Child Psychiatry & Human Development

Parents' Perceptions of Internalizing and Externalizing Features in Childhood OCD Abstract Although obsessive–compulsive disorder (OCD) has often been characterized as an internalizing disorder, some children with OCD exhibit externalizing behaviors that are specific to their OCD. This study sought to demonstrate that parents perceive both internalizing and externalizing behaviors in childhood OCD by examining the factor structure of the Child Obsessive–Compulsive Externalizing/Internalizing Scale (COCEIS), a parent-report questionnaire intended to measure these constructs. This study also investigated clinical correlates of internalizing and externalizing factors in the COCEIS. A factor analysis of questionnaire responses from 122 parents of youth with OCD revealed both externalizing and internalizing factors in the COCEIS. Externalizing behaviors in childhood OCD were associated with other, co-occurring externalizing behavior problems, while both factors were positively correlated with OCD severity and co-occurring internalizing symptoms. They were positively associated with each other at a trend level, and neither showed a significant relationship with insight. Sixty-two percent of parents endorsed "often" or "always" to at least one externalizing item, though modal responses to items suggested that each individual feature captured by the COCEIS may be relatively uncommon. Mean responses were significantly greater for internalizing items. This study provides evidence for distinct but related externalizing and internalizing behaviors specific to childhood OCD. Treatment for children with OCD presenting with more externalizing behaviors may require a greater emphasis on behavioral parent training and motivational enhancement.

Emotional Awareness Predicts Specific Cognitive-Behavioral Therapy Outcomes for Anxious Youth Abstract The current study examined emotional awareness as a predictor of differential outcomes for youth treated for an anxiety disorder. 37 youth ages 7–15 received either individual cognitive-behavioral therapy or family cognitive-behavioral therapy to treat generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Diagnoses were determined by independent evaluators, following semi-structured interviews (ADIS-IV-C/P) with youth and their parents. Self-report questionnaires, including the multidimensional anxiety scale for children and the emotion expressivity scale for children, were completed at pre- and posttreatment. Youth with higher levels of pretreatment emotional awareness had better treatment outcomes than youth with lower levels of emotional awareness, with specific regard to improved ability to cope with worry. Findings suggest that higher levels of emotional awareness facilitate better specific outcomes for anxious youth. Findings highlight the importance of understanding the emotions associated with worry during the treatment process.

Pathways from Father Engagement during Infancy to Child Aggression in Late Childhood Abstract Child aggression and its dire consequences cause social problems. Informed by family systems theory and parenting stress theory, this study specifically examined the mediating pathways from father engagement to child aggression through maternal parenting stress, child resistant attachment, and maternal physical abuse. We conducted a secondary data analysis on 2016 mother–child dyads from the Fragile Families and Child Wellbeing Study by building structural equation models. We found indirect effects of father engagement on child aggression through influencing mothers' parenting stress. Children's attachment and mothers' physical abuse mediated the effects of mothers' stress on child behavior-based aggression and verbal- and mood-based aggression. Interventions should target fostering fathers' engagement, alleviating mothers' parenting stress and changing mothers' abusive parenting, and improving mother–child attachment.

Youth Depression Screening with Parent and Self-Reports: Assessing Current and Prospective Depression Risk Abstract Few studies have examined the incremental validity of multi-informant depression screening approaches. In response, we examined how recommendations for using a multi-informant approach may vary for identifying concurrent or prospective depressive episodes. Participants included 663 youth (AgeM = 11.83; AgeSD = 2.40) and their caregiver who independently completed youth depression questionnaires, and clinical diagnostic interviews, every 6 months for 3 years. Receiver operating characteristic (ROC) analyses showed that youth-report best predicted concurrent episodes, and that both youth and parent-report were necessary to adequately forecast prospective episodes. More specifically, youth-reported negative mood symptoms and parent-reported anhedonic symptoms incrementally predicted future depressive episodes. Findings were invariant to youth's sex and age, and results from person and variable-centered analyses suggested that discrepancies between informants were not clinically meaningful. Implications for future research and evidence-based decision making for depression screening initiatives are discussed.

Identifying Distinct Latent Classes of Adverse Childhood Experiences Among US Children and Their Relationship with Childhood Internalizing Disorders Abstract This study aimed to determine the relationship between latent classes of adverse childhood experience (ACEs) and internalizing disorders (anxiety and depression) among US children. The 2016 National Survey of Children's Health data for children aged 6–17 was used. Latent class analysis was performed to identify distinct sub-types of ACE exposures and survey-weighted logistic regression models were employed to determine whether these classes were associated with any or comorbid childhood internalizing disorders, after controlling for meaningful covariates. Four latent classes were identified: income hardship, divorce, mental health or substance abuse exposure, and high ACEs overall. Children in three of the four classes were significantly more likely to have any childhood internalizing disorder when compared to children reporting no ACEs, while children in all classes were significantly more likely to have a comorbid history of anxiety and depression. Thus, children exposed to ACEs should receive necessary mental health screenings and treatments.

Parental Risk Factors among Children with Reactive Attachment Disorder Referred to Specialized Services: A Nationwide Population-Based Study Abstract This nationwide population-based register study examined the family and parental risk factors associated with offspring reactive attachment disorder (RAD). We identified 614 children diagnosed with RAD from the Finnish Care Register for Health Care and each case was matched with four controls. Univariate and multivariate models examined the associations between risk factors and RAD. In the multivariate model, offspring RAD was associated with only mother, only father and both parents having psychiatric diagnoses. Increased odds were observed for maternal smoking during pregnancy, single motherhood and paternal age ≥ 45 years. This study provides information on several parental adversities and offspring RAD that have important implications for public health, when planning early prevention and interventions in infant mental health.

Continuity and Change in Psychopathic Traits Among School-Aged Children with Conduct Problems Abstract The three dimensions of psychopathic traits in childhood have been consistently associated with high levels of conduct problems among children. However, little is known about the continuity and change in psychopathic traits among children with conduct problems. This study aimed to examine the homotypic continuity and change of the three dimensions of psychopathic traits from 8 to 14 years old among 370 children (40.3% girls) who were identified at school as having conduct problems at study inception. Results supported the structural continuity of the tridimensional model of psychopathic traits and revealed that the callous-unemotional dimension is more stable than the two other dimensions. However, the levels of the three dimensions of psychopathic traits remained high over time among a substantial number of children with conduct problems. This study has implications regarding the longitudinal assessment of psychopathic traits within this specific population.

Difficulties in Emotion Regulation Predict Depressive Symptom Trajectory from Early to Middle Adolescence Abstract Major depressive disorder begins to increase in early adolescence and is associated with significant impairment (e.g., suicidality). Difficulties in emotion regulation (ER) have been associated with depressive symptoms; however, little research has examined this relation over time beginning in early adolescence. Starting when they were 11–14 years old, 246 adolescents (nboys = 126; nwhite = 158) completed self-report questionnaires on their ER at Time 1 and depressive symptoms every year for 2 years. Results revealed that overall difficulties in ER (and limited access to ER strategies) at Time 1 predicted depressive symptoms both cross-sectionally and longitudinally. Gender moderated this relation cross-sectionally, such that higher overall ER difficulties at Time 1 was more strongly associated with higher depressive symptoms for girls than for boys. These findings suggest that depression prevention efforts should promote adaptive ER in early adolescence, particularly for girls, in order to prevent the increases in depressive symptoms seen into middle adolescence.

Psychometric Properties of the Safety Maneuver Scale for Adolescents (SMS-A) and Relationship to Outcomes of a Transdiagnostic Treatment Abstract Safety behaviors are common in anxiety and have been thought to reduce the efficacy of exposure therapy, although some investigations have indicated that safety behaviors may have a non-significant or beneficial impact on exposure efficacy. There have been few investigations of the characteristics and impact of safety behavior use in youth compared to adults, and no known validated, transdiagnostic youth measure of safety behaviors exists. In Study 1, we investigated the psychometric properties of a transdiagnostic measure of adolescent safety behavior use. In Study 2, we examined the relationship between safety behavior use and treatment outcome in 51 anxious and depressed adolescents. Results of Study 1 supported the measure's psychometric properties, while results of Study 2 revealed that decreased safety behavior use is associated with better treatment outcomes. This investigation supports the importance of safety behavior reduction and provides a tool for further investigating adolescent safety behavior use.

Parent- and Teacher-Rated Effectiveness of Cognitive-Behavioral Therapy for Children and Adolescents Under Usual Care Conditions in a University Outpatient Clinic Abstract Compared to randomized controlled trials, studies examining the effectiveness of cognitive behavioral therapy (CBT) in children and adolescents with mental disorders are rare, and a teacher perspective is scarce. The present study investigated the effectiveness of routine CBT in 519 patients aged 6–18 years with mental disorders. Changes in mental health problems were assessed in teacher (Teacher Report Form, TRF) and parent rating (Child Behavior Checklist, CBCL) and were analyzed within the total sample, yielding statistically significant, small to medium effect sizes (teacher rating: d = .74–2.39; parent rating: d = .65–1.18). Changes in a subgroup of patients with elevated symptom scores at treatment start were compared to a historical control group receiving weekly academic tutoring. Net total score effect sizes lay between d = 0.98 and d = 1.29 for teacher rating (parent rating: d = 0.84 to d = 1.01). Nevertheless, a substantial number of patients remained in the clinical range. Symptom changes during family- and patient-based CBT interventions did not differ from treatments including additional school-based interventions, as was also the case for the comparison of treatments with and without additional pharmacotherapy.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Gastroenterology

A new era for understanding genetic evolution of multistep carcinogenesis Abstract Cancer development is a multistep process involving genetic and cellular alterations, and recent advances in next-generation sequencing have elucidated mutation landscapes of premalignant lesions as well as early- and late-stage tumors. In this issue of Journal of Gastroenterology, Kim and colleagues contributed to the better understanding of genetic events in putative precursors of hepatocellular carcinoma (HCC). Precancerous tissues are divided into canonical and non-canonical types, which share common driver mutations with cancerous lesions or not, and potential gatekeeper gene(s) for clonal selection play a critical role in driving precursors to cancers not only in HCC, but also in esophageal, gastric, colorectal, and pancreatic cancers.

Efficacy and safety of glecaprevir and pibrentasvir treatment for 8 or 12 weeks in patients with recurrent hepatitis C after liver transplantation: a Japanese multicenter experience Abstract Background Efficacy of 8-week regimen with direct-acting antivirals (DAA) for patients with hepatitis C after liver transplantation has not been clarified. This study aimed to clarify the efficacy and safety of glecaprevir and pibrentasvir therapy for 8 and 12 weeks in Japanese patients with recurrent hepatitis C after liver transplantation. Methods A cohort study of liver transplant recipients with recurrent hepatitis C treated with glecaprevir (300 mg/day) and pibrentasvir (120 mg/day) was performed at nine liver transplant centers in Japan. Results Twenty-five patients with hepatitis C after liver transplantation were treated with glecaprevir and pibrentasvir. Twenty-four patients completed the treatment protocol; treatment was discontinued in one patient who had nausea at 3 days after the initiation of treatment. All the 24 patients who completed the 8- or 12-week treatment protocol achieved a sustained virological response 12 weeks after completion of treatment (SVR12). The SVR12 rates in patients with HCV genotype 1 and 2 were 100% (21 of 21 patients) and 75% (3 of 4 patients), respectively. All patients with prior DAA therapy failure (n = 6), jaundice (n = 4), and liver cirrhosis (n = 4) achieved SVR12. Seven of 8 patients (88%) with severe renal impairment achieved SVR12. Adverse events occurred in 6 of 25 patients (24%), including serious adverse events in 2 patients (8%). Treatment-related adverse events were nausea, pruritus, and mild renal dysfunction. Conclusions Eight- or 12-week regimen of glecaprevir and pibrentasvir is efficacious and safe in patients with recurrent HCV infection after liver transplantation, even in difficult-to-treat populations, including patients with severe renal impairment, prior DAA experience, liver cirrhosis, or jaundice after liver transplantation.

Feasibility of a simplified narrow-band imaging classification system for Barrett's esophagus for novice endoscopists Abstract Background Narrow-band imaging (NBI) classifications for Barrett's esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear. Methods In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett's esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6 weeks before (1st test), immediately after (2nd test), and 6 weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests. Results The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], but sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all). Conclusions The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.

Epidemiological analysis of achalasia in Japan using a large-scale claims database Abstract Background Achalasia is a well-known esophageal motility disorder, but epidemiological studies in Japan are lacking. We investigated the incidence and period prevalence of achalasia in Japan, including the rate of coexistence of esophageal carcinoma, and evaluated treatment trends. Methods To estimate the nationwide number of patients with achalasia, a large-scale insurance claims database from 2005 to 2017 were used for our analyses. Patients with achalasia and coexistence of esophageal carcinoma were identified based on the diagnosis code registered. Interventional treatment was also evaluated. Results Of the total 5,493,650 populations, 385 were diagnosed with primary achalasia. The incidence was calculated as 0.81–1.37 per 100,000 person-years (male-to-female ratio was almost 1; mean age at diagnosis was 43.3 ± 14.4 years). The period prevalence was 7.0 per 100,000 persons. There were statistically significant trends of increase in the incidence and period prevalence over age groups (all p values < 0.0001). Four men with achalasia developed esophageal carcinoma, and the incidence of esophageal carcinoma with achalasia was estimated as 0.25 per 100 person-years. With regard to intervention, esophageal dilation was performed as a first treatment in 64.7% of patients, with repeat intervention required in 56.9% of these. The proportion of patients treated using peroral endoscopic myotomy (POEM) increased annually to 41.1% in 2017. Conclusions In Japan, the incidence and period prevalence of achalasia is comparable to that in other countries. The absolute risk of esophageal carcinoma is rather low. Esophageal dilation has been the mainstay of achalasia treatment, and the role of POEM has increased annually.

Management of elderly ulcerative colitis in Japan Abstract Japan has the largest aging society, where many elderly people have intractable diseases including ulcerative colitis (UC). Along with the increasing total number of UC patients, the number of elderly UC patients has also been increasing and will continue to do so in the future. Although the clinical features and natural history of UC in the elderly have many similarities with UC in the non-elderly population, age-specific concerns including comorbidities, immunological dysfunction, and polypharmacy make the diagnosis and management of elderly UC challenging compared to UC in non-elderly patients. Based on increasing data related to elderly UC patients from Japan, as well as other countries, we reviewed the epidemiology, clinical course, differential diagnosis, management of comorbidities, surveillance, medical therapy, and surgery of UC in the elderly.

Establishment of a system to evaluate the therapeutic effect and the dynamics of an investigational drug on ulcerative colitis using human colonic organoids Abstract Background Ulcerative colitis (UC) is a chronic inflammatory disease of the colon with an intractable, recurrent course. The goal of UC therapy is to target mucosal healing because immune-suppressive therapy for UC frequently results in relapse. However, few drugs directly target mucosal healing. We, therefore, aim to evaluate the therapeutic effect of an investigational drug on intestinal epithelial cells in an in vitro UC model using human colonic organoids. Methods Colonic organoids were isolated from human colon and cultured. A mixture of cytokines and bacterial components were used to mimic UC in humans. The effect of the investigational drug on colonic organoid was evaluated by microarray analysis and 3D immunofluorescence. The enrichment of stem cells was assessed with a colony formation assay. Results Inflammatory stimulation resulted in a significant induction of inflammatory-related genes in colonic organoids whereas cell differentiation was suppressed. Treatment with the investigational drug KAG-308 showed reciprocal dynamics of gene expression to inflammatory stimulation, which resulted in not only the suppression of immune response but also the promotion of cellular differentiation towards secretory lineages. Moreover, SPDEF and Reg4 were identified as novel targets for the enrichment of intestinal epithelial stem cells and mucosal healing. Conclusions The establishment of in vitro UC model using human colonic organoid could reveal the effects and targets of investigational drugs in intestinal epithelial cells under inflammation conditions. Further maturation of this system might be more efficient to predict the effect on UC, as compared with the use of animal model, for the development of new drugs.

Comprehensive analysis of genetic aberrations linked to tumorigenesis in regenerative nodules of liver cirrhosis Abstract Background Hepatocellular carcinoma (HCC) recurrently develops in cirrhotic liver containing a number of regenerative nodules (RNs). However, the biological tumorigenic potential of RNs is still unclear. To uncover the molecular bases of tumorigenesis in liver cirrhosis, we investigated the genetic aberrations in RNs of cirrhotic tissues using next-generation sequencing. Methods We isolated 205 RNs and 7 HCC tissues from the whole explanted livers of 10 randomly selected patients who had undergone living-donor liver transplantation. Whole-exome sequencing and additional targeted deep sequencing on 30 selected HCC-related genes were conducted to reveal the mutational landscape of RNs and HCCs. Results Whole-exome sequencing demonstrated that RNs frequently harbored relatively high-abundance genetic alterations, suggesting a clonal structure of each RN in cirrhotic liver. The mutation signature observed in RNs was similar to those determined in HCC, characterized by a predominance of C>T transitions, followed by T>C and C>A mutations. Targeted deep sequencing analyses of RNs identified nonsynonymous low-abundance mutations in various tumor-related genes, including TP53 and ARID1A. In contrast, TERT promoter mutations were not detected in any of the RNs examined. Consistently, TERT expression levels in RNs were comparable to those in normal livers, whereas every HCC tissue demonstrated an elevated level of TERT expression. Conclusion Analyses of RNs constructing cirrhotic liver indicated that a variety of genetic aberrations accumulate in the cirrhotic liver before the development of clinically and histologically overt HCC. These aberrations in RNs could provide the basis of tumorigenesis in patients with liver cirrhosis.

Comparison of intracellular responses between HBV genotype A and C infection in human hepatocyte chimeric mice Abstract Background and aims The clinical course and responsiveness to antiviral treatments differs among hepatitis B virus (HBV) genotypes. However, the cause of these differences is unclear. In the present study, we compared mRNA expression profiles in human hepatocyte chimeric mice infected with HBV genotypes A and C. Methods Fifteen chimeric mice were prepared and divided into the following three groups: uninfected control mice, HBV genotype A-infected mice, and HBV genotype C-infected mice. Human hepatocytes were collected from these mouse livers and gene expression analyses were performed using next-generation RNA sequencing. Results Although similar pathways were influenced by HBV infection, including inflammation mediated by chemokine and cytokine signaling, p53, and integrin signaling pathways, expression levels of up-regulated genes by HBV genotype A or C infection were quite different. In HBV genotype A-infected hepatocytes, 172 genes, including KRT23 and C10orf54, were significantly more highly expressed than in HBV genotype C-infected cells, whereas 10 genes, including SPX and IER3, were expressed at significantly lower levels. Genes associated with the p53 pathway and the inflammation mediated by chemokine and cytokine signaling pathway were more highly expressed in cells with HBV genotype A infection, whereas genes associated with CCKR signaling map and oxidative stress response were more highly expressed in cells with HBV genotype C infection. Conclusion Several differences in gene expression with respect to HBV genotype A and C infection were detected in human hepatocytes. These differences might be associated with genotypic difference in the clinical course or responsiveness to treatment.

Marked impact of tumor location on the appropriate cutoff values and the prognostic significance of the lymph node ratio in stage III colon cancer: a multi-institutional retrospective analysis Abstract Background The prognostic significance of lymph node ratio (LNR) is not constant among studies. Exploration of appropriate location-specific cutoffs might be necessary because the number of lymph nodes harvested is generally higher in right than in left colon cancer. We aimed to determine appropriate cutoff values of LNR in right and left colon cancer and to clarify its clinical significance. Methods The clinicopathologic data of 5463 patients with stage III colon cancer were collected. The best cutoff for LNR as a prognostic indicator for patients with right and left colon cancer was studied separately. We compared the prognostic impact between LNR and the number of lymph node metastasis using the Akaike information criterion (AIC), and evaluated the prognostic significance of LNR in each stage III subcategory. Results The best performance was noted when LNR was categorized by cutoffs of 0.16 and 0.22 for right and left colon cancer, respectively. AIC scores were better with these categorizations than with subgrouping by number of positive nodes. LNR-low right colon cancer patients showed better cancer-specific survival than LNR-high in stage IIIA (95.7% vs. 89.3%), IIIB (86.7% vs. 77.2%), and IIIC (71.2% vs. 58.7%). The same results were obtained in left colon cancer patients with stage IIIB (88.3% vs. 80.7%) and IIIC (79.8% vs. 68.4%). Conclusions We demonstrated the difference in the appropriate cutoffs of LNR between right and left colon cancer. Categorization by location-specific cutoff of LNR may be useful for risk stratification of patients with stage III cancer.

Safety and efficacy of glecaprevir and pibrentasvir in Japanese hemodialysis patients with genotype 2 hepatitis C virus infection Abstract Background Until recently, interferon-free anti-hepatitis C virus (HCV) therapy for genotype 2 (GT2) HCV-infected hemodialysis patients was an unfulfilled medical need. Recent clinical trials of glecaprevir and pibrentasvir (G/P) for hemodialysis patients showed high efficacy and safety; however, the number of GT2 HCV-infected patients, especially Asian patients, was limited and most of them were treated with a 12-week regimen. In this prospective multicenter study, we aimed to investigate the efficacy and safety of G/P in Japanese hemodialysis patients with GT2 HCV infection. Methods Twenty-seven Japanese hemodialysis patients with GT2 HCV infection who were started on with 8- or 12-week G/P regimen between November 2017 and June 2018 were included and followed up for around 12 weeks after treatment completion. Results Among the 27 included patients, 13 non-liver cirrhosis (LC) and direct-acting antivirals (DAAs)-naïve patients were treated with 8 weeks of G/P and 14 patients with LC (n = 13) or history of failure of DAAs (n = 1) were treated with a 12-week regimen. The overall sustained virological response at 12 weeks after treatment completion (SVR 12) was 96.3% (26/27). All patients with 8 weeks of treatment achieved SVR12. Two patients discontinued the therapy at 2 and 11 weeks after treatment initiation. The patient who discontinued at 2 weeks due to pruritus alone failed to respond to G/P. No patients experienced lethal adverse events during the therapy, and the most common adverse event was pruritus. Conclusions An 8- or 12-week G/P regimen is highly effective and safe in GT2 HCV-infected hemodialysis patients.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Aging Clinical and Experimental Research

Waist circumference or sarcopenic obesity: which is more predictive?

Methodological aspects in studies involving high-intensity interval training

Response to letter to the editor on "Methodological aspects in studies involving high-intensity interval training"

Basic guide for the application of the main variables of resistance training in elderly

Possible association between circulating CTRP3 and knee osteoarthritis in postmenopausal women Abstract Background Osteoarthritis (OA) is considered as one of the most common cause of chronic pain and functional disabilities in the elderly. Aim To examine serum levels of complement-C1q TNF-related protein 3 (CTRP3) in postmenopausal women with knee OA. Methods A population-based cross-sectional study was performed in women who complained of chronic knee pain. All subjects were followed by clinical and weight-bearing bilateral anteroposterior radiographical examinations. The Kellgren and Lawrence (K&L) score was used for knee OA classification. Two groups of postmenopausal women were chosen to investigate CTRP3 as an OA marker who had the K&L score ≥ 3 as a case group and K&L ≤ 1 as a control group. Serum levels of CTRP3 were measured in two groups. Results According to K&L classification, 36 subjects with knee OA and 54 age-matched without or mild OA were selected. After adjusting the obtained data for taking NSAID drugs, the concentration of Ln CTRP3 in serum of patients with OA was lower compared to control group [mean ± SE, (0.39 ± 0.05 ng/ml vs. 0.48 ± 0.03 ng/ml, respectively, p = 0.04)]. Discussion There is a possible role for CTRP3 as an anti-inflammatory mediator in knee OA in postmenopausal women. Conclusions Our results indicate an association between CTRP3 and knee OA. However, a much more robust study is required to draw that circulating CTRP3 could be a clinical marker for osteoarthritis.

Cut-off points for weight and body mass index adjusted bioimpedance analysis measurements of muscle mass Abstract Aim Low skeletal muscle mass (LMM) is a criterion to define both sarcopenia and malnutrition. Muscle mass varies with gender, height, weight or fat mass, and many indices of adjusted-muscle mass have been proposed. We aimed to find reference cut-off points of the skeletal muscle mass index (SMMI) adjusted for weight and body mass index (BMI) in Turkish population. Materials and methods Adults between 18 and 39 years of age and community-dwelling older adults of 60–99 years of age were included. Body composition was assessed with bioimpedance analysis (BIA). SMMI adjusted for weight and BMI were calculated [SMMI (weight) and SMMI (BMI)]. Muscle strength was assessed by hand-grip-strength with hand dynamometer. SMMI (weight) cut points were calculated from the healthy young adults' data as "mean SMMI-2 standard deviation (SD)". SMMI (BMI) cut points that predict low muscle strength were calculated with ROC analysis. To define low muscle strength, we used three currently suggested low muscle-strength thresholds, i.e., 32 kg/22 kg, 30 kg/20 kg, 26 kg/16 kg in males/females, respectively. Results 301 healthy young adults (187 male, 114 female) and 992 older people (308 male, 684 female) were included. LMM cut points for SMMI (weight) were 37.4% and 33.6% for males and females, respectively. SMMI (BMI) cut points that best predict the low grip-strength for 32 kg/22 kg; 30 kg/20 kg; 26 kg/16 kg thresholds were1.017 kg/BMI and 0.677 kg/BMI; 1.014 kg/BMI and 0.710 kg/BMI; 1.036 kg/BMI and 0.770 kg/BMI for males and females, respectively. Conclusions Muscle-mass adjustment methods and techniques show diversity among the studies and have impact on the LMM cut-off points. This study presents population specific LMM thresholds for skeletal muscle mass adjusted for weight and BMI aiming to increase and improve the general applicability of the leading sarcopenia consensus definitions.

Prevalence of sarcopenia and 9-year mortality in nursing home residents Abstract Background Sarcopenia is a progressive loss of muscle mass, strength, and function. It is linked to functional decline, and secondary to this, to nursing home admission. Aims To look into the prevalence of sarcopenia in a nursing home population and to gain insight into the relation of sarcopenia with mortality in this cohort. Methods A longitudinal cohort follow-up started in October 2007 in 52 nursing homes in Belgium. Following data were procured: anthropometrics (weight/length), body composition (muscle mass through bio-impedance absorptiometry, BIA), functional status (Katz), nutritional status (mini-nutritional assessment-short form, MNA), and a number of laboratory parameters. Results In total, 745 residents were included. Mean age was 84.6 ± 7.2 years. Mean follow-up time was 1632 ± 1026 days. In total, 17% had severe sarcopenia, 45% had moderate sarcopenia, and 38% had no sarcopenia. Following items were significant (p < 0.05) on univariate analysis with mortality as outcome: sarcopenia, gender, BMI, skeletal muscle mass, age, MNA, and functional level. In multivariate analysis, only MNA, skeletal muscle mass, and age were still significant. Odds ratio for skeletal muscle mass was 1.171 for the highest percentile group, 2.277 for the middle percentile group, and 4.842 for the lowest percentile group. Discussion The prevalence of sarcopenia was higher than in comparative literature, for which there are a few hypotheses. Cut-off values for sarcopenia using BIA for specific cohorts need to be re-evaluated. Conclusions It seems to remain useful to screen for muscle mass in institutionalized elderly, because there is a clear and significant correlation with long-term mortality.

Prevalence and related factors of office and home hypotension in older treated hypertensive patients Abstract Background Older hypertensive adults under treatment are especially susceptible to hypotensive episodes, which entail an elevated risk. However, data on this subject are very scarce. Aim The purpose of this study was to determine the prevalence and predictors of office and home hypotension in older (≥ 65 years) treated hypertensive adults. Methods Blood pressure (BP) was measured at the office and at home, using a validated oscillometric device. Office and home hypotension were defined as systolic BP (SBP) < 110 and/or diastolic BP (DBP) < 70 mmHg, and SBP < 105 and/or DBP < 65 mmHg, respectively. Masked hypotension was considered when office BP ≥ 110/70 and home BP < 105 and/or < 65 mmHg. We evaluated factors associated with hypotension both at the office and at home through multivariable models. Results The prevalence of hypotension among the 302 patients included in the study was 29.8% at the office and 23.9% at home, whereas the prevalence of masked hypotension was 10.4%. Older age, lower body mass index and use of calcium channel blockers were associated with office hypotension, while older age, diabetes and ischemic heart disease were predictors for home hypotension. Conclusion Hypotension is frequent in older hypertensive adults under treatment. The presence of diabetes, ischemic heart disease and older age should alert for screening of hypotension at home to avoid overtreatment.

Practical guidance for engaging patients in health research, treatment guidelines and regulatory processes: results of an expert group meeting organized by the World Health Organization (WHO) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) Abstract There is increasing emphasis on patient-centred research to support the development, approval and reimbursement of health interventions that best meet patients' needs. However, there is currently little guidance on how meaningful patient engagement may be achieved. An expert working group, representing a wide range of stakeholders and disciplines, was convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the World Health Organization (WHO). Through a structured, collaborative process the group generated practical guidance to facilitate optimal patient engagement in clinical development and regulatory decisions. Patient engagement is a relational process. The principles outlined in this report were based on lessons learned through applied experience and on an extensive dialogue among the expert participants. This practice guidance forms a starting point from which tailoring of the approach to suit different chronic diseases may be undertaken.

Predictive model of length of stay in hospital among older patients Abstract Background Most National Health Service (NHS) hospital bed occupants are older patients because of their frequent admissions and prolonged length of stay (LOS). We evaluated demographic and clinical factors as predictors of LOS in a single NHS Trust and derived an equation to estimate LOS. Methods Stepwise logistic and linear regressions were used to predict prolonged LOS (upper-quintile LOS > 17 days) and LOS respectively, from demographic factors and acute and pre-existing conditions. Results Of 374 (men:women = 127:247) admitted patients (20% to orthogeriatric, 69% to general medical and 11% to surgical wards), median age of 85 years (IQR = 78–90), 77 had acute first hip fracture; 297 had previous hip fracture (median time since previous fracture = 2.4 years) and 21 (7.1%) had recurrent hip fracture, with median time since first fracture = 2.4 years. Median LOS was 6.5 days (IQR = 1.8–14.8), and 38 (10.2%) died after 4.8 days (IQR = 1.6–14.3). Prolonged LOS was associated with discharge to places other than usual residence: OR = 3.1 (95% CI 1.7–5.7), acute stroke: OR = 10.1 (3.7–26.7), acute first hip fractures: OR = 6.8 (3.1–14.8), recurrent hip fractures: OR = 9.5 (3.2–28.7), urinary tract infection/pneumonia: OR = 4.0 (2.1–8.0), other acute fractures: OR = 9.8 (3.0–32.3) and malignancy: OR = 15.0 (3.1–71.8). Predictive equation showed estimated LOS was 11.6 days for discharge to places other than usual residence, 15 days for pre-existing or acute stroke, 9–14 days for acute and recurrent hip fractures, infections, other acute fractures and malignancy; these factors together explained 32% of variability in LOS. Conclusions A useful estimate of outcome and LOS can be made by constructing a predictive equation from information on hospital admission, to provide evidence-based guidance for resource requirements and discharge planning.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Psychopharmacology

L-DOPA improves extinction memory retrieval after successful fear extinction Abstract Rationale A promising strategy to prevent a return of fear after exposure-based therapy in anxiety disorders is to pharmacologically enhance the extinction memory consolidation presumed to occur after exposure. Accumulating evidence suggests that the effect of a number of pharmacological consolidation enhancers depends on a successful fear reduction during exposure. Here, we employed the dopamine precursor L-DOPA to clarify whether its documented potential to enhance extinction memory consolidation is dependent on successful fear extinction. Methods In two double-blind, randomized and placebo-controlled experiments (experiment 1: N = 79, experiment 2: N = 32) comprising fear conditioning (day 1), extinction followed by administration of 150 mg L-DOPA or placebo (day 2) and a memory test (day 3) in healthy male adults, conditioned responses were assessed as differential skin conductance responses. We tested whether the effect of L-DOPA on conditioned responses at test depended on conditioned responses at the end of extinction in an experiment with a short (10 trials, experiment 1) and long (25 trials, experiment 2) extinction session. Results In both experiments, the effect of L-DOPA was dependent on conditioned responses at the end of extinction. That is, post-extinction L-DOPA compared to placebo administration reduced conditioned responses at test only in participants showing a complete reduction of conditioned fear at the end of extinction. Conclusion The results support the potential use of L-DOPA as a pharmacological adjunct to exposure treatment, but point towards a common boundary condition for pharmacological consolidation enhancers: a successful reduction of fear in the exposure session.

Preconception maternal cocaine self-administration increases the reinforcing efficacy of cocaine in male offspring Abstract Rationale Although the influence of gestational cocaine exposure on offspring has been the focus of a sustained research effort, the effect of preconception cocaine self-administration by dams on progeny has received far less attention. Method In the current study, adult female rats were allowed to self-administer cocaine 2 h a day for 60 days and then after a 10-day wash out period, bred to naïve males. Maternal behavior was measured in dams until weaning. When male and female progeny reached adulthood, anxiety-like behavior, memory, and cocaine self-administration were assessed in separate cohorts of rats. Results Despite a total of at least 30 days of cocaine abstinence, the quality of maternal behaviors was negatively affected by previous cocaine exposure as reflected by less time spent with pups as well as an excess of other maladaptive maternal behaviors. Measures of anxiety-like behavior and memory were not affected by maternal cocaine intake in either male or female offspring. In contrast, male, but not female, the progeny of dams exposed to cocaine showed increased reinforcing efficacy of cocaine as measured by cocaine self-administration under a progressive ratio schedule. The fact that cocaine self-administration was influenced only in the male offspring of cocaine-exposed dams argues against this phenotype being linked to altered maternal behavior, although this possibility cannot be ruled out completely. Conclusions Collectively, these results indicate that preconception cocaine self-administration by dams results in the relatively selective enhancement of cocaine addiction-like behavior in male offspring.

The effect of acute cocoa flavanol intake on the BOLD response and cognitive function in type 1 diabetes: a randomized, placebo-controlled, double-blinded cross-over pilot study Abstract Rationale Type 1 diabetes (T1D), a chronic autoimmune disease, can result in cognitive dysfunction and is associated with vascular dysfunction. Cocoa flavanols (CFs) can stimulate nitric oxide-dependent vasodilation, resulting in enhanced hemodynamic responses and better cognitive function. Objectives To investigate whether acute CF supplementation can improve cognitive function and hemodynamic responses in T1D. Methods In this randomized, double-blinded, cross-over pilot study, 11 patients with T1D and their healthy matched controls consumed CF (900 mg CF) and placebo (15 mg CF) 2 h before a flanker test. fMRI was used to measure blood oxygen level–dependent (BOLD) response during the cognitive test. Repeated measure ANOVAs were used to test the effects of CF and T1D on BOLD response and cognitive performance. Results CF improved reaction time on the flanker test and increased the BOLD response in the supramarginal gyrus parietal lobe and inferior frontal gyrus, compared to placebo, in both groups. In patients with T1D, cognitive performance was not deteriorated while the BOLD response was smaller in T1D compared to healthy controls in the subgyral temporal lobe and the cerebellum. Conclusions Acute CF intake improved reaction time on the flanker test and increased the BOLD response in the activated brain areas in patients with T1D and their matched controls.

A comparison of regional brain volumes and white matter connectivity in subjects with stimulant induced psychosis versus schizophrenia Abstract Rationale Schizophrenia and stimulant-induced psychosis (SIP) represent two different forms of psychotic disorder, with different etiologies. While many of the symptoms of psychosis are common to both disorders, there have been few direct comparisons between these conditions, especially when controlling for stimulant use in individuals with schizophrenia. Objectives We directly compared both psychotic disorders with a comprehensive battery of clinical, neurocognitive and neuroanatomical measures. This included one group with SIP (and concurrent stimulant dependence) and two groups with schizophrenia (either with or without concurrent stimulant dependence). Methods Ninety-six participants were recruited from a marginalized urban population, which included 39 with SIP (and concurrent stimulant dependence), 18 with schizophrenia (without stimulant dependence), and 39 with schizophrenia (with concurrent stimulant dependence). All subjects had extensive clinical and neurocognitive evaluations, complemented with structural MRI including diffusion tensor imaging (DTI) sequences to determine regional brain volumes and white matter connectivity. Results Both positive and negative symptoms were greater in the SZ-dependent group than the other two. Neurocognitive function was broadly similar. The structural brain imaging revealed lateralized changes to the left parietal/temporal lobe, in which regional volumes were smaller in the SZ-dependent than the SZ-non-dependent group. DTI analysis indicated extensive decreases in fractional anisotropy, with parallel increases in radial diffusivity, in the SIP group compared to the SZ-dependent group. Conclusions These findings reveal both similarities and differences between SIP and schizophrenia. Furthermore, schizophrenia with concurrent stimulant dependence may be associated with a different clinical and neuroanatomical profile as compared to schizophrenia alone.

Modeling subjective belief states in computational psychiatry: interoceptive inference as a candidate framework Abstract The nascent field computational psychiatry has undergone exponential growth since its inception. To date, much of the published work has focused on choice behaviors, which are primarily modeled within a reinforcement learning framework. While this initial normative effort represents a milestone in psychiatry research, the reality is that many psychiatric disorders are defined by disturbances in subjective states (e.g., depression, anxiety) and associated beliefs (e.g., dysmorphophobia, paranoid ideation), which are not considered in normative models. In this paper, we present interoceptive inference as a candidate framework for modeling subjective—and associated belief—states in computational psychiatry. We first introduce the notion and significance of modeling subjective states in computational psychiatry. Next, we present the interoceptive inference framework, and in particular focus on the relationship between interoceptive inference (i.e., belief updating) and emotions. Lastly, we will use drug craving as an example of subjective states to demonstrate the feasibility of using interoceptive inference to model the psychopathology of subjective states.

Dopamine D2-like receptor stimulation blocks negative feedback in visual and spatial reversal learning in the rat: behavioural and computational evidence Abstract Rationale Dopamine D2-like receptors (D2R) are important drug targets in schizophrenia and Parkinson's disease, but D2R ligands also cause cognitive inflexibility such as poor reversal learning. The specific role of D2R in reversal learning remains unclear. Objectives We tested the hypotheses that D2R agonism impairs reversal learning by blocking negative feedback and that antagonism of D1-like receptors (D1R) impairs learning from positive feedback. Methods Male Lister Hooded rats were trained on a novel visual reversal learning task. Performance on "probe trials", during which the correct or incorrect stimulus was presented with a third, probabilistically rewarded (50% of trials) and therefore intermediate stimulus, revealed individual learning curves for the processes of positive and negative feedback. The effects of D2R and D1R agonists and antagonists were evaluated. A separate cohort was tested on a spatial probabilistic reversal learning (PRL) task after D2R agonism. Computational reinforcement learning modelling was applied to choice data from the PRL task to evaluate the contribution of latent factors. Results D2R agonism with quinpirole dose-dependently impaired both visual reversal and PRL. Analysis of the probe trials on the visual task revealed a complete blockade of learning from negative feedback at the 0.25 mg/kg dose, while learning from positive feedback was intact. Estimated parameters from the model that best described the PRL choice data revealed a steep and selective decrease in learning rate from losses. D1R antagonism had a transient effect on the positive probe trials. Conclusions D2R stimulation impairs reversal learning by blocking the impact of negative feedback.

Subjective responses to amphetamine in young adults with previous mood elevation experiences Abstract Rationale One risk factor for alcohol and substance misuse is hypomanic experiences, or periods of mood elevation. Young people who report hypomanic states are more likely to develop bipolar disorder (BP), and BP and other mood disorders increase the risk of addiction. We recently reported that young adults with a history of mood elevation experience less subjective effects from a low dose of alcohol, which may be predictive of future alcohol use. The finding with alcohol raised the question of whether this dampened response to a drug also applies to other drugs, such as amphetamine. Objective This study assessed responses of d-amphetamine in healthy young adults with varying experiences of mood elevation, as measured by the Mood Disorders Questionnaire (MDQ). Methods Healthy 18–19-year-olds (N = 30) with a range of MDQ scores participated in three 4-h laboratory sessions in which they received placebo, 10 mg, or 20 mg d-amphetamine. They completed mood questionnaires and cardiovascular measures. Results Individuals with higher MDQ scores reported less stimulation and euphoria after 10 mg, but not 20 mg, d-amphetamine, than individuals with lower scores. MDQ scores were not related to cardiovascular responses to the drug. Conclusions A history of mood elevation experiences or hypomania states is related to dampened response to a low dose of a psychostimulant drug, extending previous findings with dampened response to alcohol. This phenotype for mood disorders of dampened responses to drugs may contribute to risk for subsequent drug use or misuse.

Cannabinoid modulation of opioid analgesia and subjective drug effects in healthy humans Abstract Rationale Dozens of preclinical studies have reported cannabinoid agonist potentiation of the analgesic effects of μ-opioid agonists. Objectives The aim of this study was to determine if a cannabinoid agonist could potentiate opioid analgesia in humans using several laboratory pain models. Methods Healthy participants (n = 10) with/out current drug use/pain conditions completed this within-subject, double-blind, placebo-controlled, randomized outpatient study. Nine 8-h sessions were completed during which dronabinol (0, 2.5, 5 mg, p.o.) was administered 1 h before oxycodone (0, 5, 10 mg, p.o.) for a total of 9 test conditions. Outcomes included sensory threshold and tolerance from four experimental pain models (cold pressor, pressure algometer, hot thermode, cold hyperalgesia), along with participant- and observer-rated, performance and physiological effects. Results Oxycodone produced miosis (p < 0.05) and analgesic responses (e.g., pressure algometer [p < 0.05]), while dronabinol did not (p > 0.05). Depending on the dose combination, dronabinol attenuated or did not alter oxycodone analgesia; for example, dronabinol (2.5 mg) decreased the analgesic effects of oxycodone (10 mg) on pressure tolerance. Conversely, dronabinol increased oxycodone subjective effects (e.g., drug liking) (p < 0.05); oxycodone (5 mg) ratings of "high" were potentiated by 5 mg dronabinol (p < 0.05; placebo = 1.1 [± 0.7]; 5 mg oxycodone = 4.7 [± 2.2]; 5 mg dronabinol = 9.9 [± 8.4]; 5 mg oxycodone + 5 mg dronabinol = 37.4 [± 11.3]). Conclusions This study indicates that dronabinol did not enhance the analgesic effects of oxycodone and increased abuse- and impairment-related subjective effects. These data suggest that dronabinol may not be an effective or appropriate opioid adjuvant; it could potentially increase opioid dose requirements, while increasing psychoactive opioid effects.

Replication and extension of a model predicting response to psilocybin Abstract Background Recent research demonstrated the potential of psychedelic drugs as treatment for depression and death-related anxiety and as an enhancement for well-being. While generally positive, responses to psychedelic drugs can vary according to traits, setting, and mental state (set) before and during ingestion. Most earlier models explain minimal response variation, primarily related to dosage and trust, but a recent study found that states of surrender and preoccupation at the time of ingestion explained substantial variance in mystical and adverse psilocybin experiences. Objectives The current study sought to replicate the previous model, extend the model with additional predictors, and examine the role of mystical experience on positive change. Method A hierarchical regression model was created with crowdsourced retrospective data from 183 individuals who had self-administered psilocybin in the past year. Scales explored mental states before, during, and after psilocybin ingestion, relying on open-ended memory prompts at each juncture to trigger recollections. Controlled drug administration was not employed. Results This study replicated the previous model, finding a state of surrender before ingestion a key predictor of optimal experience and preoccupation a key predictor of adverse experience. Additional predictors added to the explanatory power for optimal and adverse experience. The model supported the importance of mystical experiences to long-term change. Conclusion Mental states of surrender or preoccupation at the time of ingestion explain variance in mystical or adverse psilocybin experiences, and mystical experiences relate to long-term positive change. The capacity to recognize this optimal preparatory mental state may benefit therapeutic use of psilocybin in clinical settings.

Toward an animal model of borderline personality disorder Abstract Background Borderline personality disorder (BPD) is a pervasive psychiatric disorder characterized by emotion dysregulation, impulsivity, impaired self-perceptions, and interpersonal relationships and currently affects 1–3% of the US population as reported by Torgersen et al. (Arch Gen Psychiatry 58:590–596, Torgersen et al. 2001), Lenzenweger et al. (Biol Psychiatry 62:553–564, Lenzenweger et al. 2007), and Tomko et al. (J Personal Disord 28:734–750, Tomko et al. 2014). One major obstacle to our understanding of the neural underpinnings of BPD is a lack of valid animal models that translate the key known features of the disorder to a system that is amenable to study. Objective To summarize the etiology, major symptoms, and symptom triggers of BPD and then propose a blueprint for building an animal model of BPD by choosing key components of the disorder that can be implemented in rodents. Results We identify the role of early life stress and subsequent mild stress in adulthood as contributing etiological factors and the potential use of altered communication between frontal cortices and the amygdala in extinction and habituation, increased impulsivity, dysregulation of the hypothalamic pituitary axis (HPA), and increased neuroinflammation as biological markers of BPD. Building upon these features of BPD, we propose a two-hit animal model that uses maternal abandonment to alter maturation of the HPA axis and mild secondary adult stress to evoke behavioral symptoms such as increased impulsivity and impaired extinction, habituation, and social interactions. Conclusion Through exploration of the etiology, symptom presentation, and altered neurological function, we propose an animal model of BPD. We believe that a number of existing animal paradigms that model other mental health disorders should be combined in a unique way to reflect the etiology, symptom presentation, and altered neurological function that is evident in BPD. These model, when compared with available human data, will inform research and treatment in humans for better understanding of systems from the micro-molecular level to more global physiology underlying BPD.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Developmental and Physical Disabilities

Acquiring the Skill of Identifying Fractions through the Virtual-Abstract Framework Abstract Fractions are an important component of mathematics instruction, with implications for both academics and daily living. Yet, more research is needed regarding fraction instruction for students with disabilities, including those with developmental disabilities. This study investigated the effects of using the Virtual-Abstract framework to teach sixth-grade students with developmental disabilities to identify fractions. Through a multiple probe across participants design, researchers examined if a functional relation existed between students' acquisition of the mathematical behavior of identifying fractions and the Virtual-Abstract (VA) framework. For each student, the study involved three-to-five baseline sessions, six-to-nine intervention sessions, and two maintenance sessions. Two of the students also completed three abstract boost sessions and two additional maintenance sessions. Accuracy data reflected students' ability to identify fractions on five problems answered independently. A functional relation existed between students' acquisition of identifying fractions and the VA framework. Yet, two of the students failed to initially maintain their levels of accuracy. The VA framework can help students with developmental disabilities acquire mathematical behaviors, such as identifying fractions.

Snakes and Ladders: Barriers and Facilitators Experienced by Immigrant Families when Accessing an Autism Spectrum Disorder Diagnosis Abstract There presently exists limited information or studies on means to support immigrant families as they attempt to access quality services for children with autism spectrum disorder (ASD). An ASD diagnosis is the gateway to support services and adapted interventions. Yet, studies show that immigrant families typically experience longer delays in obtaining a diagnosis and more challenges in gaining access to services. Twenty-four families who immigrated to Québec (Canada) participated in semi-structured interviews in which they listed the obstacles and facilitators encountered in their service trajectory to obtain a diagnosis for their child. Families' attitudes toward ASD, as a function of native culture, and their advice to other families in a similar situation are were also reported. Obstacles most often mentioned by participants were the waiting period for diagnostic services, feelings of social isolation, and a lack of professionals' knowledge about ASD. Parental advocacy, the competency and expertise of the professionals who conducted the evaluation, and parental education and awareness of ASD were the most frequently named facilitators. Finally, the most common recommendations made to other parents were to be persistent and proactive. In light of these reported experiences and perceptions, a series of clinical recommendations are provided to guide ASD evaluation practices in multicultural communities.

Preference for Food and Non-food Items of Known Reinforcing Values in People with Developmental Disabilities Abstract When presenting reinforcers to individuals with developmental disabilities, many researchers use food. However, there may be other types of reinforcers which may be equally or more effective. Although preference assessment methods have been well-researched, one area that has not yet been resolved is whether food reinforcers are always more preferred than non-food reinforcers, when both are presented in the same assessment. This study compared preference for food and non-food items with similar and dissimilar reinforcing values in three people with developmental disabilities. The study first evaluated the reinforcing value of food and non-food items in an ABAB design. Selected food and non-food items with similar and dissimilar reinforcing values were presented in a subsequent paired-stimulus preference assessment. Results showed that when food and non-food items were of approximately equal reinforcing value, or when food was more reinforcing than the non-food items, food tended to be preferred. However, when non-food items were much more reinforcing than food items, non-food items tended to be preferred.

Robotic Intervention Program for Enhancement of Social Engagement among Children with Autism Spectrum Disorder Abstract This study investigated the effectiveness of a robotic intervention in enhancing the social engagement of children with autism spectrum disorder (ASD). The clinical use of social or interactive robots is promising for enhancing the social skills of children with ASD. Teaching and intervention programs using humanoid robots for children with ASD are developing rapidly. In this study, a repeated-measures design was adopted to test the treatment effectiveness of a robotic intervention program; 14 students with ASD were recruited in this study. An individual-based social skills training program using the NAO robot was administered to each participant. Video recording was performed throughout the course of training. Systematic video analysis was conducted for the pre-intervention, mid-intervention, end of intervention and maintenance phases regarding 3 variables: frequency of eye contact, duration of eye contact, and frequency of verbal initiation. One-way analysis of variance for repeated measures was employed to demonstrate that the robotic intervention program significantly enhanced the eye contact (both frequency and duration) and verbal initiation of children with ASD. The robot served as a role model and facilitating agent to enable a therapeutic transaction between the child, environment, and activities to elicit self-initiated changes in the children with ASD.

Depression and Life Satisfaction among Parents Caring for Individuals with Developmental Disabilities in South Korea Abstract Caring for an individual with developmental disabilities can be challenging and time consuming for parents. This study examined the mediating effect of depression in the relationship between caregiving-related stressors (caregiving time and behavior problems) and life satisfaction among parents caring for individuals with developmental disabilities. We performed a secondary analysis of data from the 2011 Survey on the Actual Conditions of Individuals with Developmental Disabilities, conducted by the Korean Ministry of Health and Welfare. Caregiving time, behavior problems, parental depression, and life satisfaction were measured. The proposed path model showed a good fit to the data: caregiving time and severity of behavior problems in individuals with developmental disabilities influenced parental life satisfaction, and these relationships were partially mediated by depression. These results could help health care providers in developing prevention and treatment programs by providing greater insight into the modifiable factors related to depression and life satisfaction among parents caring for individuals with developmental disabilities.

Social Validity of Strategies to Assist Females with ASD during Gynecological Examinations Abstract This study aimed to identify strategies that stakeholders would deem appropriate for use during a gynecological exam for a female with autism spectrum disorder (ASD) who also has limited language (LL). Females with ASD are not receiving the same gynecological care as their non-ASD peers yet may have a greater need for such care due to increased health risks. Twenty-three parents and six caregivers of a female with ASD and LL, three females with ASD/Asperger's, and two nurses responded to an online survey about possible strategies to use with a female with ASD and LL during a routine gynecological exam. With the use of an embedded video to explain the strategies, participants were asked to choose those they identify as being effective for the successful completion of a gynecological exam. The use of visual supports via an electronic device or picture prompts, reinforcement of incremental steps, and non-contingent escape were identified as the top three strategies that would support a female with ASD and LL during a gynecological exam. Participants also offered anecdotal commentary about their fears and concerns related to this issue. The patient's voice in the decision-making process is crucial to the buy-in of the services offered by their providers. Once patient preference is known, it is imperative that researchers use that information. Identifying strategies with a higher rate of social validity, or acceptance of treatment prior to implementation, may assist future researchers in conducting studies on the effectiveness of those strategies.

Conceptions of Learning and Thinking Styles Among Deaf, Hard-of-Hearing, and Hearing Students Abstract This study explores how students' conceptions of learning relate to their thinking styles by administering the Conceptions of Learning Inventory III and the Thinking Styles Inventory-Revised II to 350 deaf or hard-of-hearing (DHH) and 463 hearing university students in mainland China. The reliabilities for the two inventories were first estimated using Cronbach's alpha coefficients. Then, confirmatory factor analysis (CFA) was conducted to test the validity of the COL-III. Finally, to predict thinking styles from conceptions of learning, hierarchical multiple regressions were conducted. Results showed that, among both DHH and hearing students, qualitative conceptions of learning (understanding, personal change, continuous, social competence, and duty) were significantly positively associated with a wide range of thinking styles. For DHH students, the contributions of conceptions of learning ranged from 11% to 32%, with a median of 25%. The predominant predictor was personal change. For hearing students, the contributions of conceptions of learning to thinking styles ranged from 9% to 22% (with a median of 15%), with the predominant predictor being duty. Thus, conceptions of learning significantly predicted thinking styles among both DHH and hearing students. The contributions, limitations, and implications of this research are discussed.

The Effects of Inclusive Soccer Program on Motor Performance and Sport Skill in Young Adults with and without Intellectual Disabilities Abstract This study aimed at investigating the effect of inclusive soccer program on motor performance and sport skill in young adults with and without intellectual disabilities (ID). Twelve participants with ID and twelve typical partners practiced 50-min each session, twice a week for 15-week long. All participants were encouraged to perform the practice at moderate exercise intensity. Measures of manual dexterity, mobility and soccer skills were tested pre- and post- program. This study showed participants with ID were able to perceive and report a number of exertion level in response to the intensity of exercise. In addition, participants with and without ID improved their performance in the Purdue Pegboard Test and Special Olympics Soccer Skill test. Thus, the mutual benefits in physical and motor performance were also evident in the typical partners. Our findings can encourage school and community to implement the inclusive sport programs. Lastly, the comparison groups and more measures are needed to generalize the findings to the large group.

An Exploratory Study of the Utility of the Dyadic Parent-Child Interaction Coding System for Children with Autism Spectrum Disorder Abstract Parent-child interactions are critically important for children with autism spectrum disorder (ASD) as a number of the core symptoms of ASD are specifically impacted by parental behaviors and many efficacious treatment options for children with ASD rely on altering parental behaviors. Research has reported on the use and effectiveness of Parent Child Interaction Therapy (PCIT) in addressing behavioral difficulties in children with ASD. A core feature of PCIT is observations of parent-child interactions using the Dyadic Parent-Child Interaction Coding System (DPICS) for assessment, treatment planning, and outcome monitoring. As the clinical usage and evidence base for PCIT with children with ASD grows, the question of the utility of the DPICS in children with ASD remains. The current study explores the reliability, validity, and utility of the DPICS in 88 parent-child dyads of children with (n = 46) and without (n = 42) autism symptomology. Results indicate fair to strong inter-correlations for all DPICS behavioral categories but do not support convergent validity with the Eyberg Child Behavior Inventory or the Parent Stress Index for dyads of a child with ASD. Significant differences were found between parents of children with ASD and those without on the DPICS. Within the context of interactions of children with ASD, inter-rater reliability was broadly obtained, although more research on the convergent validity is needed. The DPICS gathers important information to characterize parent-child interactions in dyads of children with ASD, but may not be as tied to parent report of child behaviors as in typically developing samples.

Resurgence of Challenging Behavior Following Functional Communication Training for Children with Disabilities: a Literature Review Abstract Functional communication training (FCT) is highly effective in reducing challenging behavior and increasing appropriate communication in children with developmental disabilities. However, the challenging behavior may re-occur following successful treatment with functional communication training when the functional communication response contacts extinction. Therefore, it is imperative to evaluate the variables that reduce resurgence of challenging behavior following successful treatment. For the current review, the systematic search yielded 14 articles from the current literature that evaluated resurgence following functional communication training. The effect of demand fading, the language of instruction, the presence of stimuli associated with the intervention, previous exposures to extinction, schedule of reinforcement during baseline, and reinforcing multiple mands were evaluated in the present literature review. Overall, relatively few applied studies with human participants have evaluated variables that affect resurgence. It is imperative that future research utilizes systematic manipulation to identify variables that reduce the resurgence of challenging behavior. Implications for practice and directions for future research are discussed.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com