Stimulation of the Prefrontal Cortex Reduces Intentions to Commit Aggression: A Randomized, Double-Blind, Placebo-Controlled, Stratified, Parallel-Group Trial

Although prefrontal brain impairments are one of the best-replicated brain imaging findings in relation to aggression, little is known about the causal role of this brain region. This study tests whether stimulating the dorsolateral prefrontal cortex using transcranial direct current stimulation (tDCS) reduces the likelihood of engaging in aggressive acts, and the mechanism underlying this relationship. In a double-blind, stratified, placebo-controlled, parallel-group, randomized trial, 81 human adults (36 males, 45 females) were randomly assigned to an active (N = 39) or placebo (N = 42) condition, and then followed up 1 d after the experiment session. Intentions to commit aggressive acts and behavioral aggression were assessed using hypothetical vignettes and a behavioral task, respectively. The secondary outcome was the perception of the moral wrongfulness of the aggressive acts. Compared with the sham controls, participants who received anodal stimulation reported being less likely to commit physical and sexual assault (p \u3c 0.01). They also judged aggressive acts as more morally wrong (p \u3c 0.05). Perceptions of greater moral wrongfulness regarding the aggressive acts accounted for 31% of the total effect of tDCS on intentions to commit aggression. Results provide experimental evidence that increasing activity in the prefrontal cortex can reduce intentions to commit aggression and enhance perceptions of the moral wrongfulness of the aggressive acts. Findings shed light on the biological underpinnings of aggression and theoretically have the potential to inform future interventions for aggression and violence

The Application of Accounting Concepts Through Case Studies

My thesis addresses several important concepts of accounting principles. These concepts are explored through twelve different case studies that each help address a specific topic. The topics cover the treatment of items such as accounts receivables, property, plant, and equipment, long-term debt, shareholder’s equity, marketable securities, deferred income taxes, and revenue recognition rules. The methods used to complete these cases was to take the information I learned in class as well as reference my textbooks. It helped me to understand what the questions were asking and therefore the corresponding solutions. For each case, I had to search through each company’s financial statements to discover the significances of what was being reported. An important aspect of combing through the financial statements was to carefully read the notes to the financial statements. The notes held the most crucial information to answer the questions presented in the cases. Working through all of these cases taught me real-world uses of the information I was learning in all of my accounting classes. These practical applications were helpful because it taught me further how to take the information and apply it to the questions being asked. This thesis is set to explore several highly important and relative accounting concepts that benefited me greatly in my education and my real-life experiences as an intern in the tax practice of public accounting.

Sporadic cerebral small vessel disease and cognitive abilities

Cerebral small vessel disease (SVD) is a leading cause of vascular cognitive impairment, contributing to multiple neurological disorders ranging from stroke, to mild cognitive impairment and dementia. However, despite a huge number of studies on the subject, we have a limited understanding of how SVD affects cognitive ability. This thesis aims to address this knowledge gap, by examining domain-specific cognitive abilities in a range of clinical and non-clinical presentations of SVD. In the introductory chapters of this thesis I will discuss what is meant by the term cerebral small vessel disease (SVD), describing key radiological features of SVD and its varied clinical and non-clinical presentations. However, before considering the current consensus on how SVD impacts different domains of cognitive ability, I will first consider what happens to these abilities in the context healthy cognitive ageing. Finally, I will consider the current consensus on the pattern of cognitive changes that occur in SVD and will examine the vast and often conflicting evidence that underpins this. To gain a comprehensive overview of the published literature examining cognitive abilities in SVD, Chapter 4 presents a systematic review and meta-analysis of 69 studies presenting cognitive data for at least one cohort with SVD (n=3679) and one comparison control group without SVD (n=3229). Results indicated that relative to controls, cohorts with SVD performed more poorly on cognitive tests in all of the cognitive domains examined. Meta-regression analyses suggested that fewer years of education in the SVD vs. control groups accounted for a proportion of the differences in their test scores in some cognitive domains. Further meta-regression analyses suggested that cohorts with SVD-related cognitive impairment or dementia performed more poorly on tests in certain cognitive domains than cohorts with stroke or non-clinical presentations of SVD. Overall, however, SVD cohorts performed more poorly than controls on cognitive tests in all domains, regardless of their SVD presentation. Chapters 5 and 6 focus more closely on the key radiological markers of SVD and their associations with cognitive test scores using data from the Lothian Birth Cohort 1936 (LBC1936): a cohort of relatively healthy, community-dwelling, older individuals. To increase the fidelity with which SVD is typically measured, I combined computational volumes and visually-rated MRI markers of SVD to construct a variable representing the total MRI-visible burden of SVD. The study in Chapter 5 presents the results of cross-sectional associations between this latent SVD variable and latent variables of processing speed, verbal memory and visuospatial ability, within a structural equation modelling framework (SEM; n=540; mean age 72.6±0.7 years). Age, sex, vascular risk, depression status, and age-11 IQ were included as covariates. The latent SVD variable was negatively associated with all cognitive factors, in line with the results of the systematic review and meta-analysis. However, after accounting for the shared variance between the different cognitive domains (a construct described as general cognitive ability, which previous studies have not accounted for), only the association between the latent SVD variable and processing speed remained significant. This suggests that SVD’s association with slowed processing speed is not driven by, but is independent of its association with poorer general cognitive ability. In Chapter 6 this work is developed further by exploring associations between the latent SVD variable and decline in the same latent cognitive factors over a period of 9 years, from the age of around 73 to 82, again in the LBC1936. This was carried out using latent growth curve modelling within a SEM framework. Age, sex, vascular risk, and age-11 IQ were included as covariates. Results indicated that the latent SVD variable was associated with greater decline in general cognitive ability and processing speed. However, after accounting for the covariance between tests of processing speed and general cognitive ability, only the association between greater SVD burden and decline in general cognitive ability remained significant. Whereas the results of Chapter 5 suggested that SVD burden at age 73 may have specific and independent effects on processing speed measured at the same age, the results of our longitudinal analyses suggest that SVD burden at age 73 associates with declining processing speed due to SVD’s overarching association with general cognitive decline. In the final chapter of this thesis, I summarise the findings of these three studies, discuss their limitations, and make recommendations for future research

Proxy rated quality of life of care home residents with dementia: a systematic review

Quality of life (QoL) is an important outcome for people with dementia living in care homes but usually needs to be rated by a proxy. We do not know if relative or paid carer proxy reports differ. We conducted the first systematic review and meta-analysis of data investigating whether and how these proxy reports of QoL differ. We searched four databases: Medline, Embase, PsychInfo, and CINAHL in October 2015 with the terms: dementia, QoL, proxy, and care home. Included studies either compared proxy QoL ratings or investigated the factors associated with them. We meta-analyzed data comparing staff and family proxy rated QoL. We included 17/105 papers identified. We found no difference between global proxy ratings of QoL (n = 1,290; pooled effect size 0.06 (95% CI = −0.08 to 0.19)). Studies investigating factors associated with ratings (n = 3,537) found family and staff ratings correlated with the resident's physical and mental health. Staff who were more distressed rated resident QoL lower. Relatives rated it lower when the resident had lived in the care home for longer, when they observed more restraint, or contributed more to fees. Relatives and staff proxy QoL ratings share a clear relationship to resident health and overall ratings were similar. Rater-specific factors were, however, also associated with scores. Understanding why different raters consider the QoL of the same person differently is an important consideration when evaluating the meaning of proxy rated QoL. Proxy raters’ backgrounds may affect their rating of QoL

Cognitive impairment in sporadic cerebral small vessel disease:A systematic review and meta-analysis

This paper is a proposal for an update on the characterization of cognitive impairments associated with sporadic cerebral small vessel disease (SVD). We pose a series of questions about the nature of SVD-related cognitive impairments and provide answers based on a comprehensive review and meta-analysis of published data from 69 studies. Although SVD is thought primarily to affect executive function and processing speed, we hypothesize that SVD affects all major domains of cognitive ability. We also identify low levels of education as a potentially modifiable risk factor for SVD-related cognitive impairment. Therefore, we propose the use of comprehensive cognitive assessments and the measurement of educational level both in clinics and research settings, and suggest several recommendations for future research

Sex Differences in Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

Background: Cerebral small vessel disease (SVD) is a common cause of stroke, mild cognitive impairment, dementia and physical impairments. Differences in SVD incidence or severity between males and females are unknown. We assessed sex differences in SVD by assessing the male-to-female ratio (M:F) of recruited participants and incidence of SVD, risk factor presence, distribution, and severity of SVD features. Methods: We assessed four recent systematic reviews on SVD and performed a supplementary search of MEDLINE to identify studies reporting M:F ratio in covert, stroke, or cognitive SVD presentations (registered protocol: CRD42020193995). We meta-analyzed differences in sex ratios across time, countries, SVD severity and presentations, age and risk factors for SVD. Results: Amongst 123 relevant studies (n = 36,910 participants) including 53 community-based, 67 hospital-based and three mixed studies published between 1989 and 2020, more males were recruited in hospital-based than in community-based studies [M:F = 1.16 (0.70) vs. M:F = 0.79 (0.35), respectively; p < 0.001]. More males had moderate to severe SVD [M:F = 1.08 (0.81) vs. M:F = 0.82 (0.47) in healthy to mild SVD; p < 0.001], and stroke presentations where M:F was 1.67 (0.53). M:F did not differ for recent (2015–2020) vs. pre-2015 publications, by geographical region, or age. There were insufficient sex-stratified data to explore M:F and risk factors for SVD. Conclusions: Our results highlight differences in male-to-female ratios in SVD severity and amongst those presenting with stroke that have important clinical and translational implications. Future SVD research should report participant demographics, risk factors and outcomes separately for males and females. Systematic Review Registration: [PROSPERO], identifier [CRD42020193995]

How do care home staff understand, manage and respond to agitation in people with dementia? A qualitative study

Objectives: Little is known about how care home staff understand and respond to distress in residents living with dementia labelled as agitation. The aim of this study was to describe how care home staff understand and respond to agitation and the factors that determine how it is managed. Design: We conducted a qualitative thematic analysis. Setting: We recruited staff from six care homes in South East England including residential and nursing homes of differing sizes run by both the private and charity sector and located in urban and rural areas. Participants: We interviewed 25 care home staff using purposive sampling to include staff of either sex, differing age, ethnicity, nationality and with different roles and experience. Results: We identified four overarching themes: (1) behaviours expressing unmet need; (2) staff emotional responses to agitation; (3) understanding the individual helps and (4) constraints on staff responses. Staff struggled with the paradox of trying to connect with the personhood of residents while seeing the person as separate to and, therefore, not responsible for their behaviours. Staff often felt powerless, frightened and overwhelmed, and their responses were constrained by care home structures, processes and a culture of fear and scrutiny. Conclusions: Responding to agitation expressed by residents was not a linear process and staff faced tensions and dilemmas in deciding how to respond, especially when initial strategies were unsuccessful or when attempts to respond to residents’ needs were inhibited by structural and procedural constraints in the care home. Future trials of psychosocial interventions should support staff to identify and respond to residents’ unmet needs and include how staff can look after themselves

Translational neuroscience: the state of the nation (a PhD student perspective)

Many brain disorders are currently untreatable. It has been suggested that taking a ‘translational’ approach to neuroscientific research might change this. We discuss what ‘translational neuroscience’ is and argue for the need to expand the traditional translational model if we are to make further advances in treating brain disorders

Carbon or cash: Evaluating the effectiveness of environmental and economic messages on attitudes about wind energy in the United States

Public support or opposition to the expansion of wind energy plays a key role in energy policy and the development of the industry. For more than 30 years, scholars have attempted to understand the nature of public opinion about wind energy. Unfortunately, the largely observational and correlational nature of the evidence limits the abilities of scholars to isolate the causal relationships that shape attitudes about wind energy. Recent summaries of the literature illustrate the need for experimental designs to improve our understanding of the public’s view on this growing technology. Using an original survey experiment with a national sample, we test the effectiveness of messages about the economic and environmental implications of the expansion of wind energy. Our results indicate that 1) the public is sensitive to messaging about both the environmental and economic effects of wind energy; 2) the messages have both a persuasive (changing the content of attitudes) and priming (changing the weight applied to existing attitudes) effect on the public; and 3) the environmental messages have a greater effect on public opinions of wind energy than economic messages. Those interested in promoting positive attitudes about alternative energy need to be aware of both the persuasive and priming influences in messages about wind energy

Cerebral Small Vessel Disease Burden and Longitudinal Cognitive Decline from age 73 to 82: the Lothian Birth Cohort 1936

Slowed processing speed is considered a hallmark feature of cognitive decline in cerebral small vessel disease (SVD); however, it is unclear whether SVD’s association with slowed processing might be due to its association with overall declining general cognitive ability. We quantified the total MRI-visible SVD burden of 540 members of the Lothian Birth Cohort 1936 (age: 72.6 ± 0.7 years; 47% female). Using latent growth curve modelling, we tested associations between total SVD burden at mean age 73 and changes in general cognitive ability, processing speed, verbal memory and visuospatial ability, measured at age 73, 76, 79 and 82. Covariates included age, sex, vascular risk and childhood cognitive ability. In the fully adjusted models, greater SVD burden was associated with greater declines in general cognitive ability (standardised β: −0.201; 95% CI: [−0.36, −0.04]; pFDR = 0.022) and processing speed (−0.222; [−0.40, −0.04]; pFDR = 0.022). SVD burden accounted for between 4 and 5% of variance in declines of general cognitive ability and processing speed. After accounting for the covariance between tests of processing speed and general cognitive ability, only SVD’s association with greater decline in general cognitive ability remained significant, prior to FDR correction (−0.222; [−0.39, −0.06]; p = 0.008; pFDR = 0.085). Our findings do not support the notion that SVD has a specific association with declining processing speed, independent of decline in general cognitive ability (which captures the variance shared across domains of cognitive ability). The association between SVD burden and declining general cognitive ability supports the notion of SVD as a diffuse, whole-brain disease and suggests that trials monitoring SVD-related cognitive changes should consider domain-specific changes in the context of overall, general cognitive decline