A systematic evaluation of the psychological and behavioural effects of the combined consumption of glucose and caffeine and comparison to the effects produced by consuming either substance in isolation

Extensive research has found glucose and caffeine to have beneficial effects on cognition and mood. Broadly, glucose has been found to improve memory and caffeine to improve attention and alertness. Relatively little research has investigated the effects of their combined consumption, although to date, similar effects on cognitive performance and mood have been found. The aim of this thesis was to systematically evaluate the behavioural effects of combined consumption of these substances and compare them with the effects of consuming either substance in isolation. Moderating factors, such as cognitive effort, were considered along with the evaluation of neural and neuroendocrine responses. The first study (chapter 2) found evidence of beneficial effects of caffeine, glucose and their combination on memory and mood, with individual effects varying across doses. However, concurrent measurement of the neuroendocrine response found no effects (chapter 3). Investigation into pre-retrieval administration of the substances memory performance (chapter 4) found no effects of any substance, in contrast to the beneficial effects found for pre-learning administration. A parallel assessment of glucose and caffeine on different attentional networks and systems (chapter 5) failed to find any effects on this aspect of cognitive performance. In chapter 6 the effects of the substances on participants who were in a sub-optimal state were examined. The findings were not able to show that effects of the substances can be more clearly elucidated when participants are not performing optimally. The final experimental study (chapter 7) investigated the effects of caffeine and glucose on neurocognitive processes, but no beneficial effects were found. Overall, the findings suggest that the effects of caffeine, glucose and their combination are modulated by dose and domain

Current methods of evaluating speech-language outcomes for preschoolers with communication disorders: A scoping review using the ICF-CY

Purpose: The purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health – Children and Youth (ICF-CY) (World Health Organization, 2007). Method: The review included five phases outlined by Arksey and O’Malley (2005) and further developed by Levac et al. 2010: (a) articulating the research question, (b) identifying relevant studies, (c) study selection, (d) charting the data, and (e) collating, summarizing and reporting the results. The WHO ICF-CY was used to frame the measures included. Results: A total of 214 relevant peer-reviewed publications were included in the review. Most publications used measures to evaluate changes in outcomes for Activities (65%), followed by measures evaluating changes in Body Functions (20%), and finally measures evaluating changes at the level of Participation (15%). There has been a slight increase in the evaluation of Participation-level outcomes in the past four years (2012-2015). Conclusion: The review revealed a dearth of measures in the pediatric speech-language literature that address Participation-level outcomes. The authors strongly advocate for use of Participation-level outcome measures to detect meaningful change in the lives of children and families

Operationalizing marketable blue carbon

The global carbon sequestration and avoided emissions potentially achieved via blue carbon is high (∼3% of annual global greenhouse gas emissions); however, it is limited by multidisciplinary and interacting uncertainties spanning the social, governance, financial, and technological dimensions. We compiled a transdisciplinary team of experts to elucidate these challenges and identify a way forward. Key actions to enhance blue carbon as a natural climate solution include improving policy and legal arrangements to ensure equitable sharing of benefits; improving stewardship by incorporating indigenous knowledge and values; clarifying property rights; improving financial approaches and accounting tools to incorporate co-benefits; developing technological solutions for measuring blue carbon sequestration at low cost; and resolving knowledge gaps regarding blue carbon cycles. Implementing these actions and operationalizing blue carbon will achieve measurable changes to atmospheric greenhouse gas concentrations, provide multiple co-benefits, and address national obligations associated with international agreements

Analysis of shared heritability in common disorders of the brain

ience, this issue p. eaap8757 Structured Abstract INTRODUCTION Brain disorders may exhibit shared symptoms and substantial epidemiological comorbidity, inciting debate about their etiologic overlap. However, detailed study of phenotypes with different ages of onset, severity, and presentation poses a considerable challenge. Recently developed heritability methods allow us to accurately measure correlation of genome-wide common variant risk between two phenotypes from pools of different individuals and assess how connected they, or at least their genetic risks, are on the genomic level. We used genome-wide association data for 265,218 patients and 784,643 control participants, as well as 17 phenotypes from a total of 1,191,588 individuals, to quantify the degree of overlap for genetic risk factors of 25 common brain disorders. RATIONALE Over the past century, the classification of brain disorders has evolved to reflect the medical and scientific communities' assessments of the presumed root causes of clinical phenomena such as behavioral change, loss of motor function, or alterations of consciousness. Directly observable phenomena (such as the presence of emboli, protein tangles, or unusual electrical activity patterns) generally define and separate neurological disorders from psychiatric disorders. Understanding the genetic underpinnings and categorical distinctions for brain disorders and related phenotypes may inform the search for their biological mechanisms. RESULTS Common variant risk for psychiatric disorders was shown to correlate significantly, especially among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia. By contrast, neurological disorders appear more distinct from one another and from the psychiatric disorders, except for migraine, which was significantly correlated to ADHD, MDD, and Tourette syndrome. We demonstrate that, in the general population, the personality trait neuroticism is significantly correlated with almost every psychiatric disorder and migraine. We also identify significant genetic sharing between disorders and early life cognitive measures (e.g., years of education and college attainment) in the general population, demonstrating positive correlation with several psychiatric disorders (e.g., anorexia nervosa and bipolar disorder) and negative correlation with several neurological phenotypes (e.g., Alzheimer's disease and ischemic stroke), even though the latter are considered to result from specific processes that occur later in life. Extensive simulations were also performed to inform how statistical power, diagnostic misclassification, and phenotypic heterogeneity influence genetic correlations. CONCLUSION The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level. This suggests a deeply interconnected nature for psychiatric disorders, in contrast to neurological disorders, and underscores the need to refine psychiatric diagnostics. Genetically informed analyses may provide important "scaffolding" to support such restructuring of psychiatric nosology, which likely requires incorporating many levels of information. By contrast, we find limited evidence for widespread common genetic risk sharing among neurological disorders or across neurological and psychiatric disorders. We show that both psychiatric and neurological disorders have robust correlations with cognitive and personality measures. Further study is needed to evaluate whether overlapping genetic contributions to psychiatric pathology may influence treatment choices. Ultimately, such developments may pave the way toward reduced heterogeneity and improved diagnosis and treatment of psychiatric disorders

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Glycaemic control and cognition:evidence across the lifespan

There has been increasing interest in the effects of nutrition on cognitive perfor- mance and more specifically how cognitive performance can be optimised using nutritional interventions. The macronutrient glucose has particularly received atten- tion and is perhaps most thoroughly researched in terms of its effects on cognition. The notion that oral glucose administration might facilitate mental performance was first proposed in the 1950s. Hafermann (1955) investigated the effects of glucose administration on school children and observed a distinct increase in cognitive per- formance, including performance in mathematics, and generally improved concen- tration. However, it was not until the mid-1980s that glucose effects on cognitive performance became more widely investigated (Gold, 1986). In this chapter the impact of glucose administration and glucose regulation on cognitive processes across the lifespan will be reviewed. We describe the ways by which glucose might facilitate cognitive performance and evaluate potential nutri- tional and lifestyle interventions that may be beneficial to optimising cognitive performance and/or prevent cognitive decline. We begin, however, by discussing some of the features of glucose metabolism that are important for the understanding of its role in cognitive performance