevention, intervention, and remediation of anger in chemically-dependent patients. A secondary aim was to explore any anger differences between males versus females. Method: Twenty-six participants (13 male, 13 female) completed three phases of treatment plus follow-up. Dependent measures were six subscales of the (STAXI) questionnaire and self-monitored frequency, duration, and intensity of anger. Results: A significant multivariate effect of phase of study accounted for 42% of the variance in STAXI scores. Univariate F-tests confirmed significant changes on all STAXI subscales. Most of these were between pre and post phases of the study, the effect sizes=+0.8 for state anger and +0.99 for trait anger. For self-monitored variables, significant reductions emerged between treatment phases, the average pre-post effect size=+1.02. Gender did not affect STAXI scores although females had more self-monitored anger, particularly anger episodes. Conclusions: Findings suggest cumulative efficacy of the anger treatment program. That trait anger declined more than state anger may indicate characterological change in addition to situational change; anger frequency and duration declined more than intensity in keeping with other reports that intensity peaks suddenly and is less modifiable. That males and females were generally similar in anger is worth noting in relation to other studies. Finally, participant attrition is discussed as a problem and a possible index of treatment outcome. [ABSTRACT FROM AUTHOR]