Executive function in first-episode schizophrenia

BACKGROUND: We tested the hypothesis that schizophrenia is primarily a frontostriatal disorder by examining executive function in first-episode patients. Previous studies have shown either equal decrements in many cognitive domains or specific deficits in memory. Such studies have grouped test results or have used few executive measures, thus, possibly losing information. We, therefore, measured a range of executive ability with tests known to be sensitive to frontal lobe function. METHODS: Thirty first-episode schizophrenic patients and 30 normal volunteers, matched for age and NART IQ, were tested on computerized test of planning, spatial working memory and attentional set shifting from the Cambridge Automated Neuropsychological Test Battery. Computerized and traditional tests of memory were also administered for comparison. RESULTS: Patients were worse on all tests but the profile was non-uniform. A componential analysis indicated that the patients were characterized by a poor ability to think ahead and organize responses but an intact ability to switch attention and inhibit prepotent responses. Patients also demonstrated poor memory, especially for free recall of a story and associate learning of unrelated word pairs. CONCLUSIONS: In contradistinction to previous studies, schizophrenic patients do have profound executive impairments at the beginning of the illness. However, these concern planning and strategy use rather than attentional set shifting, which is generally unimpaired. Previous findings in more chronic patients, of severe attentional set shifting impairment, suggest that executive cognitive deficits are progressive during the course of schizophrenia. The finding of severe mnemonic impairment at first episode suggests that cognitive deficits are not restricted to one cognitive domain

Susceptibility of Vitis vinifera 'Semillon' and 'Chardonnay' to the root-knot nematode Meloidogyne javanica

A study to assess the effect of the initial population (Pi) densities (0, 200, 400, 600 and 800 second stage juveniles (J2) kg-1 dry soil) of the root knot nematode, Meloidogyne javanica, on the growth, yield and juice characteristics of two white wine grapevine (Vitis vinifera) cvs. 'Semillon' and 'Chardonnay' was conducted in a vineyard located at the Centre for Irrigated Agriculture, Riverina, NSW, Australia. M. javanica J2 population densities in soil after harvest during 2004-2008 growing seasons increased gradually, year by year, and in most cases were higher where the initial densities were higher. Regression analysis revealed that yield, in general, was reduced significantly with the increase of the nematode population densities·kg-1 soil for both cultivars. After six years, the nematode population had increased by ca. 9.0-22.4 fold for 'Semillon' and 6.7-18.5 fold for 'Chardonnay'. All Pi densities significantly reduced Semillon yields in all years but only the highest level (800 J2·kg-1 dry soil) affected 'Chardonnay' yields. At the end of the experiment, M. javanica decreased yields by 15-20 % in Semillon but only 7-13 % in 'Chardonnay'. The nematode inoculation also caused a decrease in bunch numbers in 'Semillon' but not in 'Chardonnay'. This is the first study showing that 'Chardonnay' is less susceptible to M. javanica than 'Semillon'.

Ethical issues in implementation research: a discussion of the problems in achieving informed consent

Background: Improved quality of care is a policy objective of health care systems around the world. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice, and hence to reduce inappropriate care. It includes the study of influences on healthcare professionals' behaviour and methods to enable them to use research findings more effectively. Cluster randomized trials represent the optimal design for evaluating the effectiveness of implementation strategies. Various codes of medical ethics, such as the Nuremberg Code and the Declaration of Helsinki inform medical research, but their relevance to cluster randomised trials in implementation research is unclear. This paper discusses the applicability of various ethical codes to obtaining consent in cluster trials in implementation research. Discussion: The appropriate application of biomedical codes to implementation research is not obvious. Discussion of the nature and practice of informed consent in implementation research cluster trials must consider the levels at which consent can be sought, and for what purpose it can be sought. The level at which an intervention is delivered can render the idea of patient level consent meaningless. Careful consideration of the ownership of information, and rights of access to and exploitation of data is required. For health care professionals and organizations, there is a balance between clinical freedom and responsibility to participate in research. Summary: While ethical justification for clinical trials relies heavily on individual consent, for implementation research aspects of distributive justice, economics, and political philosophy underlie the debate. Societies may need to trade off decisions on the choice between individualized consent and valid implementation research. We suggest that social sciences codes could usefully inform the consideration of implementation research by members of Research Ethics Committees

The paradox of tenant empowerment: regulatory and liberatory possibilities

Tenant empowerment has traditionally been regarded as a means of realising democratic ideals: a quantitative increase in influence and control, which thereby enables "subjects" to acquire the fundamental properties of "citizens". By contrast governmentality, as derived from the work of Michel Foucault, offers a more critical appraisal of the concept of empowerment by highlighting how it is itself a mode of subjection and a means of regulating human conduct towards particular ends. Drawing on particular data about how housing governance has changed in Glasgow following its 2003 stock transfer, this paper adopts the insights of governmentality to illustrate how the political ambition of "community ownership" has been realized through the mobilization and shaping of active tenant involvement in the local decision making process. In addition, it also traces the tensions and conflict inherent in the reconfiguration of power relations post-transfer for "subjects" do not necessarily conform to the plans of those that seek to govern them

An Investigation of Stochastic Variance Reduction Algorithms for Relative Difference Penalized 3D PET Image Reconstruction

Penalised PET image reconstruction algorithms are often accelerated during early iterations with the use of subsets. However, these methods may exhibit limit cycle behaviour at later iterations due to variations between subsets. Desirable converged images can be achieved for a subclass of these algorithms via the implementation of a relaxed step size sequence, but the heuristic selection of parameters will impact the quality of the image sequence and algorithm convergence rates. In this work, we demonstrate the adaption and application of a class of stochastic variance reduction gradient algorithms for PET image reconstruction using the relative difference penalty and numerically compare convergence performance to BSREM. The two investigated algorithms are: SAGA and SVRG. These algorithms require the retention in memory of recently computed subset gradients, which are utilised in subsequent updates. We present several numerical studies based on Monte Carlo simulated data and a patient data set for fully 3D PET acquisitions. The impact of the number of subsets, different preconditioners and step size methods on the convergence of regions of interest values within the reconstructed images is explored. We observe that when using constant preconditioning, SAGA and SVRG demonstrate reduced variations in voxel values between subsequent updates and are less reliant on step size hyper-parameter selection than BSREM reconstructions. Furthermore, SAGA and SVRG can converge significantly faster to the penalised maximum likelihood solution than BSREM, particularly in low count data

Performance evaluation of MAP algorithms with different penalties, object geometries and noise levels

A new algorithm (LBFGS-B-PC) which combines ideas of two existing convergent reconstruction algorithms, relaxed separable paraboloidal surrogate (SPS) and limited-memory Broyden-Fletcher-Goldfarb-Shanno with boundary constraints (LBFGS-B), is proposed. Its performance is evaluated in terms of log-posterior value and regional recovery ratio. The results demonstrate the superior convergence speed of the proposed algorithm to relaxed SPS and LBFGS-B, regardless of the noise level, activity distribution, object geometry, and penalties

Improving escalation of deteriorating patients through cognitive task analysis: Understanding differences between work-as-prescribed and work-as-done

AbstractBackgroundAppropriate care escalation requires the detection and communication of in-hospital patient deterioration. Although deterioration in the ward environment is common, there continue to be patient deaths where problems escalating care have occurred. Learning from the everyday work of health care professionals (work-as-done) and identifying performance variability may provide a greater understanding of the escalation challenges and how they overcome these. The aims of this study were to i) develop a representative model detailing escalation of care ii) identify performance variability that may negatively or positively affect this process and iii) examine linkages between steps in the escalation process.MethodsThirty Applied Cognitive Task Analysis interviews were conducted with clinical experts (> 4 years' experience) including Ward Nurses (n = 7), Outreach or Sepsis Nurses (n = 8), Nurse Manager or Consultant (n = 6), Physiotherapists (n = 4), Advanced Practitioners (n = 4), and Doctor (n = 1) from two National Health Service hospitals and analysed using Framework Analysis. Task-related elements of care escalation were identified and represented in a Functional Resonance Analysis Model.FindingsThe NEWS2's clinical escalation response constitutes eight unique tasks and illustrates work-as-prescribed, but our interview data uncovered an additional 24 tasks (n = 32) pertaining to clinical judgement, decisions or processes reflecting work-as-done. Over a quarter of these tasks (9/32, 28 %) were identified by experts as cognitively challenging with a high likelihood of performance variability. Three out of the nine variable tasks were closely coupled and interdependent within the Functional Resonance Analysis Model (‘synthesising data points’, ‘making critical decision to escalate’ and ‘identifying interim actions’) so representing points of potential escalation failure. Data assimilation from different clinical information systems with poor usability was identified as a key cognitive challenge.ConclusionOur data support the emphasis on the need to retain clinical judgement and suggest that future escalation protocols and audit guidance require in-built flexibility, supporting staff to incorporate their expertise of the patient condition and the clinical environment. Improved information systems to synthesise the required data surrounding an unwell patient to reduce staff cognitive load, facilitate decision-making, support the referral process and identify actions are required. Fundamentally, reducing the cognitive load when assimilating core escalation data allows staff to provide better and more creative care.Study registration (ISRCTN 38850) and ethical approval (REC Ref 20/HRA/3828; CAG-20CAG0106)

The antisaccade task as an index of sustained goal activation in working memory: modulation by nicotine

The antisaccade task provides a laboratory analogue of situations in which execution of the correct behavioural response requires the suppression of a more prepotent or habitual response. Errors (failures to inhibit a reflexive prosaccade towards a sudden onset target) are significantly increased in patients with damage to the dorsolateral prefrontal cortex and patients with schizophrenia. Recent models of antisaccade performance suggest that errors are more likely to occur when the intention to initiate an antisaccade is insufficiently activated within working memory. Nicotine has been shown to enhance specific working memory processes in healthy adults. MATERIALS AND METHODS: We explored the effect of nicotine on antisaccade performance in a large sample (N = 44) of young adult smokers. Minimally abstinent participants attended two test sessions and were asked to smoke one of their own cigarettes between baseline and retest during one session only. RESULTS AND CONCLUSION: Nicotine reduced antisaccade errors and correct antisaccade latencies if delivered before optimum performance levels are achieved, suggesting that nicotine supports the activation of intentions in working memory during task performance. The implications of this research for current theoretical accounts of antisaccade performance, and for interpreting the increased rate of antisaccade errors found in some psychiatric patient groups are discussed