A Systematic Review of Multiple Family Factors Associated with Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is characterized by a recurrent pattern of angry/irritable emotional lability, argumentative/defiant behavior, and vindictiveness. Previous studies indicated that ODD typically might originate within a maladaptive family environment, or was at least maintained within such an environment. As such, the present review summarized pertinent research from the last 20 years that focused on the pathways connecting family risk factors to the development of child ODD symptoms. A systematic search of electronic databases was completed in August 2020, resulting in the inclusion of 62 studies in the review. The review established a multi-level framework to describe the mechanisms underlying the pathway from familial factors to ODD psychopathological symptoms: (a) the system level that is affected by the family's socioeconomic status and family dysfunction; (b) the dyadic level that is affected by conflict within the marital dyad and parent-child interactions; and (c) the individual level that is affected by parent and child factors. Additionally, from the perspective of family systems theory, we pay special attention to the interactions among and between the various levels of the pathway (moderation and mediation) that might be associated with the occurrence and severity of ODD symptoms. Considering future prevention and intervention efforts, this three-level model emphasizes the necessity of focusing on familial risk factors at multiple levels and the mechanisms underlying the proposed pathways.

Very Young Child Survivors' Perceptions of Their Father's Suicide: Exploring Bibliotherapy as Postvention Support

Each year in the United States, 7000 to 30,000 children experience their parent's suicide. Due to the stigma associated with suicide, feelings of guilt, and intense grief, surviving family members avoid talking about suicide. Over time, children struggle with confusion and intense emotions associated with their parent's suicide. In this study, seven adults, who reported being younger than six years old at the time of their father's suicide, participated in individual semi-structured interviews. Participants' responses highlight the challenges that young children face due to limited memories of their deceased parent. Interviews concluded with an opportunity for participants to review and express their impressions of 10 children's picture books. Participants offered impressions about how these books may or may not be helpful in supporting young child survivors. Implications for applied practice include considering how children's literature may open communication and assist children in navigating Worden's tasks of grief: (a) accepting the reality of their parent's death; (b) facing the grief and pain; (c) adapting to life changes due to their father's suicide, in particular adapting to altered family relationships; and (d) building memories of the deceased loved one, when possible, to ensure healthy attachment to the deceased parent. Participants' insights provide considerations for selecting children's literature for bibliotherapy. Due to young child survivors' increased risk for attempting and completing suicide, supporting child survivors of parent suicide not only addresses postvention needs but aligns with suicide prevention.

Quantifying acceptable artefact ranges for dermatologic classification algorithms

Background

Many classifiers have been developed that can distinguish different types of skin lesions (e.g., benign nevi, melanoma) with varying degrees of success.^1–5 However, even successfully trained classifiers may perform poorly on images that include artefacts. While problems created by hair and ink markings have been published, quantitative measurements of blur, colour and lighting variations on classification accuracy has not yet been reported to our knowledge.

Objectives

We created a system that measures the impact of various artefacts on machine learning accuracy. Our objectives were to (1) quantitatively identify the most egregious artefacts and (2) demonstrate how to assess a classification algorithm's accuracy when input images include artefacts.

Methods

We injected artefacts into dermatologic images using techniques that could be controlled with a single variable. This allows us to quantitatively evaluate the impact on the accuracy. We trained two convolutional neural networks on two different binary classification tasks and measured the impact on dermoscopy images over a range of parameter values. The area under the curve and specificity‐at‐a‐given‐sensitivity values were measured for each artefact induced at each parameter.

Results

General blur had the strongest negative effect on the melanoma versus other task. Conversely, shifting the hue towards blue had a more pronounced effect on the suspicious versus follow task.

Conclusions

Classifiers should either mitigate artefacts or detect them. Images should be excluded from diagnosis/recommendation when artefacts are present in amounts outside the machine perceived quality range. Failure to do so will reduce accuracy and impede approval from regulatory agencies.

Event-related brain potentials during the visuomotor mental rotation task: The contingent negative variation scales to angle of rotation

Perceptual judgments about the angular disparity of a character from its standard upright (i.e., mental rotation task) result in a concurrent increase in reaction time (RT) and modulation of the amplitude of the P300 event-related brain potential (ERP). It has therefore been proposed that the P300 represents the neural processes associated with a visual rotation. In turn, the visuomotor mental rotation (VMR) task requires reaching to a location that deviates from a target by a predetermined angle. Although the VMR task exhibits a linear increase in RT with increasing oblique angles of rotation, work has not examined whether the task is supported via a visual rotation analogous to its mental rotation task counterpart. This represents a notable issue because seminal work involving non-human primates has ascribed VMR performance to the motor-related rotation of directionally tuned neurons in the primary motor cortex. Here we examined the concurrent behavioral and ERP characteristics of a standard reaching task and VMR tasks of 35°, 70°, and 105° of rotation. Results showed that the P300 amplitude was larger for the standard compared to each VMR task--an effect independent of the angle of rotation. In turn, the amplitude of the contingent negative variation (CNV)--an ERP related to cognitive and visuomotor integration for movement preparation--was systematically modulated with angle of rotation. Thus, we propose that the CNV represents an ERP correlate related to the cognitive and/or visuomotor transformation demands of increasing the angular separation between a stimulus and a movement goal.

Nurse-led clinic: effective and efficient delivery of assessment and review of patients with hepatitis B and C

BACKGROUND

Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for healthcare. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the healthcare system.

AIM

The aim of this study is to assess quantitatively the first 2 years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic.

METHODS

Data were extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly 1-month periods were recorded over 2 years. Patients were categorised according to the path through which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of 'did-not-attend' occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times.

RESULTS

There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified, including effective triage of patients and organisation of appropriate investigations from the initial nurse assessment.

Time Course Analysis of Closed- and Open-Loop Grasping of the Müller-Lyer Illusion

The authors investigated whether the early or later stages of closed-loop (CL) and open-loop (OL) grasping movements were differentially influenced by the Müller-Lyer (ML) illusion. Participants (N = 21) reached out and grasped small (5 cm) and large (7 cm) objects embedded within fins-in and fins-out ML configurations. Grasping time (GT) was normalized, and absolute grip aperture (GA) as well as scaled illusion effects were computed at 20%, 40%, 60%, and 80% of GT. The results indicated that CL trials were refractory to the illusory array (i.e., from 20% to 80% of GT), whereas OL trials were influenced by the ML figure during that same time. Those findings suggest that CL trials were supported by unitary and metrical visual information, whereas OL trials were entirely supported by perception-based visual information.

Online corrections can produce illusory bias during closed-loop pointing

This experiment examined whether the impact of pictorial illusions during the execution of goal-directed reaching movements is attributable to ocular motor signaling. We analyzed eye and hand movements directed toward both the vertex of the Müller-Lyer (ML) figure in a closed-loop procedure. Participants pointed to the right vertex of a visual stimulus in two conditions: a control condition wherein the figure (in-ML, neutral, out-ML) presented at response planning remained unchanged throughout the movement, and an experimental condition wherein a neutral figure presented at response planning was perturbed to an illusory figure (in-ML, out-ML) at movement onset. Consistent with previous work from our group (Heath et al. in Exp Brain Res 158:378-384, 2004; Heath et al. in J Mot Behav 37:179-185, 2005b), action-bias present in both conditions; thus illusory bias was introduced into during online control. Although primary saccades were influenced by illusory configurations (control conditions; see Binsted and Elliott in Hum Mov Sci 18:103-117, 1999a), illusory bias developed within the secondary "corrective" saccades during experimental trials (i.e., following a veridical primary saccade). These results support the position that a unitary spatial representation underlies both action and perception and this representation is common to both the manual and oculomotor systems.

Interhemispheric transmission time in persons with Down syndrome

BACKGROUND

The study of cerebral specialization in persons with Down syndrome (DS) has revealed an anomalous pattern of organization. Specifically, persons with DS elicit a right cerebral hemisphere lateralization for receptive language and a left cerebral hemisphere lateralization for the production of simple and complex movements: a pattern quite different from the left hemisphere lateralization typically characterizing the aforementioned processes in the non-DS population. It is thought that the putative separation between speech perception and movement planning systems as well as the cost of interhemispheric integration impedes verbal-motor behaviours in persons with DS. Moreover, morphological anomalies of callosal structure may further amplify between-hemisphere communication difficulties in the DS population. In the present investigation, we employed a behavioural technique (i.e. the Poffenberger paradigm; Poffenberger) to determine whether global anomalies of callosal structure further amplify deficits in interhemispheric communication.

METHODS

Fourteen individuals with DS and 25 chronological age-matched and gender-equated participants without intellectual disability performed a visuomotor reaction time (RT) test with their left or right hand to visual stimuli appearing left or right of visual fixation. Typically it is reported that responses to visual stimuli appearing ipsilateral to the responding hand (i.e. the uncrossed condition) are faster than responses wherein visual stimuli and responding hand are contralaterally mapped (i.e. the crossed condition). The increased RT associated with the crossed condition is reported on the order of 4 ms and has been interpreted to reflect the physiological result of interhemispheric transmission.

RESULTS

Not surprisingly persons with DS exhibited slower and more variable RTs relative to control counterparts. In addition, a reliable RT advantage favouring the uncrossed conditions was observed among control participants but not persons with DS.

CONCLUSIONS

In keeping with the extant literature, RT performance of the DS group was slower and more variable than control counterparts. This finding has been interpreted to reflect an 'adaptive reaction' wherein the perceptual-motor abilities of persons with DS are not optimized to respond to externally paced stimuli. In terms of evaluating interhemispheric transmission via the Poffenberger paradigm, our results show the finite measures of explicit brain-behaviour relations characterizing so-called healthy controls are not always tenable in the DS population. Indeed, we believe such a finding underpins the aforementioned 'adaptive reaction' exemplifying preferred movement control in persons with DS.

Slimline vs. glass pH electrodes: what degree of accuracy should we expect?

BACKGROUND

Ambulatory pH monitoring is considered the gold standard for measuring oesophageal acid exposure, however, data comparing antimony and glass electrodes are limited.

AIM

To compare the accuracy of the Slimline antimony pH monitoring system and a conventional glass electrode catheter pH monitoring system during ambulatory conditions.

METHODS

Eighteen subjects (13 males, 23-45 years) underwent simultaneous pH monitoring using the Slimline antimony pH electrode and MIC M3 glass pH electrode pH monitoring systems for 12 h. Acid exposure was analysed and compared by manual extraction of the data onto an excel spreadsheet.

RESULTS

There was no statistical difference in the median per cent time the pH was <4 recorded by the two systems (Slimline, 3%, Glass MIC M3, 2%, P = 0.77) and the correlation was excellent (r = 0.84). The difference in recorded reflux events was also not significantly different between the two systems, with the absolute difference being 23 events (s.d., 26). Point-by-point discrepancy was 28% (s.d., 18%), however, the agreement in terms of reflex events was excellent (Kappa value, 0.89, s.d., 0.09).

CONCLUSION

Despite substantial point-by-point disagreement, the antimony Slimline pH catheter compares favourably to the Glass MIC M3 pH catheter in terms of measuring standard pH parameters.

The influence of letrozole on serum lipid concentrations in postmenopausal women with primary breast cancer who have completed 5 years of adjuvant tamoxifen (NCIC CTG MA.17L)

BACKGROUND

The purpose of this study was to evaluate changes in serum lipid parameters {cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides and lipoprotein(a) [Lp(a)]}, in postmenopausal women receiving letrozole or placebo after adjuvant tamoxifen for early stage breast cancer (NCIC CTG MA.17L).

PATIENTS AND METHODS

MA.17L is a substudy of MA.17, a randomized, double-blind, placebo-controlled trial of letrozole 2.5 mg taken daily for 5 years in postmenopausal women with primary breast cancer completing approximately 5 years of prior adjuvant tamoxifen. Patients consenting to participate in this companion study had blood drawn and lipid parameters (total cholesterol, HDL cholesterol, LDL cholesterol, Lp(a), triglycerides) evaluated at baseline, 6 months, 12 months and yearly thereafter until completion of protocol therapy. It was required that women be non-hyperlipidemic and not taking lipid-lowering drugs at time of entry on this trial.

RESULTS

Three hundred and forty seven women were enrolled in the study. The letrozole and the placebo groups demonstrated marginally significant differences in the percentage change from baseline in HDL cholesterol at 6 months (P=0.049), in LDL cholesterol at 12 months (P=0.033) and triglycerides at 24 months (P=0.036). All comparisons of lipid parameters at other time points were not significantly different between the two treatment groups. No statistically significant differences in the number of patients exceeding the thresholds defined for the lipid parameters were found between the two treatment groups.

CONCLUSIONS

The MA.17 trial demonstrated a significant improvement in disease-free survival with the use of letrozole as extended adjuvant therapy post tamoxifen. Results from this study suggests that letrozole does not significantly alter serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides or Lp(a) in non-hyperlidiemic postmenopausal women with primary breast cancer treated up to 36 months following at least 5 years of adjuvant tamoxifen therapy. These findings further support the tolerability of extended adjuvant letrozole in postmenopausal women following standard tamoxifen therapy.

Cacao domestication II: progenitor germplasm of the Trinitario cacao cultivar

Cacao (Theobroma cacao L.) has been cultivated in Central America since pre-Columbian times. The type of cacao cultivated in this region was called Criollo; cacao populations from the Amazon basin were called Forastero. The type of Forastero most commonly cultivated until 1950 was named Amelonado. Historical data show Trinitario cacao to have originated in Trinidad, resulting from natural hybridisation between Criollo and Amelonado Forastero. Doubts persist on the source of the Amelonado Forastero involved in the origin of Trinitario; the Amelonado parent may have come from the Lower Amazon, the Orinoco or the Guyanas. Most of the cacao cultivated worldwide until 1950 consisted of Criollo, Trinitario and Amelonado. From the early 1950s, Forastero material collected in the Upper Amazon region during the 1930s and 1940s began to be employed in breeding programmes. To gain a better understanding of the origin and the genetic basis of the cacao cultivars exploited before the utilisation of germplasm collected in the Upper Amazon, a study was carried out using restriction fragment length polymorphism and microsatellite markers. Trinitario samples from 17 countries were analysed. With molecular markers, it was possible to clearly identify three main genotypes (represented by clones SP1, MAT1-6 and SIAL70) implicated in the origin of most Trinitario clones.