Clinical validation of an aggregate learning ratio from the neuropsychological assessment battery.

Quantifying learning deficits provides valuable information in identifying and diagnosing mild cognitive impairment and dementia. Previous research has found that a learning ratio (LR) metric, derived from the list learning test from the Neuropsychological Assessment Battery (NAB), was able to distinguish between those with normal cognition versus memory impairment. The current study furthers the NAB LR research by validating a NAB story LR, as well as an aggregate LR. The aggregate LR was created by combining the individual list and story LRs. Participants were classified as those with normal cognition (n = 51), those with MCI (n = 39) and those with dementia (n = 35). Results revealed the story LR was able to accurately distinguish normal controls from those with mild cognitive impairment and those with dementia and offers enhanced discriminability beyond the story immediate recall score (sum of trial 1 and trial 2). Further, the aggregate LR provided superior discriminability beyond the individual list and story LRs and accounted for additional variance in diagnostic group classification. The NAB aggregate LR provides improved sensitivity in detecting declines in impaired learning, which may assist clinicians in making diagnoses earlier in a disease process, benefiting the individual through earlier interventions.

Deep learning for the prediction of clinical outcomes in internet-delivered CBT for depression and anxiety.

In treating depression and anxiety, just over half of all clients respond. Monitoring and obtaining early client feedback can allow for rapidly adapted treatment delivery and improve outcomes. This study seeks to develop a state-of-the-art deep-learning framework for predicting clinical outcomes in internet-delivered Cognitive Behavioural Therapy (iCBT) by leveraging large-scale, high-dimensional time-series data of client-reported mental health symptoms and platform interaction data. We use de-identified data from 45,876 clients on SilverCloud Health, a digital platform for the psychological treatment of depression and anxiety. We train deep recurrent neural network (RNN) models to predict whether a client will show reliable improvement by the end of treatment using clinical measures, interaction data with the iCBT program, or both. Outcomes are based on total improvement in symptoms of depression (Patient Health Questionnaire-9, PHQ-9) and anxiety (Generalized Anxiety Disorder-7, GAD-7), as reported within the iCBT program. Using internal and external datasets, we compare the proposed models against several benchmarks and rigorously evaluate them according to their predictive accuracy, sensitivity, specificity and AUROC over treatment. Our proposed RNN models consistently predict reliable improvement in PHQ-9 and GAD-7, using past clinical measures alone, with above 87% accuracy and 0.89 AUROC after three or more review periods, outperforming all benchmark models. Additional evaluations demonstrate the robustness of the achieved models across (i) different health services; (ii) geographic locations; (iii) iCBT programs, and (iv) client severity subgroups. Results demonstrate the robust performance of dynamic prediction models that can yield clinically helpful prognostic information ready for implementation within iCBT systems to support timely decision-making and treatment adjustments by iCBT clinical supporters towards improved client outcomes.

Novel learning ratio from the NAB list learning test distinguishes between clinical groups: clinical validation and sex-related differences.

List-learning tasks provide a wealth of information about an individual's cognitive abilities: attention, encoding, storage, retrieval, recognition. A more recently developed metric, the Learning Ratio (LR), supplements information about cognitive ability and can assist the clinician in determining whether an individual has cognitive impairment. The LR is calculated by taking the difference between the individuals' raw score on the first learning trial and their raw score on the last learning trial, which is then divided by the number of words left to be learned after the first learning trial. A LR derived from the list-learning task from the Neuropsychological Assessment Battery (NAB) was evaluated to determine ability to distinguish those with normal cognition from those with mild cognitive impairment (MCI) and dementia. Results from the present study indicate the NAB LR is able to distinguish between clinical groups; recommended cutoffs for the NAB LR scores are provided. We also found a significant female sex-advantage for the NAB LR in those with normal memory ability and demonstrated the female sex advantage decreased with increasing memory impairment. Taken together, the NAB LR may assist clinicians in making an accurate and early diagnosis and may be helpful for tracking learning and functioning across multiple assessments. .

Workplace Adjustments for Autistic Employees: What is 'Reasonable'?

Autistic adults are inadequately supported in the workplace. This study sought a definition of 'reasonable' and explored facilitators and barriers to employers making reasonable adjustments. 98 employers and employees across a UK city completed a survey; 15% identified as being autistic. Qualitative data were analysed using framework analysis. Reasonable adjustments were defined as having a positive impact on autistic employees' wellbeing and work outputs without being detrimental to non-autistic employees or the organisation; they were low cost and easily implemented. Recommendations were for autism awareness training, low-stimulus work spaces, clear instructions and flexible working hours. A definition of reasonable is added to the literature, with suggestions of where to invest support efforts. Recommendations mostly apply to the education sector.

The vicissitudes of conducting psychodynamic research in a naturalistic setting.

This article reports on our experiences conducting naturalistic research as clinician-researchers in a training setting within a public safety-net hospital. The naturalistic, practice-based context has presented various challenges to the research process, including the following: supporting research with limited finances, establishing continuity of research personnel, designating time for research within an intensive clinical training program, responding to difficulties obtaining data, seeking consultation for advanced data analysis, organizing the writing process, and determining order of authorship. In addition, in mixed-methods research of psychodynamic psychotherapy, each of these challenges has interacted with the inherent challenges of qualitative research. We describe the systemic and project-specific challenges of conducting such research, as well as practical strategies that we have used to overcome them, with the aim of helping other clinician-researchers facilitate naturalistic research. The challenges reflect the problem of being "stuck" in the gap that this special section of Psychotherapy is examining, although the strategies serve as optimistic reminders that this type of work is indeed possible. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Initial Observations of Lingual Movement Characteristics of Children With Cerebral Palsy.

Purpose: This preliminary study compared the speech motor control of the tongue and jaw between children with cerebral palsy (CP) and their typically developing (TD) peers. Method: Tongue tip and jaw movements of 4 boys with spastic CP and 4 age- and sex-matched TD peers were recorded using an electromagnetic articulograph during 10 repetitions of "Dad told stories today." The duration, path distance, average speed, and speech movement stability of the movements were calculated for each repetition. Results: The children with CP had longer durations than their TD peers. Children with CP had longer path distances and faster average speed as compared with their TD peers for both articulators. The TD group but not the CP group had longer path distances and faster average speeds for the tongue than the jaw. The CP group had reduced speech movement stability for the tongue as compared with their TD peers, but both groups had similar speech movement stability for the jaw. Conclusions: Children with CP had impaired speech motor control of the tongue and jaw as compared with their TD peers, and these speech motor control deficits were more pronounced in the tongue tip than the jaw.

Dosimetric comparison of single-beam multi-arc and 2-beam multi-arc VMAT optimization in the Monaco treatment planning system.

The purpose of this study was to evaluate the dosimetric and practical effects of the Monaco treatment planning system "max arcs-per-beam" optimization parameter in pelvic radiotherapy treatments. We selected for this study a total of 17 previously treated patients with a range of pelvic disease sites including prostate (9), bladder (1), uterus (3), rectum (3), and cervix (1). For each patient, 2 plans were generated, one using an arc-per-beam setting of "1" and another with an arc-per-beam setting of "2" using the volumes and constraints established from the initial clinical treatments. All constraints and dose coverage objects were kept the same between plans, and all plans were normalized to 99.7% to ensure 100% of the planning target volume (PTV) received 95% of the prescription dose. Plans were evaluated for PTV conformity, homogeneity, number of monitor units, number of control points, and overall plan acceptability. Treatment delivery time, patient-specific quality assurance procedures, and the impact on clinical workflow were also assessed. We found that for complex-shaped target volumes (small central volumes with extending arms to cover nodal regions), the use of 2 arc-per-beam (2APB) parameter setting achieved significantly lower average dose-volume histogram values for the rectum V20 (p = 0.0012) and bladder V30 (p = 0.0036) while meeting the high dose target constraints. For simple PTV shapes, we found reduced monitor units (13.47%, p = 0.0009) and control points (8.77%, p = 0.0004) using 2APB planning. In addition, we found a beam delivery time reduction of approximately 25%. In summary, the dosimetric benefit, although moderate, was improved over a 1APB setting for complex PTV, and equivalent in other cases. The overall reduced delivery time suggests that the use of mulitple arcs per beam could lead to reduced patient-on-table time, increased clinical throughput, and reduced medical physics quality assurance effort.

"When You're Sitting on the Fence, Hope's the Hardest Part": Challenges and Experiences of Heterosexual and Same-Sex Couples Adopting Through the Child Welfare System.

Foster-to-adopt families can be viewed as systems that are influenced by many other systems (e.g., the legal system, the social service agency, and the birth family). The current qualitative study of 84 foster-to-adopt parents (members of 42 lesbian, gay, and heterosexual couples) examined the types of challenges that parents faced as they navigated multiple systems during the initial post-placement period. Some participants described the legal insecurity associated with their role as foster-to-adopt parents as impacting their personal well-being and their attachment to their children. Lack of support services and disorganization within social service agencies, as well as strained relationships with birth parents, were also identified as stressors for foster-to-adopt parents. Importantly, lesbian and gay participants faced additional concerns regarding the security of their placement, due to the possibility for discrimination within the various systems involved with the foster-to-adopt process. Participants as a whole also identified positive aspects of their experiences within various systems; for example, they appreciated child care subsidies, state-provided health insurance, and supportive social workers. Our findings provide insights into foster-to-adopt parents' experiences during the initial post-placement period, and have implications for adoption services aimed to improve placement stability and enhance family functioning in foster-to-adopt families.

On the border: young adults with LGBQ parents navigate LGBTQ communities.

Little research has examined the perspectives of young adults with lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents, particularly in relation to their identification with the LGBTQ community. To address this gap, we conducted a qualitative study of 42 young adults (ages 18-29) who were raised by LGBQ parents. We found that participants often described their sense of belonging to the LGBTQ community as shifting over the life course. Some participants, particularly those whose parents had always been out, felt connected to the LGBTQ community as children. Of these, most maintained those connections over time. However, some increasingly deidentified with the LGBTQ community, which they sometimes attributed to their own heterosexual identification. Others, particularly those whose parents came out later in life, described a lack of connection to the LGBTQ community as children. Of these, most became increasingly identified with the community, which they often attributed to their own and their parents' increasing sense of comfort with their parents' sexuality. Heterosexual participants who sought out LGBTQ-oriented groups in young adulthood sometimes encountered resistance from these groups, whereby participants' reasons for wanting to become involved were not readily apparent or appreciated. Our findings highlight the need for practitioners to understand the complex and often changing role of the LGBTQ community in the lives of young adults with LGBQ parents.

A weak C' box renders U3 snoRNA levels dependent on hU3-55K binding.

The rate of ribosome biogenesis, which is downregulated in terminally differentiated cells and upregulated in most cancers, regulates the growth rate and is linked to the cell's proliferative potential. The U3 box C/D small nucleolar RNP (snoRNP) is an integral component of the small subunit (SSU) processome and is essential for 18S rRNA processing. We show that U3 snoRNP assembly, and therefore U3 snoRNA accumulation, is regulated through the U3-specific protein hU3-55K. Furthermore, we report that the levels of several SSU processome components, including the U3 snoRNA but not other box C/D snoRNAs, are specifically downregulated during human lung (CaCo-2) and colon (CaLu-3) epithelial cell differentiation. c-Myc is reported to play an integral role in regulating ribosome production by controlling the expression of many ribosome biogenesis factors. Our data, however, indicate that this regulation is not dependent on c-Myc since the level of this protein does not change during epithelial cell differentiation. In addition, depletion of c-Myc had only a mild affect on the levels of SSU processome proteins. CaCo-2 cells are colon adenocarcinoma epithelial cells that are believed to revert to their precancerous state during differentiation. This suggests a significant increase in the levels of specific SSU processome components during tumorogenesis.