Neuroscience-informed Auditory Training in Schizophrenia: A Final Report of the Effects on Cognition and Serum Brain-Derived Neurotrophic Factor.

ObjectiveWe previously reported the interim effects in a per protocol analysis of a randomized controlled trial of an innovative neuroscience-informed computerized cognitive training approach in schizophrenia. Here we report the effects of training on behavioral outcome measures in our final sample using an intent-to-treat analysis. We also report the effects on serum brain-derived neurotrophic factor (BDNF).MethodEighty-seven clinically stable participants with schizophrenia were randomly assigned to either targeted auditory training (AT, N=46) or a computer games control condition (CG, N=41). Participants were assessed on neurocognition, symptoms and functional outcome at baseline and after 50 hours of intervention delivered over 10 weeks. Serum BDNF was assessed at baseline, at 2 weeks, and at 10 weeks.ResultsAfter the intervention, AT participants showed significant gains in global cognition, speed of processing, verbal learning, and verbal memory, relative to CG participants, with no changes in symptoms or functioning. At baseline, schizophrenia participants had significantly lower-than-normal serum BDNF. AT participants showed a significant increase in serum BDNF compared to CG participants, and "normalized" levels by post training.ConclusionsParticipants with chronic schizophrenia made significant cognitive gains after 50 hours of intensive computerized training delivered as a stand-alone treatment, but no improvement in symptoms or functioning. Serum BDNF levels were significantly increased, and may serve as a peripheral biomarker for the effects of training. Future research must focus on: 1) Methods of integrating cognitive training with psychosocial treatments; 2) A deeper understanding of underlying neurophysiology in order to enhance critical mechanisms of action

Master of Science

thesisBALB/c mice have been used to study multiple diseases that cause inflammation such as Lyme arthritis, rheumatoid arthritis, and systemic lupus erythematosus. Lyme disease or, more specifically, Lyme arthritis is caused by Borrelia burgdorferi that has disseminated into joint tissues. A spectrum of Lyme disease severity and symptoms has been seen in Lyme disease patients, which suggests that genetics play a role in host response. Inbred mouse strains display the range of arthritis severity seen in patients from the mild arthritis phenotype in C57BL/6 mice to the severe arthritis phenotype in C3H mice. The C3H mouse model develops severe Lyme arthritis that can be attributed to 2 important inflammatory factors: a hypomorphic allele of GusB and hyper production of Type I IFN-induced transcripts. Using SNP-based assessment, the BALB/c mouse was found to be closely related to the C3H mouse; however, the BALB/c mouse does not have the hypomorphic GusB allele. It was hypothesized that the BALB/c mouse, which develops severe, dose-dependent arthritis, would also hyperproduce Type I IFN-related transcripts. This study found that the BALB/c mouse does not develop an IFN profile similar to the C3H mouse. Multiple inflammatory markers were analyzed to compare and contrast BALB/c and C3H mice, and TNFα was determined to be elevated in the BALB/c mouse above the levels in the C3H mouse both in vivo during infection and in vitro using bone marrow-derived macrophages. This suggests an important role of the innate immune response in these mice. Interestingly, peritoneal macrophages derived from BALB/c were able to internalize B. burgdorferi much better than C3H-derived peritoneal macrophages. This suggests an elevated intrinsic response in controlling B. burgdorferi numbers. TNFα blockade has been shown to be beneficial in relieving symptoms in rheumatoid arthritis patients, so it was hypothesized that TNFα blockade in BALB/c mice would reduce Lyme arthritis symptoms. This study did not see any benefit to TNFα blockade in Lyme arthritis reduction. Overall, this study has shown that there are still mechanisms that are yet to be fully understood in the pathogenic relationship between the BALB/c mouse and the spirochete bacteria B. burgdorferi

Arthritis and disability

Executive summary: Arthritis Australia commissioned the Social Policy Research Centre (SPRC) at UNSW Australia to carry out research on the lived experience of people with arthritis related conditions. This report outlines the methods, findings and implications of the research. Arthritis is the second leading cause of disability and the most common cause of chronic pain in Australia; it is the most prevalent long-term health condition, affecting 3 million people or about 15 per cent of the population. Studies are available on the health costs and loss of productivity associated with arthritis, but not as much is understood about the extent to which arthritis is associated with disability–who is affected, how people are affected, what helps people cope with their condition day to day, and how support services can be improved. Improving understanding of the disability impact of arthritis is particularly important given the transition in Australia to the National Disability Insurance Scheme and the impact this may have on service availability and delivery

Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets.

Limited access to Cognitive Training (CT) for people with schizophrenia (SZ) prevents widespread adoption of this intervention. Delivering CT remotely via tablets may increase accessibility, improve scheduling flexibility, and diminish patient burden.In this reanalysis of data from a larger trial of CT, we compared two samples of individuals with SZ who chose to complete 40 h of CT either on desktop computers in the laboratory (N = 33) or remotely via iPads (N = 41). We examined attrition rates and adherence to training, and investigated whether remote iPad-based CT and in-person desktop-based CT induced significantly different improvements in cognitive and real-world functioning.The attrition rate was 36.6%. On average, participants completed 3.06 h of CT per week. There were no significant between-group differences in attrition and adherence to CT requirements. Participants who completed iPad-based CT were significantly younger and had lower symptoms at baseline compared to participants who completed CT on the lab desktops. Controlling for age and symptom severity, rANCOVA showed that iPad-based and desktop-based CT similarly and significantly improved verbal learning and problem solving. Main effects of time, at trend level significance, were evident in global cognition, verbal memory, quality of life, and social functioning. All group by time interactions were non-significant except for verbal memory, where iPad users showed greater gains. Within-group effect sizes for changes in outcomes were in the small range.Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples

Self-directed disability support: building people’s capacity through peer support and action research

How are people with disability experiencing and managing the transition towards self directed support and preparing for the NDIS? In this project, small groups of people with disability around Australia met over 6 months to talk about their disability support. The peer support groups enabled action research about how they are deciding the practical details about support, such as how, when and by whom it is provided

Foreword

Foreword to the Themed Issue:Anthropology of Versus Anthropology for Business: Exploring the Borders and Crossovers between an Anthropology of Business and Anthropological ConsultancyGuest editor: Daniela Pelus

Model selection and prediction of outcomes in recent onset schizophrenia patients who undergo cognitive training.

Predicting treatment outcomes in psychiatric populations remains a challenge, but is increasingly important in the pursuit of personalized medicine. Patients with schizophrenia have deficits in cognition, and targeted cognitive training (TCT) of auditory processing and working memory has been shown to improve some of these impairments; but little is known about the baseline patient characteristics predictive of cognitive improvement. Here we use a model selection and regression approach called least absolute shrinkage and selection operator (LASSO) to examine predictors of cognitive improvement in response to TCT for patients with recent onset schizophrenia. Forty-three individuals with recent onset schizophrenia randomized to undergo TCT were assessed at baseline on measures of cognition, symptoms, functioning, illness duration, and demographic variables. We carried out 10-fold cross-validation of LASSO for model selection and regression. We followed up on these results using linear models for statistical inference. No individual variable was found to correlate with improvement in global cognition using a Pearson correlation approach, and a linear model including all variables was also found not to be significant. However, the LASSO model identified baseline global cognition, education, and gender in a model predictive of improvement on global cognition following TCT. These findings offer guidelines for personalized approaches to cognitive training for patients with schizophrenia

Childhood Maltreatment Predicts Poor Economic and Educational Outcomes in the Transition to Adulthood.

ObjectivesTo test whether childhood maltreatment was a predictor of (1) having low educational qualifications and (2) not being in education, employment, or training among young adults in the United Kingdom today.MethodsParticipants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative UK cohort of 2232 twins born in 1994 to 1995. Mothers reported on child maltreatment when participants were aged 5, 7, 10, and 12 years. Participants were interviewed about their vocational status at age 18 years.ResultsThe unadjusted odds of having low educational qualifications or of not being in education, employment, or training at age 18 years were more than 2 times greater for young people with a childhood history of maltreatment versus those without. These associations were reduced after adjustments for individual and family characteristics. Youths who reported having a supportive adult in their lives had better education outcomes than did youths who had less support.ConclusionsCloser collaboration between the child welfare and education systems is warranted to improve vocational outcomes for maltreated youths