Working Memory Deficits and Emotion Dysregulation in Youth with Attention-Deficit/Hyperactivity Disorder: Understanding Relationships and Treatment Implications

Evidence suggests that working memory (WM) impairment is a primary deficit in attention-deficit/hyperactivity disorder (ADHD), underlying core symptoms of the disorder and associated impairments. However, the relationship between deficits in different WM components and emotional problems specifically in ADHD has not yet been studied. Knowledge of the cognitive substrates contributing to emotional deficits in ADHD could inform efforts toward refining cognitive remediation as a treatment for emotion dysregulation in this population. The first aim of this study (Aim 1) investigated whether WM deficits, as a global construct, were related to and mediated the relationship between ADHD and emotion dysregulation. The first sub-aim (Aim 1A) examined whether different components of WM, as defined by the traditional Baddeley Model (i.e., phonological loop, visuospatial sketchpad, central executive), were related to and differentially mediated emotion regulation deficits in ADHD. The second sub-aim (Aim 1B) examined whether WM constructs mediated the relationship of ADHD symptoms severity with degree of emotion dysregulation, after examining mediating effects of, and adjusting for, other factors related to emotional functioning. Other factors included inattention (relative to total ADHD symptoms), hyperactivity/impulsivity (relative to total ADHD symptoms), comorbid ODD symptoms, negative parenting behaviors, parental stress, and social skills deficits. Given a possible relationship between WM deficits and emotion dysregulation, Aim 2 investigated whether improvement in WM skills following cognitive remediation was related to improvement in emotion regulation ability. Participants were youth with ADHD (ages 7 - 11 years) who were recruited for a larger treatment study investigating the augmentative and complementary effects of combined WM training and behavioral parent training. At a baseline visit, objective neuropsychological data measuring Baddeley components of WM ability and parent-ratings of emotion dysregulation, ADHD symptoms, comorbid ODD symptoms, parenting behaviors, and parental stress were collected (Aim 1). Teacher ratings of ADHD symptoms, ODD symptoms, and social skills were also collected at baseline. For Aim 2, participants were randomly assigned to an active or low-level, non-scaffolded ( placebo ) condition of WM training. Upon the completion of WM training, WM deficits and parent-rated emotion dysregulation were again measured. Aim 1 and sub-aims results: Deficits in WM, as a composite measure, were not associated with emotion dysregulation in this sample and, therefore, not included in the mediation model. With regard to the Baddeley components of WM, a deficit in the phonological loop was associated with parent-rated emotion dysregulation in ADHD (but not visuospatial sketchpad and central executive deficits). As such, the phonological loop factor was included in the mediation model. Lastly, a phonological loop deficit, comorbid ODD symptom severity, negative parenting behaviors (e.g., inconsistent use of discipline), parental stress, and social skills deficits together mediated the relationship between ADHD and emotion dysregulation. However, no variables contributed to the mediation above and beyond comorbid ODD symptom severity. Aim 2 Results: Improvement in overall WM functioning was significantly associated with better emotion regulation from pre-to-post WM training in the active group relative to the placebo group. Results suggest that many factors, including a deficit in the phonological loop, contribute to emotional impairment in youth with ADHD, the strongest being severity of comorbid ODD symptoms. Results also suggest that, while comorbid ODD may contribute most strongly to emotion dysregulation in this study, improvements in total WM ability after cognitive remediation were nonetheless associated with improvement in emotion regulation skills. Taken together, cognitive remediation may have effects on emotional functioning in youth with ADHD; developing a more precise understanding of the neurocognitive substrates underlying emotional deficits in ADHD could thus inform treatment strategies

Attributes of age-identity

Chronological age can be an unsatisfactory method of discriminating between older people. The lay concept of how old people actually feel may be more useful. The aim of the analyses reported in this paper was to investigate indicators of age-identity (or subjective age) among a national random sample of people aged 65 or more years living at home in Britain. Information was initially collected by home interview and a follow-up postal questionnaire 12-18 months later. The age that respondents felt was a more sensitive indicator than chronological age of many indicators of the respondents' health, psychological and social characteristics. Multiple regression analysis showed that baseline health and functional status, and reported changes in these at follow-up, explained 20.4 per cent of the variance in self-perceived age. Adding baseline mental health (anxiety/depression), feelings and fears about ageing at follow-up explained a further 0.8 per cent of the variance, making the total variance explained 21.2 per cent. It is concluded that measures of physical health and functional status and their interactions influenced age-identity. Mental health status and psychological perceptions made a small but significant additional contribution

MR Imaging of the Ankle and Hindfoot

Magnetic Resonance Imaging (MRI) is the diagnostic modality of choice for evaluation of traumatic ligamentous and tendinous injuries of the ankle and hindfoot. MRI is also valuable in the detection of occult bony trauma, osteochondral injuries, avascular necrosis, osteomyelitis, and a variety of other osseous conditions. This unit presents basic protocols for T1‐ and T2‐weighted sequences and short tau inversion recovery (STIR) imaging. Additional imaging following intravenous gadolinium is indicated in selected cases.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145347/1/cpmia2501.pd

Automatic noninvasive measurement of systolic blood pressure using photoplethysmography

<p>Abstract</p> <p>Background</p> <p>Automatic measurement of arterial blood pressure is important, but the available commercial automatic blood pressure meters, mostly based on oscillometry, are of low accuracy.</p> <p>Methods</p> <p>In this study, we present a cuff-based technique for automatic measurement of systolic blood pressure, based on photoplethysmographic signals measured simultaneously in fingers of both hands. After inflating the pressure cuff to a level above systolic blood pressure in a relatively slow rate, it is slowly deflated. The cuff pressure for which the photoplethysmographic signal reappeared during the deflation of the pressure-cuff was taken as the systolic blood pressure. The algorithm for the detection of the photoplethysmographic signal involves: (1) determination of the time-segments in which the photoplethysmographic signal distal to the cuff is expected to appear, utilizing the photoplethysmographic signal in the free hand, and (2) discrimination between random fluctuations and photoplethysmographic pattern. The detected pulses in the time-segments were identified as photoplethysmographic pulses if they met two criteria, based on the pulse waveform and on the correlation between the signal in each segment and the signal in the two neighboring segments.</p> <p>Results</p> <p>Comparison of the photoplethysmographic-based automatic technique to sphygmomanometry, the reference standard, shows that the standard deviation of their differences was 3.7 mmHg. For subjects with systolic blood pressure above 130 mmHg the standard deviation was even lower, 2.9 mmHg. These values are much lower than the 8 mmHg value imposed by AAMI standard for automatic blood pressure meters.</p> <p>Conclusion</p> <p>The photoplethysmographic-based technique for automatic measurement of systolic blood pressure, and the algorithm which was presented in this study, seems to be accurate.</p

Fight, flight, freeze, (for)give: what do we hear when we listen to child psychotherapists talk about parents and parent work in the context of their daily practice

This thesis presents qualitative research exploring the place of parents and parent work in child psychotherapy through the way in which child psychotherapists in England talk about it. The idea was formed by the researcher’s own experience as a child psychotherapist trainee in a CAMHS setting, where she noticed marked differences in how professionals practiced parent work. Further exploration revealed an area that suffers from a lack of resources and support in both theoretical literature and training schools. To explore the gaps in literature and in practice, an open-ended interview of four questions was designed. The first and broadest question was: ‘What is the place of parents in Child Psychotherapy? How do you make sense of Parent work in your daily practice?’ Eleven senior child psychotherapists in private practice in London (in parallel to NHS posts in the past or present) agreed to be interviewed. All interviews were recorded, transcribed and kept confidentially in a non-identifiable way, but only seven were chosen for full analysis. Narrative Analysis, which helps reveal personal stories based on an individual’s experience, was the methodology used to analyse participants’ accounts. Gee’s (1991) linguistic approach specifically was used, which focuses on audible characteristics of speech, like emphasised and prolonged words, breaks, stammering. Analysis of the material revealed three main narrative themes: ‘Threat’- a serious, careful approach with a sense of heavy responsibility and burden; ‘A wobbly space’- a therapeutic space where parents seem to be coming in and out of focus and the attitude towards them alternates between distant and close; ‘Identity in action’- an active, assertive professional identity that pushes towards development and change. The thesis will discuss possible underlying reasons for these narratives, including issues to do with ‘power’, boundaries within the profession, and therapists’ passion to make a difference in their patients’ lives

From Host Heme To Iron: The Expanding Spectrum of Heme Degrading Enzymes Used by Pathogenic Bacteria

Iron is an essential nutrient for many bacteria. Since the metal is highly sequestered in host tissues, bound predominantly to heme, pathogenic bacteria often take advantage of heme uptake and degradation mechanisms to acquire iron during infection. The most common mechanism of releasing iron from heme is through oxidative degradation by heme oxygenases (HOs). In addition, an increasing number of proteins that belong to two distinct structural families have been implicated in aerobic heme catabolism. Finally, an enzyme that degrades heme anaerobically was recently uncovered, further expanding the mechanisms for bacterial heme degradation. In this analysis, we cover the spectrum and recent advances in heme degradation by infectious bacteria. We briefly explain heme oxidation by the two groups of recognized HOs to ground readers before focusing on two new types of proteins that are reported to be involved in utilization of heme iron. We discuss the structure and enzymatic function of proteins representing these groups, their biological context, and how they are regulated to provide a more complete look at their cellular role

Backup in gene regulatory networks explains differences between binding and knockout results

The complementarity of gene expression and protein–DNA interaction data led to several successful models of biological systems. However, recent studies in multiple species raise doubts about the relationship between these two datasets. These studies show that the overwhelming majority of genes bound by a particular transcription factor (TF) are not affected when that factor is knocked out. Here, we show that this surprising result can be partially explained by considering the broader cellular context in which TFs operate. Factors whose functions are not backed up by redundant paralogs show a fourfold increase in the agreement between their bound targets and the expression levels of those targets. In addition, we show that incorporating protein interaction networks provides physical explanations for knockout effects. New double knockout experiments support our conclusions. Our results highlight the robustness provided by redundant TFs and indicate that in the context of diverse cellular systems, binding is still largely functional

The Crimson Conundrum: Heme Toxicity and Tolerance in GAS

The massive erythrocyte lysis caused by the Group A Streptococcus (GAS) suggests that the β-hemolytic pathogen is likely to encounter free heme during the course of infection. In this study, we investigated GAS mechanisms for heme sensing and tolerance. We compared the minimal inhibitory concentration of heme among several isolates and established that excess heme is bacteriostatic and exposure to sub-lethal concentrations of heme resulted in noticeable damage to membrane lipids and proteins. Pre-exposure of the bacteria to 0.1 μM heme shortened the extended lag period that is otherwise observed when naive cells are inoculated into heme-containing medium, implying that GAS is able to adapt. The global response to heme exposure was determined using microarray analysis revealing a significant transcriptome shift that included 79 up regulated and 84 down regulated genes. Among other changes, the induction of stress-related chaperones and proteases, including groEL/ES (8x), the stress regulators spxA2 (5x) and ctsR (3x), as well as redox active enzymes were prominent. The heme stimulon also encompassed a number of regulatory proteins and two-component systems that are important for virulence. A three-gene cluster that is homologous to the pefRCD system of the Group B Streptococcus was also induced by heme. PefR, a MarR-like regulator, specifically binds heme with stoichiometry of 1:2 and protoporphyrin IX (PPIX) with stoichiometry of 1:1, implicating it is one of the GAS mediators to heme response. In summary, here we provide evidence that heme induces a broad stress response in GAS, and that its success as a pathogen relies on mechanisms for heme sensing, detoxification, and repair