The relationship between amount of training and performance on a new task

This paper was designed to examine the relationship between training and transfer tasks and performance on these tasks whereby training can be used to predict transfer. Previous research has assumed that performance of an established task should extrapolate the power function of learning. That is, performance of an established skill in a new domain will continue to improve at the same rate with practice as if there was no change in the domain. 60 participants were recruited from the University of Edith Cowan and were randomly assigned to one of three conditions; I 0 block condition, 20 block condition, or 30 block condition. Participants were required to complete a dot counting task. The training and transfer phases differed such that the items presented in the transfer phase were also present in the training phase but with additional items. The results revealed that performance of old skills executed in the context of a new task were slower than predicted in the 10 and 30 block condition. These results indicated that a change in the presentation context of a new task affects response time performance on an old task, and extrapolations of the learning curve cannot be applied to predicting transfer performance

The Moral Obligation to Prioritize Research Into Deep Brain Stimulation Over Brain Lesioning Procedures for Severe Enduring Anorexia Nervosa

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost

Autonomy, eating disorders and elite gymnastics: ethical and conceptual issues

Participation in elite sport, and in particular those sports with special demands in terms of weight and shape, is associated with a higher risk for eating disorders such as anorexia nervosa [Sundgot-Borgen, J., & Torstveit, M. K. (2010). Aspects of disordered eating continuum in elite high intensity sports. Scandinavian Journal of Medicine and Science in Sports, 20, 112–121]. We report upon research exploring eating attitudes and behaviours within elite gymnastics. The study comprised 42 semi-structured interviews with gymnasts and support staff—34 gymnasts and 9 staff/support staff. The majority of those interviewed were acrobatic gymnasts (22; 16 males and 6 females) with 7 rhythmic gymnasts (all female) and 5 tumblers (all female). The mean age of those gymnasts interviewed was 17.4. A difficulty in precisely delineating extreme eating patterns (disordered eating) from having an eating disorder was noted. Within an elite sports context behaviours thought to be pathological in a more general setting might be fairly commonplace and even functional to the athlete's performance. The extent to which the athlete consents to these patterns of behaviour is problematic given their age and development. We argue that conceptualising consent as ‘authority to be cared for by a trustworthy coach’, more felicitously applies to the child/adolescent elite sporting context, helping us understand not only the focus of the elite gymnast, but also their relationship with the coach and the coaches' responsibilities

Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study

Objectives: To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020–31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019–31 January 2020, referred to as 2019/2020), between CEV children and the general population. Design: Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list. Setting: Primary and secondary healthcare settings covering 80% of the population of Wales. Participants: Children aged 2–17 in Wales: CEV (3769); living with a CEV person (20 033); or neither (415 009). Primary outcome measure: First record of anxiety or depression in primary or secondary healthcare in 2019/2020 and 2020/2021, identified using Read and International Classification of Diseases V.10 codes. Results: A Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (HR=2.27, 95% CI=1.94 to 2.66, p<0.001). Compared with the general population, the risk among CEV children was higher in 2020/2021 (risk ratio 3.04) compared with 2019/2020 (risk ratio 1.90). In 2020/2021, the period prevalence of anxiety or depression increased slightly among CEV children, but declined among the general population. Conclusions: Differences in the period prevalence of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic

Abdominal intussusception associated with coeliac disease: case report and literature review

In genetically susceptible individuals, gluten ingestion triggers and immune infiltration and bowel damage in the classical pattern of coeliac disease, with variable symptoms. Intussusception is a condition where one segment of intestine ‘telescopes’ inside of another portion of intestine, which may cause symptoms of abdominal pain due to obstruction. Intussusception has been associated with coeliac disease. We report a 4-year-old girl presented with recurrent abdominal pain of variable severity and found to have intussusception on two occasions, which on both occasions reduced spontaneously during ultrasound examinations. She was later diagnosed with coeliac disease. This case highlights the importance of considering coeliac screening in patients with a history of recurrent abdominal pain and intussusception

Nasogastric tube feeding under restraint: understanding the impact and improving care

Background Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement. Aims To examine the impact of this intervention on people with lived experience, carers and staff. Method People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed. Results Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored. Conclusion This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts

School achievement as a predictor of depression and self-harm in adolescence: linked education and health record study

BackgroundMental disorders in children and adolescents have an impact on educational attainment.AimsTo examine the temporal association between attainment in education and subsequent diagnosis of depression or self-harm in the teenage years.MethodGeneral practitioner, hospital and education records of young people in Wales between 1999 and 2014 were linked and analysed using Cox regression.ResultsLinked records were available for 652 903 young people and of these 33 498 (5.1%) developed depression and 15 946 (2.4%) self-harmed after the age of 12 but before the age of 20. Young people who developed depression over the study period were more likely to have achieved key stage 1 (age 7 years) but not key stage 2 (age 11) (hazard ratio (HR) = 0.79, 95% CI 0.74–0.84) milestones, indicating that they were declining in academic attainment during primary school. Conversely, those who self-harmed were achieving as well as those who did not self-harm in primary school, but showed a severe decline in their attainment during secondary school (HR = 0.72, 95% CI 0.68–0.78).ConclusionsLong-term declining educational attainment in primary and secondary school was associated with development of depression in the teenage years. Self-harm was associated with declining educational attainment during secondary school only. Incorporating information on academic decline with other known risk factors for depression/self-harm (for example stressful life events, parental mental health problems) may improve risk profiling methods.Declaration of interestNone

HIV patients stable on ART retain evidence of a high CMV load but changes to Natural Killer cell phenotypes reflect both HIV and CMV

Background: Whilst ART corrects many effects of HIV disease, T cell populations retain features of accelerated immunological aging. Methods: Here we analyse phenotypic changes to natural killer (NK) cells in HIV patients who began ART with <200 CD4 T-cells/µl and maintained virological control for 12-17 years, compared with CMV seropositive and seronegative healthy control donors. Results: Humoral responses to CMV antigens (lysate, gB, IE-1) remain elevated in the patients (P <0.0001) despite the long duration of ART. Patient's NK cells responded poorly to K562 cells when assessed by CD107a and IFNγ, but this could not be attributed to CMV as responses were low in CMV-seronegative controls. Moreover HIV (and not CMV) increased expression of CD57 on CD56lo cells. Conclusions: Comparisons with published studies suggest that CMV accelerates age-related increases in CD57 expression but levels plateau by 60-70 years of age, so the effect of CMV disappears. In HIV patients the plateau is higher and perhaps reached sooner