Psychopathology and Adaptive Functioning Across the Life Span: Top-down, bottom-up, multi-informant, and multi-cultural challenges and solutions

This keynote address will outline some important challenges for assessment of psychopathology and adaptive functioning from age 1 to 90+ years. It will then present practical ways to meet the challenges

Understanding the Mechanisms through Which an Influential Early Childhood Program Boosted Adult Outcomes

A growing literature establishes that high quality early childhood interventions targeted toward disadvantaged children have substantial impacts on later life outcomes. Little is known about the mechanisms producing these impacts. This paper uses longitudinal data on cognitive and personality skills from an experimental evaluation of the influential Perry Preschool program to analyze the channels through which the program boosted both male and female participant outcomes. Experimentally induced changes in personality skills explain a sizable portion of adult treatment effects

A study of genetic and environmental influences on maternal and paternal CBCL syndrome scores in a large sample of 3-year-old Dutch twins.

Background. There is increasing evidence that behavioral problems are common in very young children, yet little is known about the etiology of individual differences in these problems. It is unclear to what degree environmental and genetic factors influence the development of early child psychopathology. In this paper, we focus on the following issues. Firstly, to what degree do genetic and environmental factors influence variation in behavioral problems? Secondly, to what degree are these underlying etiological factors moderated by sex and informant? We investigate these issues by analyzing Child Behavior Checklist (CBCL) data on 9689 3-year-old twin pairs. Methods. Rater Bias and Psychometric Models were fitted to CBCL/2-3 data obtained from mothers and fathers to determine the genetic and environmental contributions to the five CBCL syndromes:aggressive, oppositional, overactive, withdrawn, and anxious/depressed behavior. Results. Parental ratings are influenced by aspects of the child's behavior that are experienced in the same way by both parents and by aspects of the child's behavior that are experienced uniquely by each parent. There is evidence for high genetic contributions to all CBCL syndromes. Shared and non-shared environmental influences play significant roles as well. One exception is overactive behavior, which is influenced by genetic and non-shared environmental influences only. Conclusions. Variation in behavior problems in the very young shows high heritability. Individual raters offer unique perspectives that can have an impact on estimates of problem behavior and genetic architecture. Therefore, multi-informant approaches in the assessment of the very young will be useful to clinicians and researchers alike

Predictors of early scaffold thrombosis: results from the multicenter prospective German-Austrian ABSORB RegIstRy

Background: In randomized clinical trials, the risk of thrombotic events with the absorb bioresorbable vascular scaffold (BVS) was significantly higher than with metallic drug-eluting stents. We evaluated predictors of scaffold thrombosis in the large-scale, multicenter German-Austrian ABSORB RegIstRy.Methods and Results: 3178 patients with treatment of 4252 lesions using 5020 scaffolds were included. Follow-up rate at 6 months was 97.4%. Forty-five (1.42%) patients experienced definite/probable scaffold thrombosis during follow-up. Multiple regression analysis showed implantation of absorb BVS in bifurcation lesions [odds ratio (OR): 4.43;95% confidence interval (CI): 1.69-11.59;P=0.0024] or treatment in the years 2013/2014 (OR: 1.88;95% CI: 1.02-3.47;P=0.04) to be significant predictors of scaffold thrombosis. Excluding bifurcation lesions, the incidence of definite/probable scaffold thrombosis decreased from 1.8% (95% CI: 1.17-2.64%) in 2013/2014 to 0.89% (95% CI: 0.5-1.46%) in 2015/2016. In the latter period, absorb BVS were implanted more often in younger patients with less complex de novo lesions, and debulking devices and postdilatation were used more frequently. Between the two treatment periods, there was a significant reduction in myocardial infarction (2.73-1.24%, P<0.01;OR: 0.45;95% CI: 0.26-0.77), definite/probable scaffold thrombosis (1.79-0.88%, P<0.05;OR: 0.49;95% CI: 0.26-0.93), and target lesion failure and revascularization during follow-up.Conclusion: Improved procedural technique and more strict patient selection may explain a significant decrease in the absorb BVS thrombosis rates during the recruitment period of the large-scale German-Austrian ABSORB RegIstRy. In addition, treatment of bifurcation lesions was identified as an independent predictor of definite/probable scaffold thrombosis

Cross-national comparison of the link between socioeconomic status and emotional and behavioral problems in youths

Introduction: In previous longitudinal studies in the US, lower socioeconomic status (SES) was associated with more emotional and behavioral problems. It remains unclear whether these findings can be generalized outside the US, as different countries vary in their health care systems and prevention of psychopathology in youth. Therefore, we studied the same associations in a comparable sample in The Netherlands and directly tested for differences between the US and The Netherlands. Methods: The US (N = 833) and Dutch (N = 708) population samples were followed-up for 9 years. Age at baseline ranged from 8 to 16 years. Parents filled out behavior checklists. Results: Analyses revealed very few differences between the two countries. In both countries, SES predicted syndrome scores and cumulative prevalence rates for internalizing and externalizing problems (withdrawn and aggressive behavior) and for thought and attention Problems. The SES gradient in syndrome scores was stable over time. Only for withdrawn behavior, the gradient was larger in young adulthood. Conclusion: Although the health care systems differ between the US and The Netherl

Standardized measurement of coronary inflammation using cardiovascular computed tomography: integration in clinical care as a prognostic medical device

Aims: Coronary computed tomography angiography (CCTA) is a first-line modality in the investigation of suspected coronary artery disease (CAD). Mapping of perivascular fat attenuation index (FAI) on routine CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which integrates standardized FAI mapping together with clinical risk factors and plaque metrics to provide individualized cardiovascular risk prediction. Methods and results: The study included 3912 consecutive patients undergoing CCTA as part of clinical care in the USA (n = 2040) and Europe (n = 1872). These cohorts were used to generate age-specific nomograms and percentile curves as reference maps for the standardized interpretation of FAI. The first output of CaRi-Heart® is the FAI-Score of each coronary artery, which provides a measure of coronary inflammation adjusted for technical, biological, and anatomical characteristics. FAI-Score is then incorporated into a risk prediction algorithm together with clinical risk factors and CCTA-derived coronary plaque metrics to generate the CaRi-Heart® Risk that predicts the likelihood of a fatal cardiac event at 8 years. CaRi-Heart® Risk was trained in the US population and its performance was validated externally in the European population. It improved risk discrimination over a clinical risk factor-based model [Δ(C-statistic) of 0.085, P = 0.01 in the US Cohort and 0.149, P < 0.001 in the European cohort] and had a consistent net clinical benefit on decision curve analysis above a baseline traditional risk factor-based model across the spectrum of cardiac risk. Conclusion: Mapping of perivascular FAI on CCTA enables the non-invasive detection of coronary artery inflammation by quantifying spatial changes in perivascular fat composition. We now report the performance of a new medical device, CaRi-Heart®, which allows standardized measurement of coronary inflammation by calculating the FAI-Score of each coronary artery. The CaRi-Heart® device provides a reliable prediction of the patient's absolute risk for a fatal cardiac event by incorporating traditional cardiovascular risk factors along with comprehensive CCTA coronary plaque and perivascular adipose tissue phenotyping. This integration advances the prognostic utility of CCTA for individual patients and paves the way for its use as a dual diagnostic and prognostic tool among patients referred for CCTA

Helicity-dependent cross sections and double-polarization observable E in η photoproduction from quasifree protons and neutrons

Precise helicity-dependent cross sections and the double-polarization observable E were measured for η photoproduction from quasifree protons and neutrons bound in the deuteron. The η → 2γ and η → 3π0 → 6γ decay modes were used to optimize the statistical quality of the data and to estimate systematic uncertainties. The measurement used the A2 detector setup at the tagged photon beam of the electron accelerator MAMI in Mainz. A longitudinally polarized deuterated butanol target was used in combination with a circularly polarized photon beam from bremsstrahlung of a longitudinally polarized electron beam. The reaction products were detected with the electromagnetic calorimeters Crystal Ball and TAPS, which covered 98% of the full solid angle. The results show that the narrow structure observed earlier in the unpolarized excitation function of η photoproduction off the neutron appears only in reactions with antiparallel photon and nucleon spin (σ1/2). It is absent for reactions with parallel spin orientation (σ3/2) and thus very probably related to partial waves with total spin 1/2. The behavior of the angular distributions of the helicity-dependent cross sections was analyzed by fitting them with Legendre polynomials. The results are in good agreement with a model from the Bonn-Gatchina group, which uses an interference of P11 and S11 partial waves to explain the narrow structure

International comparisons of behavioral and emotional problems in preschool children: parents’ reports from 24 societies

International comparisons were conducted of preschool children’s behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N¼19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes<1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies

The effects of crisis plans for patients with psychotic and bipolar disorders: A randomised controlled trial

Background: Crises and (involuntary) admissions have a strong impact on patients and their caregivers. In some countries, including the Netherlands, the number of crises and (involuntary) admissions have increased in the last years. There is also a lack of effective interventions to prevent their occurrence. Previous research has shown that a form of psychiatric advance statement - joint crisis plan - may prevent involuntary admissions, but another study showed no significant results for another form. The question remains which form of psychiatric advance statement may help to prevent crisis situations. This study examines the effects of two other psychiatric advance statements. The first is created by the patient with help from a patient's advocate (Patient Advocate Crisis Plan: PACP) and the second with the help of a clinician only (Clinician facilitated Crisis Plan: CCP). We investigate whether patients with a PACP or CCP show fewer emergency visits and (involuntary) admissions as compared to patients without a psychiatric advance statement. Furthermore, this study seeks to identify possible mechanisms responsible for the effects of a PACP or a CCP. Methods/Design: This study is a randomised controlled trial with two intervention groups and one control condition. Both interventions consist of a crisis plan, facilitated through the patient's advocate or the clinician respectively. Outpatients with psychotic or bipolar disorders, who experienced at least one psychiatric crisis during the previous two years, are randomly allocated to one of the three groups. Primary outcomes are the number of emergency (after hour) visits, (involuntary) admissions and the length of stay in hospital. Secondary outcomes include psychosocial fun