Disparity between General Symptom Relief and Remission Criteria in the Positive and Negative Syndrome Scale (PANSS): A Post-treatment Bifactor Item Response Theory Model.

Objective: Total scale scores derived by summing ratings from the 30-item PANSS are commonly used in clinical trial research to measure overall symptom severity, and percentage reductions in the total scores are sometimes used to document the efficacy of treatment. Acknowledging that some patients may have substantial changes in PANSS total scores but still be sufficiently symptomatic to warrant diagnosis, ratings on a subset of 8 items, referred to here as the "Remission set," are sometimes used to determine if patients' symptoms no longer satisfy diagnostic criteria. An unanswered question remains: is the goal of treatment better conceptualized as reduction in overall symptom severity, or reduction in symptoms below the threshold for diagnosis? We evaluated the psychometric properties of PANSS total scores, to assess whether having low symptom severity post-treatment is equivalent to attaining Remission. Design: We applied a bifactor item response theory (IRT) model to post-treatment PANSS ratings of 3,647 subjects diagnosed with schizophrenia assessed at the termination of 11 clinical trials. The bifactor model specified one general dimension to reflect overall symptom severity, and five domain-specific dimensions. We assessed how PANSS item discrimination and information parameters varied across the range of overall symptom severity (θ), with a special focus on low levels of symptoms (i.e., θ<-1), which we refer to as "Relief" from symptoms. A score of θ=-1 corresponds to an expected PANSS item score of 1.83, a rating between "Absent" and "Minimal" for a PANSS symptom. Results: The application of the bifactor IRT model revealed: (1) 88% of total score variation was attributable to variation in general symptom severity, and only 8% reflected secondary domain factors. This implies that a general factor may provide a good indicator of symptom severity, and that interpretation is not overly complicated by multidimensionality; (2) Post-treatment, 534 individuals (about 15% of the whole sample) scored in the "Relief" range of general symptom severity, but more than twice that number (n = 1351) satisfied Remission criteria (37%). 2 in 3 Remitted patients had scores that were not in a low symptom range (corresponding to Absent or Minimal item scores); (3) PANSS items vary greatly in their ability to measure the general symptom severity dimension; while many items are highly discriminating and relatively "pure" indicators of general symptom severity (delusions, conceptual disorganization), others are better indicators of specific dimensions (blunted affect, depression). The utility of a given PANSS item for assessing a patient depended on the illness level of the patient. Conclusion: Satisfying conventional Remission criteria was not strongly associated with low levels of symptoms. The items providing the most information for patients in the symptom Relief range were Delusions, Preoccupation, Suspiciousness Persecution, Unusual Thought Content, Conceptual Disorganization, Stereotyped Thinking, Active Social Avoidance, and Lack of Judgment and Insight. Lower scores on these items (item scores ≤2) were strongly associated with having a low latent trait θ or experiencing overall symptom relief. The inter-rater agreement between Remission and Relief subjects suggested that these criteria identified different subsets of patients. Alternative subsets of items may offer better indicators of general symptom severity and provide better discrimination (and lower standard errors) for scaling individuals and judging symptom relief, where the "best" subset of items ultimately depends on the illness range and treatment phase being evaluated

Double Doping of a Low-Ionization-Energy Polythiophene with a Molybdenum Dithiolene Complex

Doping of organic semiconductors is crucial for tuning the charge-carrier density of conjugated polymers. The exchange of more than one electron between a monomeric dopant and an organic semiconductor allows the polaron density to be increased relative to the number of counterions that are introduced into the host matrix. Here, a molybdenum dithiolene complex with a high electron affinity of 5.5 eV is shown to accept two electrons from a polythiophene that has a low ionization energy of 4.7 eV. Double p-doping is consistent with the ability of the monoanion salt of the molybdenum dithiolene complex to dope the polymer. The transfer of two electrons to the neutral dopant was also confirmed by electron paramagnetic resonance spectroscopy since the monoanion, but not the dianion, of the molybdenum dithiolene complex features an unpaired electron. Double doping allowed an ionization efficiency of 200% to be reached, which facilitates the design of strongly doped semiconductors while lessening any counterion-induced disruption of the nanostructure

Visualisation of individual dopants in a conjugated polymer: sub-nanometre 3D spatial distribution and correlation with electrical properties

While molecular doping is ubiquitous in all branches of organic electronics, little is known about the spatial distribution of dopants, especially at molecular length scales. Moreover, a homogeneous distribution is often assumed when simulating transport properties of these materials, even though the distribution is expected to be inhomogeneous. In this study, electron tomography is used to determine the position of individual molybdenum dithiolene complexes and their three-dimensional distribution in a semiconducting polymer at the sub-nanometre scale. A heterogeneous distribution is observed, the characteristics of which depend on the dopant concentration. At 5 mol% of the molybdenum dithiolene complex, the majority of the dopant species are present as isolated molecules or small clusters up to five molecules. At 20 mol% dopant concentration and higher, the dopant species form larger nanoclusters with elongated shapes. Even in case of these larger clusters, each individual dopant species is still in contact with the surrounding polymer. The electrical conductivity first strongly increases with dopant concentration and then slightly decreases for the most highly doped samples, even though no large aggregates can be observed. The decreased conductivity is instead attributed to the increased energetic disorder and lower probability of electron transfer that originates from the increased size and size variation in dopant clusters. This study highlights the importance of detailed information concerning the dopant spatial distribution at the sub-nanometre scale in three dimensions within the organic semiconductor host. The information acquired using electron tomography may facilitate more accurate simulations of charge transport in doped organic semiconductors

Understanding the association between negative symptoms and performance on effort-based decision-making tasks: The importance of defeatist performance beliefs

Effort-based decision-making paradigms are increasingly utilized to gain insight into the nature of motivation deficits. Research has shown associations between effort-based decision making and experiential negative symptoms; however, the associations are not consistent. The current study had two primary goals. First, we aimed to replicate previous findings of a deficit in effort-based decision making among individuals with schizophrenia on a test of cognitive effort. Second, in a large sample combined from the current and a previous study, we sought to examine the association between negative symptoms and effort by including the related construct of defeatist beliefs. The results replicated previous findings of impaired cognitive effort-based decision making in schizophrenia. Defeatist beliefs significantly moderated the association between negative symptoms and effort-based decision making such that there was a strong association between high negative symptoms and deficits in effort-based decision making, but only among participants with high levels of defeatist beliefs. Thus, our findings suggest the relationship between negative symptoms and effort performance may be understood by taking into account the role of defeatist beliefs, and finding that might explain discrepancies in previous studies

The characteristics of cognitive neuroscience tests in a schizophrenia cognition clinical trial: Psychometric properties and correlations with standard measures.

In comparison to batteries of standard neuropsychological tests, cognitive neuroscience tests may offer a more specific assessment of discrete neurobiological processes that may be aberrant in schizophrenia. However, more information regarding psychometric properties and correlations with standard neuropsychological tests and functional measures is warranted to establish their validity as treatment outcome measures. The N-back and AX-Continuous Performance Task (AX-CPT) are two promising cognitive neuroscience tests designed to measure specific components of working memory and contextual processing respectively. In the current study, we report the psychometric properties of multiple outcome measures from these two tests as well as their correlations with standard neuropsychological measures and functional capacity measures. The results suggest that while the AX-CPT and N-back display favorable psychometric properties, they do not exhibit greater sensitivity or specificity with functional measures than standard neurocognitive tests

Phase separation at all interaction strengths in the t-J model

We investigate the phase diagram of the two-dimensional t-J model using a recently developed Green's Function Monte Carlo method for lattice fermions. We use the technique to calculate exact ground-state energies of the model on large lattices. In contrast to many previous studies, we find the model phase separates for all values of J/t. In particular, it is unstable at the hole dopings and interaction strengths at which the model was thought to describe the cuprate superconductors.Comment: Revtex, 4 pages, 3 figures. Some minor changes were made to the text and figures, and some references were adde

Ethylenediamine Addition Improves Performance and Suppresses Phase Instabilities in Mixed-Halide Perovskites

We show that adding ethylenediamine (EDA) to perovskite precursor solution improves the photovoltaic device performance and material stability of high-bromide-content, methylammonium-free, formamidinium cesium lead halide perovskites FA1-xCsxPb(I1-yBry)3 which are currently of interest for perovskite-on-Si tandem solar cells. Using spectroscopy and hyperspectral microscopy, we show that the additive improves film homogeneity and suppresses the phase instability that is ubiquitous in high-Br perovskite formulations, producing films that remain stable for over 100 days in ambient conditions. With the addition of 1 mol% EDA we demonstrate 1.69 eV-gap perovskite single-junction p-i-n devices with a VOC of 1.22 V, and a champion maximum power point tracked power conversion efficiency of 18.8%, comparable to the best reported methylammonium-free perovskites. Using nuclear magnetic resonance (NMR) spectroscopy and X-ray diffraction techniques, we show that EDA reacts with FA+ in solution, rapidly and quantitatively forming imidazolinium cations. It is the presence of imidazolinium during crystallization which drives the improved perovskite thin-film properties

Amicus Brief, Lebron v. Gottlieb Memorial Hospital

Illinois Public Act 82-280, § 2-1706.5, as amended by P.A. 94-677, § 330 (eff. Aug. 25, 2005), and as codified as 735 ILCS 5/2-1706.5(a), imposes a $500,000 “cap” on the noneconomic damages that may be awarded in a medical malpractice suit against a physician or other health care professional, and a$1 million “cap” on the noneconomic damages that may be awarded against a hospital, its affiliates, or their employees. This brief will address two of the questions presented for review by the parties: 1. Does the cap violate the Illinois Constitution’s prohibition on “special legislation,” Art. IV, § 3, because it unnecessarily, arbitrarily, and irrationally grants exceptional benefits and privileges exclusively to certain classes of tort defendants. 2. Does the cap violate the Illinois Constitution’s guarantee of “equal protection,” Art. I, § 2, because it unnecessarily, arbitrarily, and irrationally imposes extraordinary burdens uniquely upon certain classes and sub-classes of tort plaintiffs

Feasibility and Pilot Efficacy Results from the Multi-site Cognitive Remediation in the Schizophrenia Trials Network (CRSTN) Study

The true benefit of pharmacological intervention to improve cognition in schizophrenia may not be evident without regular cognitive enrichment. Clinical trials assessing the neurocognitive effects of new medications may require engagement in cognitive remediation exercises to stimulate the benefit potential. However, the feasibility of large-scale multi-site studies using cognitive remediation at clinical trials sites has not been established

Characterisation of a dipolar chromophore with third-harmonic generation applications in the near-IR

E-2-Tricyanovinyl-3-n-hexyl-5-[4-{bis(4-n-butylphenyl)amino}-2-methoxystyryl]-thiophene, 1, has previously been used to demonstrate applications relying on frequency tripling of 1.55 μm light. Here we report the synthesis and chemical characterisation of 1, along with quantum-chemical calculations and additional experimental investigations of its third-order nonlinear properties that give more insight into its frequency tripling properties. Although 1 can be processed into amorphous films, crystals can also be grown by slow evaporation of solutions; the crystal structure determined by X-ray diffraction shows evidence of significant contributions from zwitterionic resonance forms to the ground-state structure, and reveals centrosymmetric packing exhibiting π–π and C–H···N≡C interactions. Both solutions and films of 1 exhibit near-infrared two-photon absorption into the low-lying one-photon-allowed state with a peak two-photon cross-section of cɑ. 290 GM (measured using the white-light continuum method with a pump wavelength of 1800 nm) at a transition energy equivalent to degenerate two-photon absorption at cɑ. 1360 nm; two related chromophores are also found to show comparable near-IR two-photon cross-sections. Closed-aperture Z-scan measurements and quantum-chemical calculations indicate that the nonlinear refractive index and third-harmonic generation properties of 1 are strongly dependent on frequency in the telecommunications range, due the aforementioned two-photon resonance