The unified protocol for transdiagnostic treatment of emotional disorders for misophonia: a pilot trial exploring acceptability and efficacy

Introduction

Misophonia is a recently defined disorder characterized by distressing responses to everyday sounds, such as chewing or sniffling. Individuals with misophonia experience significant functional impairment but have limited options for evidenced-based behavioral treatment. To address this gap in the literature, the current pilot trial explored the acceptability and efficacy of a transdiagnostic cognitive-behavioral approach to treating symptoms of misophonia.

Methods

This trial was conducted in two studies: In Study 1, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was delivered to eight patients in order to receive feedback to guide revisions to the treatment to suit this population. In Study 2, ten patients received the revised UP treatment to explore its acceptability and preliminary efficacy. This study used a single-case experimental design with multiple baselines, randomizing patients to either a 2-week baseline or 4-week baseline prior to the 16 weeks of treatment, followed by four weeks of follow-up.

Results

The findings from these studies suggested that patients found both the original and adapted versions of the UP to be acceptable and taught them skills for how to manage their misophonia symptoms. Importantly, the findings also suggested that the UP can help remediate symptoms of misophonia, particularly the emotional and behavioral responses.

Discussion

These findings provide preliminary evidence that this transdiagnostic treatment for emotional disorders can improve symptoms of misophonia in adults.

Phenotyping misophonia: Psychiatric disorders and medical health correlates

Misophonia is characterized by decreased tolerance to specific sounds and associated stimuli that causes significant psychological distress and impairment in daily functioning (Swedo et al., 2022). Aversive stimuli (often called “triggers”) are commonly repetitive facial (e.g., nose whistling, sniffling, and throat clearing) or oral (e.g., eating, drinking, and mouth breathing) sounds produced by other humans. Few empirical studies examining the nature and features of misophonia have used clinician-rated structured diagnostic interviews, and none have examined the relationship between misophonia and psychiatric disorders in the Diagnostic and Statistical Manual-5th version (DSM-5; American Psychiatric Association, 2013). In addition, little is known about whether there are any medical health problems associated with misophonia. Accordingly, the purpose of the present study was to improve the phenotypic characterization of misophonia by investigating the psychiatric and medical health correlates of this newly defined disorder. Structured diagnostic interviews were used to assess rates of lifetime and current DSM-5 psychiatric disorders in a community sample of 207 adults. The three most commonly diagnosed current psychiatric disorders were: (1) social anxiety disorder, (2) generalized anxiety disorder, and (3) specific phobia. The three most common lifetime psychiatric disorders were major depressive disorder, social anxiety disorder, and generalized anxiety disorder. A series of multiple regression analyses indicated that, among psychiatric disorders that were correlated with misophonia, those that remained significant predictors of misophonia severity after controlling for age and sex were borderline personality disorder, obsessive compulsive disorder, and panic disorder. No medical health problems were significantly positively correlated with misophonia severity.

Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study

OBJECTIVE

Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts.

METHOD

We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353).

RESULTS

The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]).

DISCUSSION

Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.

Complex foraging behaviours in wild birds emerge from social learning and recombination of components

Recent well-documented cases of cultural evolution towards increasing efficiency in non-human animals have led some authors to propose that other animals are also capable of cumulative cultural evolution, where traits become more refined and/or complex over time. Yet few comparative examples exist of traits increasing in complexity, and experimental tests remain scarce. In a previous study, we introduced a foraging innovation into replicate subpopulations of great tits, the 'sliding-door puzzle'. Here, we track diffusion of a second 'dial puzzle', before introducing a two-step puzzle that combines both actions. We mapped social networks across two generations to ask if individuals could: (1) recombine socially-learned traits and (2) socially transmit a two-step trait. Our results show birds could recombine skills into more complex foraging behaviours, and naïve birds across both generations could learn the two-step trait. However, closer interrogation revealed that acquisition was not achieved entirely through social learning-rather, birds socially learned components before reconstructing full solutions asocially. As a consequence, singular cultural traditions failed to emerge, although subpopulations of birds shared preferences for a subset of behavioural variants. Our results show that while tits can socially learn complex foraging behaviours, these may need to be scaffolded by rewarding each component. This article is part of a discussion meeting issue 'The emergence of collective knowledge and cumulative culture in animals, humans and machines'.

A pilot study investigating the efficacy of brief, phone-based, behavioral interventions for burnout in graduate students

OBJECTIVE

This pilot study tested the efficacy of two brief, phone-administered, behavioral interventions derived from behavioral activation in reducing burnout among doctoral students.

METHODS

Sixty-six doctoral students demonstrating current high burnout were randomly assigned to one of three intervention conditions: (1) Reward: increasing pleasant, rewarding behaviors, (2) Approach: approaching important goals that they have been avoiding, or (3) Control: monitoring only.

RESULTS

Results indicated that doctoral students treated with the approach intervention reported significantly lower burnout compared to participants in the control condition immediately after the intervention and at a 1-week follow-up. Results also suggested that students in the approach intervention also reported higher well-being compared to students in the control condition.

CONCLUSION

These findings suggest that this approach intervention is an effective treatment for school burnout for doctoral students that can be delivered remotely through phone and web technology.

A Preliminary Investigation of the Association Between Misophonia and Symptoms of Psychopathology and Personality Disorders

Misophonia is a condition characterized by defensive motivational system emotional responding to repetitive and personally relevant sounds (e.g., eating, sniffing). Preliminary research suggests misophonia may be associated with a range of psychiatric disorders, including personality disorders. However, very little research has used clinician-rated psychometrically validated diagnostic interviews when assessing the relationship between misophonia and psychopathology. The purpose of this study was to extend the early research in this area by examining the relationship between symptoms of misophonia and psychiatric diagnoses in a sample of community adults, using semi-structured diagnostic interviews. Results indicated higher misophonia symptoms were associated with more clinician-rated symptoms of personality disorders, but not other disorders. Anxiety partially mediated the relationship between personality disorder symptoms and misophonia. These results suggest misophonia may be associated with a range of psychiatric symptoms and highlight the role of anxiety in this poorly understood condition.

Positive effects of high salinity can buffer the negative effects of experimental warming on functional traits of the seagrass Halophila ovalis

Coastal ecosystems, and especially estuaries, are subject to environmental fluctuations that can be amplified by anthropogenic changes. Under a future scenario of global warming, temperature and salinity are likely to be altered and the persistence of macrophyte-dominated ecosystems can be compromised, particularly native or local seagrass communities. This study examined the response of the local seagrass Halophila ovalis to the joint effect of a short-term salinity increase and a transient temperature stress, through two mesocosm experiments. Warming caused a decline in F_v/F_m, TNC content in leaves and plant growth, and increased dark respiration, revealing clear detrimental symptoms of heat stress on plant metabolism and performance. Salinity increase in isolation favoured ramet survival. However, in combination with warming, salinity had a positive effect on Gross P_max. This suggests that increased salinities might dampen the negative effects of high temperatures, buffering, to some extent, the impact of global warming in temperate estuaries.

The Mediating Role of Emotion Regulation Within the Relationship Between Neuroticism and Misophonia: A Preliminary Investigation

Misophonia is a newly described condition characterized by heightened emotional reactivity (e.g., anger, anxiety, and disgust) to common repetitive sounds (e.g., oral or nasal sounds made by others), accompanied by difficulties responding to these sounds (e.g., intolerance, avoidance, and escape) and associated impairment in functioning. Although research indicates that problematic emotional responses are a key characteristic of misophonia, it is unknown whether individual differences in experiencing and regulating emotional responses influence severity of misophonia symptoms. Examination of individual differences in emotional functioning will help to guide treatment development for misophonia. Accordingly, the present study examined the associations among trait neuroticism, difficulties with emotion regulation, and symptoms of misophonia. For this study, a sample of 49 adults completed the Difficulties with Emotion Regulation Scale, the Misophonia Questionnaire, and the neuroticism subscale of the NEO-Personality inventory. Findings indicated that difficulties with emotion regulation and neuroticism were significantly positively correlated with symptoms of misophonia. Bootstrapped mediation analyses suggested that difficulties controlling impulsive behavior while experiencing intense negative emotions fully mediated the relationship between neuroticism and symptoms of misophonia. Results from this study suggest that neuroticism and difficulties with emotion regulation may be important risk factors and treatment targets for adults with misophonia, and difficulties controlling impulsive behavior when distressed may be an important individual difference accounting for the relationship between neuroticism and misophonia.

Psychiatric and physical outcomes of long-term use of lithium in older adults with bipolar disorder and major depressive disorder: A cross-sectional multicenter study

OBJECTIVE

Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD.

METHOD

Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants.

RESULTS

Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p < 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism.

LIMITATIONS

Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed.

CONCLUSION

Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.

A Path From Childhood Sensory Processing Disorder to Anxiety Disorders: The Mediating Role of Emotion Dysregulation and Adult Sensory Processing Disorder Symptoms

Although maladaptive sensory processing has been observed among individuals with persistent heightened anxiety, it is unclear if difficulties processing sensory input early in life lead to anxiety disorders in adulthood and what mechanisms would drive this progression. In a transdiagnostic clinical sample of 231 adults characterized by heightened difficulties with emotion regulation, the present study sought to examine whether: (a) childhood sensory processing disorder (SPD) symptoms predict an increased probability of an anxiety disorder diagnosis in adulthood; and (b) difficulties with emotion regulation and adult SPD symptoms mediate this relationship. Participants were administered the Structured Clinical Interview for Axis-I disorders and self-reported symptoms of SPD experienced in childhood and adulthood. Results suggested that childhood SPD symptoms were significantly associated with a higher likelihood of a lifetime anxiety disorder diagnosis. Difficulties with emotion regulation fully mediated the relationship between childhood SPD and (a) any anxiety disorder in adulthood and, specifically (b) current generalized anxiety disorder (GAD). Further, we found evidence for a candidate model accounting for the relationship among childhood SPD, adulthood SPD, difficulties with emotion regulation, and anxiety disorders in adulthood. Specifically, our data indicated that high symptoms of SPD in childhood may lead to high SPD symptoms in adulthood, which then lead to high emotion dysregulation, ultimately conferring vulnerability for an anxiety disorder diagnosis. Taken together, these findings provide preliminary evidence for how sensory processing impairments in childhood may relate to anxiety through difficulties regulating emotion regulation.

Age differences in DSM-IV borderline personality disorder symptom expression: Results from a national study using item response theory (IRT)

Limited literature suggests that there may be age-related differences in borderline personality disorder (BPD) symptom expression. The present study used item response theory (IRT) methods to examine whether there are age differences in the likelihood of endorsing DSM-IV symptoms of BPD, when equating for levels of BPD symptom severity. Data were drawn from a nationally representative survey of adults in the US (n = 34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found that 7 out of the 9 DSM-IV symptoms of BPD were age invariant. However, there were statistically and clinically significant differences between the oldest and youngest age groups in two BPD symptoms: oldest adult women were less likely to report suicidal/self-harm behavior than the youngest adult women across levels of BPD severity and unstable/intense interpersonal relationships discriminated BPD severity better in the youngest age group compared to the oldest age group in both genders. Overall, our findings indicate substantial age-related differences in BPD symptom expression. Mental health care providers should be alert to these two age-related differences in BPD symptom expression when making assessment and treatment decisions across adult age groups.

Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: A national study

Prior research indicates that childhood maltreatment and impulsivity increase the risk for different types of violence, including violent behaviors directed toward the self and others. However, it is not known whether childhood maltreatment and impulsivity have independent effects on different violent behaviors. Therefore, this study examined the differential effects of childhood maltreatment and impulsivity on interpersonal violence, suicide attempts, and self-injury. Data were drawn from a nationally representative survey of 34,653 US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Structural equation modeling was used to simultaneously examine the shared and specific effects of five types of childhood maltreatment and impulsivity on the risk of different violent behaviors (i.e. interpersonal violence, suicide attempts, and self-injury). Analyses were stratified by gender and adjusted for age and ethnicity. Impulsivity and childhood maltreatment independently increased the risk of suicide attempt, self-injury, and interpersonal violence. Childhood maltreatment had stronger effects on violence directed towards the self than on interpersonal violence in both genders, while impulsivity had a stronger effect on self-injury than on suicide attempt or interpersonal violence in men. These findings indicate that childhood maltreatment and impulsivity relate differently to the risk of different types of violence.

Changes in Problematic Anger, Shame, and Disgust in Anxious and Depressed Adults Undergoing Treatment for Emotion Dysregulation

Emotion dysregulation, the pervasive difficulty managing negative emotions, is a core problem across mood and anxiety disorders. Anger, shame, and disgust are particularly problematic emotions, impacting both disorder severity and treatment outcome. We previously found that a 16-week dialectical behavior therapy skills training group (DBT-ST) was superior to an activities-based support group (ASG) in decreasing emotion dysregulation in 44 adults with high emotion dysregulation who met diagnostic criteria for an anxiety or depressive disorder. We presently examine these participants' changes in anger, shame, disgust, and distress using self-reports collected over 6 months during and after treatment. Hierarchical linear modeling analyses show that DBT-ST was superior to ASG in decreasing anger suppression (d = 0.93) and distress (d = 1.04). Both conditions significantly reduced shame, disgust propensity, and disgust sensitivity, but neither was superior for these outcomes. The treatments did not significantly reduce anger expression. Mediation analyses suggest that condition indirectly influenced 4-month anger suppression, shame, and distress through its effect on 2-month emotion dysregulation. These findings suggest that DBT-ST is efficacious for certain problematic emotions and distress in depressed and anxious adults and that common factors may account for some, but not all, of its benefits.

Contributing Factors and Mental Health Outcomes of First Suicide Attempt During Childhood and Adolescence: Results From a Nationally Representative Study

OBJECTIVE

To investigate whether risk factors for suicide attempts differ in children and adolescents and to categorize adulthood mental health outcomes of child and adolescent suicide attempters in the general population.

METHODS

Using a large (N = 34,653), nationally representative US adult sample, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions, we examined whether individuals who first attempted suicide during childhood (under the age of 13 years) differ from those who first attempted suicide during adolescence (13 through 17 years) in (1) contributing factors for first suicide attempt, including mental disorders and traumatic experiences that occurred before the first suicide attempt, parental history of mental disorders, and family poverty and (2) adulthood mental health outcomes, including lifetime and current prevalence of DSM-IV psychiatric disorders and quality of life measures.

RESULTS

Suicide attempts during childhood (n = 104) were more strongly related to childhood maltreatment, while suicide attempts during adolescence (n = 415) were more strongly associated with major depressive episode. Compared to first suicide attempts during adolescence, first attempts during childhood were associated with increased risk for multiple suicide attempts (61.3% vs 32.6%), several psychiatric disorders (mania, hypomania, and panic disorder), and poorer social functioning during adulthood (all P values < .05).

CONCLUSIONS

Suicide attempts in children and adolescents substantially differ in contributing factors and adulthood mental health outcomes. Preventing childhood maltreatment and early intervention for psychiatric disorders may have broad benefits to reduce not only the suffering of these children and adolescents, but also the burden of suicide.

Latent class analysis of the feared situations of social anxiety disorder: A population-based study

BACKGROUND

Little is known about differences in mental health comorbidity and quality of life in individuals with social anxiety disorder (SAD) according to the number and the types of feared situations.

METHODS

Using a US nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions, we performed latent class analysis to compare the prevalence rates of mental disorders and quality of life measures across classes defined by the number and the types of feared social situations among individuals with SAD.

RESULTS

Among the 2,448 participants with a lifetime diagnosis of SAD, we identified three classes of individuals who feared most social situations but differed in the number of feared social situations (generalized severe [N = 378], generalized moderate [N = 1,049] and generalized low [N = 443]) and a class of subjects who feared only performance situations [N = 578]. The magnitude of associations between each class and a wide range of mental disorders and quality of life measures were consistent with a continuum model, supporting that the deleterious effects of SAD on mental health may increase with the number of social situations feared. However, we found that individuals with the "performance only" specifier may constitute an exception to this model because these participants had significantly better mental health than other participants with SAD.

CONCLUSIONS

Our findings give additional support to the recent changes made in the DSM-5, including the introduction of the "performance only" specifier and the removal of the "generalized" specifier to promote the dimensional approach of the number of social fears.

Generalizability of Pharmacologic and Psychotherapy Clinical Trial Results for Posttraumatic Stress Disorder to Community Samples

OBJECTIVE

The present study sought to quantify the generalizability of pharmacologic and psychotherapy clinical trial results in individuals with a DSM-IV diagnosis of posttraumatic stress disorder (PTSD) to a large representative community sample.

METHODS

Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large nationally representative sample of the adult US population. We applied a standard set of exclusion criteria representative of pharmacologic and psychotherapy clinical trials to all adults with a DSM-IV diagnosis of PTSD in the previous 12 months (n = 1,715) and then to a subsample of participants seeking treatment (n = 366). Our aim was to assess how many participants with PTSD would fulfill typical eligibility criteria.

RESULTS

We found that more than 6 of 10 respondents from the overall PTSD sample and more than 7 of 10 respondents seeking treatment for PTSD would have been excluded by 1 exclusion criterion or more in a typical pharmacologic trial. In contrast, about 2 of 10 participants in the full sample and about 3 of 10 participants seeking treatment for PTSD would have been excluded in a typical psychotherapy efficacy trial.

CONCLUSIONS

We found that psychotherapy trial results may be applied to most patients with PTSD in routine clinical practice. The designers of pharmacologic clinical trials should carefully consider the trade-offs between the application of each exclusion criterion and its impact on representativeness. Specification a priori of the goals of the study, better justification for each exclusion criterion, and estimation of the proportion of individuals ineligible for the trial would assist study design. Developing integrated forms of pharmacotherapy and psychotherapy that simultaneously target commonly overlapping psychiatric disorders may yield more informative results for mental health care providers and research funding agencies.

Cross-sectional Study of Glutamate in the Anterior Cingulate and Hippocampus in Schizophrenia

BACKGROUND

There has been growing support for dysfunctions of the excitatory glutamatergic system and its implications for the psychophysiology of schizophrenia. However, previous studies reported mixed results regarding glutamate concentrations in schizophrenia with varying deviations across brain regions.

METHODS

We used an optimized proton magnetic resonance spectroscopy procedure to measure absolute glutamate concentrations in the left hippocampal region and the anterior cingulate cortex (ACC) in 29 medicated patients with schizophrenia and in 29 control participants without mental disorder.

RESULTS

The glutamate concentrations were significantly lower in the ACC but higher in the hippocampus of patients compared to controls. ACC and hippocampal glutamate concentrations correlated positively in patients but not in controls. ACC glutamate was weakly associated with Clinical Global Impression score and duration of illness in patients.

CONCLUSION

Glutamate concentrations in schizophrenia deviate from controls and show associations with disease severity. A higher concentration of hippocampal glutamate in schizophrenia compared to controls is shown. The association between ACC and hippocampus glutamate concentrations in patients with schizophrenia suggests an abnormal coupling of excitatory systems compared to controls as predicted by previous glutamate models of schizophrenia.

Psychotherapeutic Treatment of Bipolar Depression

The gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach.

Vicarious Fear Learning Depends on Empathic Appraisals and Trait Empathy

Empathy and vicarious learning of fear are increasingly understood as separate phenomena, but the interaction between the two remains poorly understood. We investigated how social (vicarious) fear learning is affected by empathic appraisals by asking participants to either enhance or decrease their empathic responses to another individual (the demonstrator), who received electric shocks paired with a predictive conditioned stimulus. A third group of participants received no appraisal instructions and responded naturally to the demonstrator. During a later test, participants who had enhanced their empathy evinced the strongest vicarious fear learning as measured by skin conductance responses to the conditioned stimulus in the absence of the demonstrator. Moreover, this effect was augmented in observers high in trait empathy. Our results suggest that a demonstrator's expression can serve as a "social" unconditioned stimulus (US), similar to a personally experienced US in Pavlovian fear conditioning, and that learning from a social US depends on both empathic appraisals and the observers' stable traits.

Childhood maltreatment and risk of intimate partner violence: A national study

OBJECTIVE

Prior research indicates that different types of childhood maltreatment frequently co-occur and confer risk for adulthood intimate partner violence (IPV). However, it is unknown whether the risk of IPV is due to specific type(s) of maltreatment or to their shared association or both. Although these competing explanations have different implications for intervention, they have never been evaluated empirically.

METHOD

Data were drawn from a nationally representative survey of 34,653 US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Structural equation modeling was used to simultaneously examine the shared and specific effects of five types of childhood maltreatment (i.e., sexual abuse, physical and emotional abuse and neglect) on the risk of different IPV behaviors (i.e., perpetration, victimization and reciprocal violence). Analyses were stratified by sex and adjusted for sociodemographic characteristics (i.e., age, personal income, educational background and race/ethnicity).

RESULTS

Most types of childhood maltreatment increased the risk of victimization, perpetration and reciprocal violence. Effects of maltreatment types on each IPV behavior were exerted mostly through a latent factor representing the shared effect across all different types of maltreatment in both sexes (CFI = 0.990, TLI = 0.990, RMSEA = 0.023), although sexual abuse had an additional effect on victimization.

CONCLUSIONS

Because childhood maltreatment types increase the risk of each intimate partner violence behavior mainly through a general maltreatment dimension, underlying biological and developmental-ecological mechanisms should be considered important targets of prevention for both victimization and perpetration of abuse in adult relationships.

Volunteerism and Mortality among the Community-dwelling Elderly

Older residents (N 5 1972) in California were investigated prospectively for association of volunteering service to others and all-cause mortality. Potential confounding factors were studied: demographics, health status, physical functioning, health habits, social support, religious involvement, and emotional states. Possible interaction effects of volunteering with religious involvement and social support were also explored. Results showed that 31 percent (n 5 630) of respondents volunteered, about half (n5289) for more than one organization. High volunteers ([.greaterequal]2 organizations) had 63 percent lower mortality than nonvolunteers (age and sex-adjusted) with relative hazard (RH) 5 0.37, confidence interval (CI) 5 0.24, 0.58. Multivariate adjustment moderately reduced difference to 44 percent (RH 5 0.56, CI 5 0.35, 0.89), mostly due to physical functioning, health habits, and social support. Unexpectedly, volunteering was slightly more protective for those with high religious involvement and perceived social support. After multivariate adjustment, any level of volunteering reduced mortality by 60 percent among weekly attenders at religious services (RH 5 0.40; CI 5 0.21,0.74). Lower mortality rates for community service volunteers were only partly explained by health habits, physical functioning, religious attendance, and social support.

The tensor distribution function

Diffusion weighted magnetic resonance imaging is a powerful tool that can be employed to study white matter microstructure by examining the 3D displacement profile of water molecules in brain tissue. By applying diffusion-sensitized gradients along a minimum of six directions, second-order tensors (represented by three-by-three positive definite matrices) can be computed to model dominant diffusion processes. However, conventional DTI is not sufficient to resolve more complicated white matter configurations, e.g., crossing fiber tracts. Recently, a number of high-angular resolution schemes with more than six gradient directions have been employed to address this issue. In this article, we introduce the tensor distribution function (TDF), a probability function defined on the space of symmetric positive definite matrices. Using the calculus of variations, we solve the TDF that optimally describes the observed data. Here, fiber crossing is modeled as an ensemble of Gaussian diffusion processes with weights specified by the TDF. Once this optimal TDF is determined, the orientation distribution function (ODF) can easily be computed by analytic integration of the resulting displacement probability function. Moreover, a tensor orientation distribution function (TOD) may also be derived from the TDF, allowing for the estimation of principal fiber directions and their corresponding eigenvalues.

Breast magnetic resonance imaging: An essential role in malignant axillary lymphadenopathy of unknown origin

The aim of this retrospective case series was to assess the role of breast MRI in the investigation of "occult" malignancy, and the associated potential to influence patient management. Between January 2000 and March 2004, 18 patients, who presented with axillary lymphadenopathy, most likely due to "occult" breast cancer, were examined with MRI of the breast. The results showed 12 true positives, four true negatives, and two false positives. This gave an overall sensitivity of 85.7% and an overall accuracy of 86.7%. In those in whom malignancy was identified on MRI and subsequently proven histologically, 78% of these cancers were identified, and localized by preoperative MRI-guided sonography. In addition, 55% of these patients were eligible for conservative surgery. As such, MRI of the breast is highly sensitive for the detection of mammographically and clinically occult breast cancer. The use of MRI enables a preoperative diagnosis to be made in a high percentage of patients and may allow retrospective targeted ultrasound localization. Definitive surgical planning, including the option of breast conservation, is made possible with the result of the MRI examination.

Application of a novel phytotoxicity assay for the detection of herbicides in Hervey Bay and the Great Sandy Straits

A novel phytotoxicity assay was incorporated into an environmental assessment of Hervey Bay and the Great Sandy Straits, to investigate the role of run-off associated herbicides in the deteriorated health of intertidal seagrass meadows. Dose response curves of common herbicides were performed and their toxicity equivalents elucidated to assist in analysis. The results of the assay were reproducible and corresponded strongly with results of chemical analyses. The incorporation of the assay into the assessment of surface waters added an important aspect to the study by allowing investigation of the toxicity of cumulative herbicide concentrations and yielding biologically relevant data. The highest herbicide concentration detected during the study was equivalent to 0.23 microg l(-1) diuron; a concentration known to inhibit photosynthetic efficiency of the assay biomaterial by approximately 3%.

Matrix metalloproteinases and tissue inhibitor of metalloproteinase-1 in sarcoidosis and IPF

The purpose of this study was to examine the role of interstitial collagenases, members of the family of matrix metalloproteinases, in the development of pulmonary fibrosis. The activity, levels and molecular forms of collagenases (matrix metalloproteinases (MMP)-1, -8 and -13), gelatinase B (MM P-9) and its main endogenous inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1) were assessed in bronchoalveolar lavage fluid (BALF) from patients with idiopathic pulmonary fibrosis (IPF) and sarcoidosis patients with varying degrees of pulmonary parenchymal involvement. Collagenase activity was elevated in IPF and group 3 sarcoidosis patients. A positive correlation between BALF collagenase activity and MMP-8 levels was also observed. Western immunoblotting revealed the presence of two isoforms of MMP-8 in patient samples; an 80 kD form representing latent enzyme from polymorphonuclear neutrophils and a 55 kD form representing the fibroblast-type proform. MMP-9 levels were also elevated in both IPF and group 3 sarcoidosis patients, while TIMP-1 levels remained normal, indicating a shift in the balance between the enzyme and inhibitor, favouring MMP-9. Matrix metalloproteinase-8 is the major contributor to the bronchoalveolar lavage fluid collagenase activity in the airways of patients with idiopathic pulmonary fibrosis and sarcoidosis and may initiate collagen destruction and remodelling leading to the development of pulmonary fibrosis.

Magnetization transfer imaging for polymer gel dosimetry

Off-resonance RF pre-saturation was used to obtain contrast in MRI images of polymer gel dosimeters irradiated to doses up to 50 Gy. Two different polymer gel dosimeters composed of 2-hydroxyethyl-acrylate or methacrylic acid monomers mixed with N, N'-methylene-bisacrylamide (BIS), dispersed in an aqueous gelatin matrix were evaluated. Radiation-induced polymerization of the co-monomers generates a fast-relaxing insoluble polymer. Saturation of the polymer using off-resonance Gaussian RF pulses prior to a spin-echo readout with a short echo time leads to contrast that is dependent on the absorbed dose. This contrast is attributed to magnetization transfer (MT) between free water and the polymer, and direct saturation of water was found to be negligible under the prevailing experimental conditions. The usefulness of MT imaging was assessed by computing the dose resolution obtained with this technique. We found a low value of dose resolution over a wide range of doses could be obtained with a single experiment. This is an advantage over multiple spin echo (MSE) experiments using a single echo spacing where an optimal dose resolution is achieved over only very limited ranges of doses. The results suggest MT imaging protocols may be developed into a useful tool for polymer gel dosimetry.

Secretory leukocyte proteinase inhibitor and elafin are resistant to degradation by MMP-8

The naturally occurring neutrophil elastase inhibitors, alpha1-proteinase inhibitor (alpha1PI), secretory leukocyte proteinase inhibitor (SLPI), and elafin, are potential therapeutic agents in the treatment of neutrophil-mediated lung disease. However alpha1PI has been shown to be susceptible to inactivation by matrix metalloproteinases (MMPs) released by neutrophils, particularly neutrophil collagenase (MMP-8). The aim of this study was to determine if SLPI and elafin are similarly susceptible to degradation by this neutrophil-specific MMP. The effect of MMP-8 on SLPI and elafin was assessed by determining the neutrophil elastase inhibitory capacity (NEIC) and electrophoretic protein profile of both inhibitors following exposure to purified MMP-8. As a positive control, the effect of MMP-8 alpha1PI was assessed in parallel. Although treatment of alpha1PI with MMP-8 resulted in a significant decrease in its NEIC (P = .025), no similar decrease was observed with SLPI or elatin. Electrophoretic analysis confirmed digestion of alpha1PI by MMP-8 but no digestion of either SLPI or elafin was observed. These results demonstrate that SLPI and elafin are resistant to proteolytic inactivation by MMP-8, a property that may enhance their therapeutic application in neutrophil-mediated inflammatory lung disease.

Brain activity during the encoding, retention, and retrieval of stimulus representations

Studies of delayed nonmatching-to-sample (DNMS) performance following lesions of the monkey cortex have revealed a critical circuit of brain regions involved in forming memories and retaining and retrieving stimulus representations. Using event-related functional magnetic resonance imaging (fMRI), we measured brain activity in 10 healthy human participants during performance of a trial-unique visual DNMS task using novel barcode stimuli. The event-related design enabled the identification of activity during the different phases of the task (encoding, retention, and retrieval). Several brain regions identified by monkey studies as being important for successful DNMS performance showed selective activity during the different phases, including the mediodorsal thalamic nucleus (encoding), ventrolateral prefrontal cortex (retention), and perirhinal cortex (retrieval). Regions showing sustained activity within trials included the ventromedial and dorsal prefrontal cortices and occipital cortex. The present study shows the utility of investigating performance on tasks derived from animal models to assist in the identification of brain regions involved in human recognition memory.

Association of a novel PDZ domain-containing peripheral Golgi protein with the Q-SNARE (Q-soluble N-ethylmaleimide-sensitive fusion protein (NSF) attachment protein receptor) protein syntaxin 6

PDZ domains are involved in the scaffolding and assembly of multi-protein complexes at various subcellular sites. We describe here the isolation and characterization of a novel PDZ domain-containing protein that localizes to the Golgi apparatus. Using an in silico cloning approach, we have identified and isolated a cDNA encoding a ubiquitously expressed 59-kDa protein that we call FIG. It is composed of two coiled coil regions, a leucine zipper, and a single PDZ domain. Cytological studies using indirect immunofluorescence microscopy revealed that FIG is a peripheral protein that uses one of its coiled coil domains to localize to the Golgi apparatus. To ascertain the modalities of this Golgi localization, the same coiled coil region was tested for its ability to interact with a panel of coiled coil domain-containing integral membrane Golgi proteins. Using a series of GST fusion protein binding assays, co-immunofluorescence and co-immunoprecipitation experiments, we show that FIG specifically binds to the coiled coil domain-containing Q-SNARE (Q-soluble NSF attachment protein receptor) protein syntaxin 6 both in vitro and in vivo. The structural features of FIG and its interaction with a SNARE protein suggest that FIG may play a role in membrane vesicle trafficking. This is the first example of a PDZ domain-containing peripheral protein that localizes to the Golgi through a coiled coil-mediated interaction with a resident membrane protein. Our results broaden the scope of PDZ domain-mediated functions.

Nutritional screening and assessment

OBJECTIVES

To review the components of nutritional screening, screening measures and tools, and the nurses' role in nutritional assessment.

DATA SOURCES

Research studies, review articles, and book chapters.

CONCLUSIONS

Timely and appropriate nutritional interventions require the adoption of routine initial nutritional screening, referral for comprehensive nutritional assessments as needed, and continued re-screening.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses should be prepared to contribute to a comprehensive nutritional assessment in their role as patient advocate and expert clinician.

Application of polyphosphate metabolism to environmental and biotechnological problems

The synthesis and degradation of polyphosphate (polyP) are influenced by the energy state of the cell and extracellular phosphate levels. The import of excess phosphate and its incorporation into polyP under phosphate- and energy-rich growth conditions allows organisms to survive when phosphate or energy are depleted. Under phosphate-starvation conditions, phosphate can be recovered from polyP by hydrolysis. When the organism is energy starved, energy can be recovered either by regenerating the high-energy phosphoanhydride bond donor (ATP in most cases) or by hydrolysis of polyP and subsequent secretion of orthophosphate to recharge the transmembrane proton gradient. Understanding how the energy state of the cell and environmental phosphate levels affect polyP metabolism is essential to improving such environmental processes as enhanced biological phosphorus removal, a treatment process that is widely used to remove excess phosphate from wastewater. Manipulation of the genes responsible for polyP metabolism can also be used to improve gene expression from phosphate-starvation promoters and to remove heavy metals from contaminated environments.

A health visitor for older people in an accident and emergency department

Published studies indicate that older people have special needs on discharge from accident and emergency (A&E) departments that are not always fully met. The literature reflects that although a significant proportion of older people have a decrease in functional independence and an increased need for services following discharge from A&E, social and functional assessment by A&E staff can be inadequate, as can the arrangement of follow-up community services. As part of a wider study into the organization of care for older people in A&E, a health visitor for older people was funded to work part-time in the A&E department of a large NHS Trust. The health visitor identified potential clients through reviewing the A&E documentation of patients aged 75 years or over discharged directly from A&E. Telephone calls or home visits were used to follow up those individuals deemed to be vulnerable by the health visitor. Interventions included health education, referral to other agencies and patient or family counselling. None of the clients followed up by the health visitor (n = 212) had been referred by A&E to a specialist in gerontology, which suggests that these clients would otherwise not have received the potential benefit of specialist intervention. The pilot study described here highlights a number of practical issues in relation to the health visitor post for older people in A&E, including the importance of dedicated office space and access to a telephone. Data collected during the study, plus the positive evaluation of the role by a small group of A&E staff confirm the claims made in other studies (e.g. Runciman et al, 1996) that health visitors for older people may be of value in meeting the post-discharge needs of these people.