Risk Factors for Release in Nurses with Substance Use Disorder

Substance Use Disorder (SUD) is defined as the continued use of mood-altering addicting substances despite adverse consequences (Morse & Flavin, 1992). Nurses are not immune from this progressive and fatal disease and if left untreated, a nurse with SUD poses a double jeopardy: risk to the patients and a threat to her or his own health. Many State Boards of Nursing (SBN) have implemented a non-disciplinary alternative to punitive treatment of professionals with SUD; such programs offer monitoring for nurses afflicted with SUD. While studies have found a lower relapse rate for healthcare professionals enrolled in these monitoring programs than that of the general public, data on risk factors for relapse of nurses participating in an alternative monitoring program are lacking. This study seeks to answer the following: 1) What characteristics are common to nurses in a SUD monitoring program who relapse? 2) What characteristics are common to nurses in a SUD monitoring program who do not relapse? Pender’s Health Promotion Model “depicts the multidimensional nature of persons interacting with their interpersonal and physical environments as they pursue health” (Pender, Murdaugh, & Parsons, 2006, p. 50). This retrospective chart review used a descriptive, correlational and comparative design to examine and describe characteristics common to two groups of nurses while enrolled in a SUD monitoring program: those who relapsed and those who did not relapse. This research identified two risk factors for relapse of nurses: a family history of SUD and self-identified concern regarding emotional well-being. Nurse monitoring programs need to assess for these risk factors among participants and specific interventions developed before more nurses are lost to this disease. A network of resources could be developed and referrals for additional help and support implemented

Comparative psychometrics: establishing what differs is central to understanding what evolves

Cognitive abilities cannot be measured directly. What we can measure is individual variation in task performance. In this paper, we first make the case for why we should be interested in mapping individual differences in task performance on to particular cognitive abilities: we suggest that it is crucial for examining the causes and consequences of variation both within and between species. As a case study, we examine whether multiple measures of inhibitory control for non-human animals do indeed produce correlated task performance; however, no clear pattern emerges that would support the notion of a common cognitive ability underpinning individual differences in performance. We advocate a psychometric approach involving a three-step programme to make theoretical and empirical progress: first, we need tasks that reveal signature limits in performance. Second, we need to assess the reliability of individual differences in task performance. Third, multi-trait multi-method test batteries will be instrumental in validating cognitive abilities. Together, these steps will help us to establish what varies between individuals that could impact their fitness and ultimately shape the course of the evolution of animal minds. Finally, we propose executive functions, including working memory, inhibitory control and attentional shifting, as a sensible starting point for this endeavour

Inhibitory control and cue relevance modulate chimpanzees’ (Pan troglodytes) performance in a spatial foraging task

This project has received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation program (Grant Agreement 639072). Brandon Tinklenberg was supported by a grant from the Social Sciences and Humanities Research Council of Canada (SSHRC 435-2016-1051).Inhibition tasks usually require subjects to exert control to act correctly when a competing action plan is prepotent. In comparative psychology, one concern about the existing inhibition tasks is that the relative contribution of inhibitory control to performance (as compared to learning or object knowledge) is rarely explicitly investigated. We addressed this problem by presenting chimpanzees with a spatial foraging task in which they could acquire food more efficiently by learning which objects were baited. In Experiment 1, we examined how objects that elicited a prepotent approach response, transparent cups containing food, affected their learning rates. Although showing an initial bias to approach these sealed cups with visible food, the chimpanzees learned to avoid them more quickly across sessions compared to a color discrimination. They also learned a color discrimination more quickly if the incorrect cups were sealed such that a piece of food could never be hidden inside them. In Experiment 2, visible food of 2 different types was sealed in the upper part of the cups: 1 type signaled the presence of food reward hidden underneath; the cups with the other type were sealed. The chimpanzees learned more quickly in a congruent condition (the to-be-chosen food cue matched the reward) than in an incongruent condition (the to-be-avoided food cue matched the reward). Together, these findings highlight that performance in inhibition tasks is affected by several other cognitive abilities such as object knowledge, memory, and learning, which need to be quantified before meaningful comparisons can be drawn.PostprintPeer reviewe

Learning from communication versus observation in great apes

This research was supported by the European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007-2013)/ERC Grant 609819 (SOMICS project).When human infants are intentionally addressed by others, they tend to interpret the information communicated as being relevant to them and worth acquiring. For humans, this attribution of relevance leads to a preference to learn from communication, making it possible to accumulate knowledge over generations. Great apes are sensitive to communicative cues, but do these cues also activate an expectation of relevance? In an observational learning paradigm, we demonstrated to a sample of nonhuman great apes (bonobos, chimpanzees, orangutans; N = 24) how to operate on a food dispenser device. When apes had the opportunity to choose between an effective and an ineffective method in the baseline conditions, the majority of them chose the effective method. However, when the ineffective method was demonstrated in a communicative way, they failed to prioritize efficiency, even though they were equally attentive in both conditions. This suggests that the ostensive demonstration elicited an expectation of relevance that modified apes’ interpretation of the situation, potentially leading to a preference to learn from communication, as human children do.Publisher PDFPeer reviewe

The factorial structure of the mini mental state examination (MMSE) in Japanese dementia patients

<p>Abstract</p> <p>Background</p> <p>The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients.</p> <p>Methods</p> <p>30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE.</p> <p>Results</p> <p>Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration.</p> <p>Conclusions</p> <p>Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.</p

Changes in cognitive domains during three years in patients with Alzheimer's disease treated with donepezil

<p>Abstract</p> <p>Background</p> <p>The objective was to identify separate cognitive domains in the standard assessment tools (MMSE, ADAS-Cog) and analyze the process of decline within domains during three years in Alzheimer's disease (AD) patients with donepezil treatment.</p> <p>Method</p> <p>AD patients (n = 421) were recruited from a clinical multi-centre study program in Sweden. Patients were assessed every six months during three years. All patients received donepezil starting directly after study entry. After dropouts, 158 patients remained for analyses over three years. Data for the other patients were analysed until they dropped out (4 groups based on length in study).</p> <p>Results</p> <p>Factor analyses of all items suggested that there were three intercorrelated factors: a General, a Memory and a Spatial factor for which we constructed corresponding domains. Overall there was a cognitive improvement at six months followed by a linear drop over time for the three domains. Some group and domain differences were identified. Patients who remained longer in the study had better initial performance and a slower deterioration rate. The early dropouts showed no improvement at six months and many dropped out due to side effects. The other groups displayed a performance improvement at six months that was less pronounced in the Memory domain. Before dropping out, deterioration accelerated, particularly in the Spatial domain.</p> <p>Conclusion</p> <p>The course of illness in the three domains was heterogeneous among the patients. We were not able to identify any clinically relevant correlates of this heterogeneity. As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.</p

A Conserved Behavioral State Barrier Impedes Transitions between Anesthetic-Induced Unconsciousness and Wakefulness: Evidence for Neural Inertia

One major unanswered question in neuroscience is how the brain transitions between conscious and unconscious states. General anesthetics offer a controllable means to study these transitions. Induction of anesthesia is commonly attributed to drug-induced global modulation of neuronal function, while emergence from anesthesia has been thought to occur passively, paralleling elimination of the anesthetic from its sites in the central nervous system (CNS). If this were true, then CNS anesthetic concentrations on induction and emergence would be indistinguishable. By generating anesthetic dose-response data in both insects and mammals, we demonstrate that the forward and reverse paths through which anesthetic-induced unconsciousness arises and dissipates are not identical. Instead they exhibit hysteresis that is not fully explained by pharmacokinetics as previously thought. Single gene mutations that affect sleep-wake states are shown to collapse or widen anesthetic hysteresis without obvious confounding effects on volatile anesthetic uptake, distribution, or metabolism. We propose a fundamental and biologically conserved concept of neural inertia, a tendency of the CNS to resist behavioral state transitions between conscious and unconscious states. We demonstrate that such a barrier separates wakeful and anesthetized states for multiple anesthetics in both flies and mice, and argue that it contributes to the hysteresis observed when the brain transitions between conscious and unconscious states

Comprehensive analysis of epigenetic clocks reveals associations between disproportionate biological ageing and hippocampal volume

The concept of age acceleration, the difference between biological age and chronological age, is of growing interest, particularly with respect to age-related disorders, such as Alzheimer’s Disease (AD). Whilst studies have reported associations with AD risk and related phenotypes, there remains a lack of consensus on these associations. Here we aimed to comprehensively investigate the relationship between five recognised measures of age acceleration, based on DNA methylation patterns (DNAm age), and cross-sectional and longitudinal cognition and AD-related neuroimaging phenotypes (volumetric MRI and Amyloid-β PET) in the Australian Imaging, Biomarkers and Lifestyle (AIBL) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Significant associations were observed between age acceleration using the Hannum epigenetic clock and cross-sectional hippocampal volume in AIBL and replicated in ADNI. In AIBL, several other findings were observed cross-sectionally, including a significant association between hippocampal volume and the Hannum and Phenoage epigenetic clocks. Further, significant associations were also observed between hippocampal volume and the Zhang and Phenoage epigenetic clocks within Amyloid-β positive individuals. However, these were not validated within the ADNI cohort. No associations between age acceleration and other Alzheimer’s disease-related phenotypes, including measures of cognition or brain Amyloid-β burden, were observed, and there was no association with longitudinal change in any phenotype. This study presents a link between age acceleration, as determined using DNA methylation, and hippocampal volume that was statistically significant across two highly characterised cohorts. The results presented in this study contribute to a growing literature that supports the role of epigenetic modifications in ageing and AD-related phenotypes

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Cannabis and creativity: highly potent cannabis impairs divergent thinking in regular cannabis users

Stress-related psychiatric disorders across the life spa