Using the biopsychosocial model for identifying subgroups of detained juveniles at different risk of re-offending in practice: a latent class regression analysis approach.

BACKGROUND: Juvenile delinquents constitute a heterogeneous group, which complicates decision-making based on risk assessment. Various psychosocial factors have been used to define clinically relevant subgroups of juvenile offenders, while neurobiological variables have not yet been integrated in this context. Moreover, translation of neurobiological group differences to individual risk assessment has proven difficult. We aimed to identify clinically relevant subgroups associated with differential youth offending outcomes, based on psychosocial and neurobiological characteristics, and to test whether the resulting model can be used for risk assessment of individual cases. METHODS: A group of 223 detained juveniles from juvenile justice institutions was studied. Latent class regression analysis was used to detect subgroups associated with differential offending outcome (recidivism at 12 month follow-up). As a proof of principle, it was tested in a separate group of 76 participants whether individual cases could be assigned to the identified subgroups, using a prototype 'tool' for calculating class membership. RESULTS: Three subgroups were identified: a 'high risk-externalizing' subgroup, a 'medium risk-adverse environment' subgroup, and a 'low risk-psychopathic traits' subgroup. Within these subgroups, both autonomic nervous system and neuroendocrinological measures added differentially to the prediction of subtypes of reoffending (no, non-violent, violent). The 'tool' for calculating class membership correctly assigned 92.1% of participants to a class and reoffending risk. CONCLUSIONS: The LCRA approach appears to be a useful approach to integrate neurobiological and psychosocial risk factors to identify subgroups with different re-offending risk within juvenile justice institutions. This approach may be useful in the development of a biopsychosocial assessment tool and may eventually help clinicians to assign individuals to those subgroups and subsequently tailor intervention based on their re-offending risk.

The effectiveness of adapted schema therapy for cluster C personality disorders in older adults - integrating positive schemas.

INTRODUCTION: Schema therapy (ST) is an efficacious psychotherapy for personality disorders (PDs) in adults. The first empirical support for the effectiveness of ST in older adults with cluster C PDs was provided recently. ST partly focusses on the positive, but there is an increasing awareness of imbalance in the ST community because of the emphasis on negative schemas versus attention to positive schemas. Positive schemas may be important vehicles of therapeutic change in psychotherapy with older people, as it may help strengthen the healthy adult mode, and it might also help change a negative life review. Suggestions were made to increase the efficacy and feasibility of ST in older adults, including adjusting the case conceptualisation, modifying the experiential techniques, making use of the patient's wisdom and reactivating positive schemas. The aim of the current study is to investigate the feasibility and effectiveness of adapted individual ST for older adults. METHODS/DESIGN: A multiple baseline design is used with positive and negative core beliefs as primary outcome measures. Ten older adults (age > 60 years) with cluster C PDs are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying randomly from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. Symptomatic distress, schema modes, early maladaptive schemas (EMS) and early adaptive schemas (EAS) are secondary outcome measures. PD will be diagnosed before baseline and after treatment phase. EAS are assessed with the Dutch version of the Young Positive Schema Questionnaire (YPSQ). DISCUSSION: To the best of our knowledge, this is the first empirical study in which positive schemas are integrated in ST treatment to examine the efficacy of an adapted form of ST for older adults. This is in line with wider developments supporting the integration of positive schema's into ST. It offers the possibility to improve the effectiveness of ST in older adults. TRIAL REGISTRATION: The Netherlands National Trial Register NL8346, registered 1 February 2020.

Registered Replication Report: Rand, Greene, and Nowak (2012).

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of -0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation.

Consideration of QRS complex in addition to ST-segment abnormalities in the estimation of the "risk region" during acute anterior or inferior myocardial infarction.

The myocardial area at risk (MaR) is an important aspect in acute ST-elevation myocardial infarction (STEMI). It represents the myocardium at the onset of the STEMI that is ischemic and could become infarcted if no reperfusion occurs. The MaR, therefore, has clinical value because it gives an indication of the amount of myocardium that could potentially be salvaged by rapid reperfusion therapy. The most validated method for measuring the MaR is (99m)Tc-sestamibi SPECT, but this technique is not easily applied in the clinical setting. Another method that can be used for measuring the MaR is the standard ECG-based scoring system, Aldrich ST score, which is more easily applied. This ECG-based scoring system can be used to estimate the extent of acute ischemia for anterior or inferior left ventricular locations, by considering quantitative changes in the ST-segment. Deviations in the ST-segment baseline that occur following an acute coronary occlusion represent the ischemic changes in the transmurally ischemic myocardium. In most instances however, the ECG is not available at the very first moments of STEMI and as times passes the ischemic myocardium becomes necrotic with regression of the ST-segment deviation along with progressive changes of the QRS complex. Thus over the time course of the acute event, the Aldrich ST score would be expected to progressively underestimate the MaR, as was seen in studies with SPECT as gold standard; anterior STEMI (r=0.21, p=0.32) and inferior STEMI (r=0.17, p=0.36). Another standard ECG-based scoring system is the Selvester QRS score, which can be used to estimate the final infarct size by considering the quantitative changes in the QRS complex. Therefore, additional consideration of the Selvester QRS score in the acute phase could potentially provide the "component" of infarcted myocardium that is missing when the Aldrich ST score alone is used to determine the MaR in the acute phase, as was seen in studies with SPECT as gold standard: anterior STEMI (r=0.47, p=0.02) and inferior STEMI (r=0.58, p<0.001). The aim of this review will be to discuss the findings regarding the combining of the Aldrich ST score and initial Selvester QRS score in determining the MaR at the onset of the event in acute anterior or inferior ST-elevation myocardial infarction.

Registered Replication Report: Schooler and Engstler-Schooler (1990).

Trying to remember something now typically improves your ability to remember it later. However, after watching a video of a simulated bank robbery, participants who verbally described the robber were 25% worse at identifying the robber in a lineup than were participants who instead listed U.S. states and capitals-this has been termed the "verbal overshadowing" effect (Schooler & Engstler-Schooler, 1990). More recent studies suggested that this effect might be substantially smaller than first reported. Given uncertainty about the effect size, the influence of this finding in the memory literature, and its practical importance for police procedures, we conducted two collections of preregistered direct replications (RRR1 and RRR2) that differed only in the order of the description task and a filler task. In RRR1, when the description task immediately followed the robbery, participants who provided a description were 4% less likely to select the robber than were those in the control condition. In RRR2, when the description was delayed by 20 min, they were 16% less likely to select the robber. These findings reveal a robust verbal overshadowing effect that is strongly influenced by the relative timing of the tasks. The discussion considers further implications of these replications for our understanding of verbal overshadowing.

A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder.

The present study examined a hierarchical model for the relationships between general and specific vulnerability factors and symptom manifestations of generalized anxiety disorder (GAD). A clinical sample of patients with GAD (N=137) completed a set of self-report questionnaires for measuring neuroticism, extraversion, intolerance of uncertainty, metacognitive beliefs, and symptoms of generalized anxiety (i.e., worry) and depression. A bootstrapping analysis yielded support for a model in which the relation between the general vulnerability factor of neuroticism and symptoms of GAD were mediated by the specific vulnerability factors of intolerance of uncertainty and negative metacognitions. Implications for the classification and treatment of GAD are discussed.

Students' and teachers' cognitions about good teachers.

BACKGROUND: Good teachers have been studied ever since Plato described how Socrates taught by asking questions of his audience. Recent findings shed light on two characteristics of good teachers: their personality and their ability. However, more attention has been paid to teachers' practices and opinions than to students' views. AIMS: The study reported here attempted to deepen our understanding of what students think about good teachers. SAMPLE: Students of four age groups (7, 10, 13, and 16 years of age) and teachers from primary and secondary schools were asked to write an essay on the good teacher. METHODS: The correspondence between conceptual items in the essays was investigated by determining the extent to which they were used in the same essays to describe good teachers. RESULTS: Correspondence analysis revealed two dimensions. The first dimension reflected the preference of students and teachers for describing the good teacher in terms of either personality or ability characteristics. The second dimension was interpreted as an orientation in the essays towards either attachment to, detachment from or commitment to school and teachers. Students and teachers were compared to establish the amount of (dis)agreement about what makes a good teacher. Primary school students described good teachers primarily as competent instructors, focusing on transfer of knowledge and skills, whereas secondary school students emphasised relational aspects of good teachers. Teachers, however, considered good teachers in the first place a matter of establishing personal relationships with their students. Consequently, primary school students and teachers disagreed about the characteristics of good teachers. In secondary education, disagreements between teachers and students were relatively small. CONCLUSIONS: The research method of collecting free essays and utilising correspondence analysis to represent conceptual items and groups of participants seems promising as long as a theoretical framework is available to interpret the resulting representation of similarities between items and groups of participants.

The polymer Polyactive as a bone-filling substance: an experimental study in rabbits.

The biocompatible, osteoconductive and resorbable polymer Polyactive (PA) was investigated for its performance as a bone-graft substitute. The model consisted of a 4 mm borehole, 1.5 cm distal of the major trochanter in both femurs of a rabbit, of which one was filled with a cylinder of porous PA. The other was left untreated. PA70/30 and PA60/40 were investigated, both before and after being incubated with allogenic bone marrow. Analyses were performed after 4, 8, 26 and 52 weeks and comprised dual energy X-ray absorptiometry (DXA) and image analysis of histological sections. DXA revealed an increased bone mineral density in the filled defects compared to the controls, both at the defect and immediately proximal and distal of the defect. Histology showed that gap-bridging had occurred within 8 weeks, with 80%-90% of the pores of PA70/30 and PA60/40 occupied by new bone, and an intimate bone-PA contact. PA70/30 seemed to be more suitable compared to PA60/40, in that the highest amount of bone was formed within the shortest period of time. Incubation of PA with allogenic bone marrow resulted in inflammatory reactions at the sites of implantation, which delayed bone growth, but did not prevent it. It was concluded that PA70/30 and PA60/40 are suitable bone-graft substitutes.

Quantitative histological analysis of bony ingrowth within the biomaterial Polyactive implanted in different bone locations: an experimental study in rabbits.

The quantity of bone formed in cylinders of a newly developed erodible copolymer, Polyactive (PA60/40) was examined. PA60/40 was implanted in three different bone locations in the rabbit: in the cortex, in bone marrow and in trabecular subchondral bone. Bony ingrowth was assessed after 4, 8, 26 and 52 w after the operation and investigated by histology and image analysis. The ingrowth of bone was observed in PA60/40 placed in the cortex from 4 w onwards. After 8 w, more than 90% of the pores of the biomaterial were filled with dense bone. In bone marrow, initially some bone formation was seen. After 26 w, all newly formed bone was resorbed. Subchondral bone formation was less than in the cortex of the femur, but somewhat comparable to the amount of bone found in healthy trabecular bone. Bone formation appeared not to be affected by the degradation of the biomaterial. It was concluded that Polyactive is a suitable bone graft substitute. Bone formation within PA60/40 is site-dependent and this follows Wolff 's law.

Long-term results of rib perichondrial grafts for repair of cartilage defects in the human knee.

Eighty-eight patients with articular cartilage defects in the knee were treated by perichondrial arthroplasty between 1986 and 1992. An autogenous strip of costal perichondrium was fixed in place with fibrin glue, followed by immobilisation, continuous passive motion, and partial weightbearing. The results were evaluated using the Hospital for Special Surgery Score for knee function, radiographs, arthroscopy and the patient's subjective opinion. The results after a mean follow-up of 52 months were good in 38%, fair in 8% and poor in 55%. Previous drilling or shaving of a defect, concomitant osteoarthritis, older age and a long history of complaints proved to be contraindications. Good results were seen in 91% of isolated defects. Perichondrial arthroplasty can be beneficial in the repair of cartilage defects. It will reduce symptoms in carefully selected cases, and avoid more extensive operations for osteoarthritis.

Femoral canal occlusion in total hip replacement using a resorbable and flexible cement restrictor.

We have investigated the use of a conically-shaped cement plug made of Polyactive (PA), a biodegradable copolymer. The flexibility and hydrogel properties were thought to facilitate occlusion of the femoral canal even when it was oval or irregular in shape. The function of the plug was first compared with that of the Thackray polyethylene model in 16 artificial plastic femora. The maximum intramedullary pressure achieved during cementing was ten times higher with the biodegradable model. Migration or leakage of cement did not occur when the diameter of the femoral canal was equal to or smaller than the diameter of the plug. We also showed that the biodegradable properties of this implant were such that it did not require removal during revision. The new plug was tested in a pilot clinical trial. At two years only two out of 21 patients had evidence of migration or leakage of cement, probably due to a mismatch in the size of plug and femoral canal. There were no local changes in the femur.