Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient

There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns

Interaction style of mothers of young children with Williams syndrome and relations with child expressive vocabulary.

Children of a given age vary widely in their expressive vocabulary abilities. One factor that is related to child expressive vocabulary ability is the style in which the mother interacts with her child. Studies that have considered this relation for either typically-developing (TD) children or children with developmental or intellectual disability (DD/ID) (e.g., autism spectrum disorder, fragile X syndrome) have shown that children whose mothers have a more sensitive/responsive interaction style have significantly larger expressive vocabularies than do children whose parents have a less sensitive/responsive style (e.g., Baker et al., 2010; Belsky et al., 2007; Brady et al., 2014; NICHD Early Child Care Research Network, 2003). In this dissertation, I provide the first examination of relations between child expressive vocabulary, child chronological age (CA), child nonverbal reasoning IQ, estimated annual family income, and maternal interaction style for young children with Williams syndrome (WS). The hypothesis of the study was that child expressive vocabulary ability relative to TD peers would be predicted by maternal interaction style beyond the effect of child nonverbal reasoning ability relative to TD peers. Participants were 75 children (35 girls, 40 boys) with classic WS deletions aged 4.01 – 8.39 years. Median estimated family income was $120,000 (IQR:$70,000 - $200,000). Children completed the Differential Ability Scales-II (DAS-II; mean Nonverbal Reasoning Cluster standard score (SS): 79.4, SD: 14.8) and the Expressive Vocabulary Test-2 (EVT-2; mean SS: 81.6, SD: 16.5). In addition, each mother-child dyad participated in a 30-minute play session with developmentally appropriate toys. Play sessions were videotaped. The mothers’ behavior during the play sessions was coded from the video-recordings using three scales from the NICHD Early Child Care Research Network: Supportive Presence, Respect for Child Autonomy, and Hostility (reversed). A 7-point Likert scale was used for each scale, with higher scores indicating more responsive maternal interaction. As in previous studies (e.g., Belsky et al., 2007; Downer & Pianta, 2006; NICHD Early Child Care Research Network, 2003), a composite of these ratings was used to evaluate maternal interaction style. The median maternal interaction style composite score was 16.0 (range: 10.5 – 21.0). To examine relations between child expressive vocabulary, child CA, child nonverbal reasoning SS, estimated annual family income, and maternal interaction style composite bivariate nonparametric correlations were computed. The maternal interaction style composite was moderately positively correlated with EVT-2 SS (rs = .42, p \u3c .001) and DAS-II Nonverbal Reasoning Cluster SS (rs = .42, p \u3c .001). EVT-2 SS was strongly positively correlated with DAS-II Nonverbal Reasoning Cluster SS (rs = .62, p\u3c .001). Estimated annual family income and child CA were not significantly correlated with any of the study variables (Mdn p-values = .849 and .382, respectively). To test the study hypothesis, sequential-model multiple regression analysis was performed. Model 1 was comprised of child CA, estimated annual family income, and DAS-II Nonverbal Reasoning Cluster SS. Maternal interaction style composite was added in Model 2. Model 2 provided a significantly better fit to the data than did Model 1, accounting for 43.4% of the variance in EVT-2 SS. Child CA and estimated family income were not significant predictors of child EVT-2 SS (ps\u3e .5). Maternal interaction style composite and DAS-II Nonverbal Reasoning Cluster SS were significant predictors of child EVT-2 SS (p = .02 and p \u3c .001, respectively). These results support the hypothesis that maternal interaction style significantly predicts child expressive vocabulary SS in children with Williams syndrome aged 4– 8 years even after taking into account the effects of nonverbal reasoning SS, estimated annual family income, and child CA. Implications for clinical interventions to facilitate more positive parent-child interactions are discussed

The relationship between alcohol purchasing, rurality, and poverty status in Zambia

The Zambian alcohol industry continues to facilitate increasing alcohol purchasing and consumption despite high rates of poverty. Data from the 2006 and 2015 Living Conditions Monitoring Surveys were analyzed to examine relationships between selfreported poverty status, alcohol purchasing, and alcohol expenditure stratified by rural-urban status. Across all poverty levels in 2006 and among the  moderately poor in 2015, rural households purchased alcohol at similar or greater levels compared to urban households. Overall alcohol purchasing decreased; however, significant differences in alcohol expenditure from 2006 to 2015 were observed among rural (p = 0.014) and urban (p = 0.009)  drinkers. Research is needed, to better understand driving factors for alcohol use and to provide targeted prevention and treatment programs in rural Zambia

Abnormal Speech Motor Control in Individuals with 16p11.2 Deletions.

Speech and motor deficits are highly prevalent (>70%) in individuals with the 600 kb BP4-BP5 16p11.2 deletion; however, the mechanisms that drive these deficits are unclear, limiting our ability to target interventions and advance treatment. This study examined fundamental aspects of speech motor control in participants with the 16p11.2 deletion. To assess capacity for control of voice, we examined how accurately and quickly subjects changed the pitch of their voice within a trial to correct for a transient perturbation of the pitch of their auditory feedback. When compared to controls, 16p11.2 deletion carriers show an over-exaggerated pitch compensation response to unpredictable mid-vocalization pitch perturbations. We also examined sensorimotor adaptation of speech by assessing how subjects learned to adapt their sustained productions of formants (speech spectral peak frequencies important for vowel identity), in response to consistent changes in their auditory feedback during vowel production. Deletion carriers show reduced sensorimotor adaptation to sustained vowel identity changes in auditory feedback. These results together suggest that 16p11.2 deletion carriers have fundamental impairments in the basic mechanisms of speech motor control and these impairments may partially explain the deficits in speech and language in these individuals

Needs of patients with parkinsonism and their caregivers:a protocol for the PRIME-UK cross-sectional study

INTRODUCTION: People with parkinsonism are a highly heterogeneous group and the disease encompasses a spectrum of motor and non-motor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. While parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe the broad range of health needs for people with parkinsonism and their carers in relation to their symptomatology, disability, disease stage, comorbidities and sociodemographic characteristics. METHODS AND ANALYSIS: In this single site cross-sectional study, people with parkinsonism will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support, if required, to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes. Results will be displayed as descriptive statistics and regression models will be used to test simple associations and interactions. ETHICS AND DISSEMINATION: This protocol was approved by the London—Brighton & Sussex Research Ethics Committee (REC reference 20/LO/0890). The results of this protocol will be disseminated through publication in an international peer-reviewed journal; presentation at academic meetings and conferences; and a lay summary uploaded to the PRIME-Parkinson website. TRIAL REGISTRATION NUMBER: ISRCTN11452969; Pre-results

The Challenges of Conducting Qualitative Research on "couples" in Abusive Intimate Partner Relationships Involving Substance Use

Undertaking qualitative dyad or couple interviews involving intimate partner abuse and substance use presents considerable ethical, safeguarding, and theoretical challenges throughout the research process from recruitment to conducting interviews and analysis. These challenges and how they were managed are outlined using the experience from a qualitative study of 14 heterosexual “couples” that explored the complex interplay between intimate partner abuse and substance use. Managing these challenges for participants, their families, and researchers included the use of safeguarding protocols and procedures to manage risk and the provision of clinical support for experienced researchers. Researchers often felt drawn into the conflicts and complex dynamics of opposing accounts from the male and females’ relationship which could be emotionally and methodologically taxing. Researchers discussing their analysis and felt experiences with each other provided a reflexive space to manage emotions and stay close to the theoretical underpinnings

Determining the Efficacy of Interventions to Reduce Intimate Partner Violence (IPV) Perpetration by Men who Use Substances: a Systematic Review and Meta-analysis

A summary of key features from a systematic review protocol registered in PROSPERO International prospective register of systematic reviews