Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021.

We detected infection with highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b in 2 red fox (Vulpes vulpes) cubs found in the wild with neurologic signs in the Netherlands. The virus is related to avian influenza viruses found in wild birds in the same area.

RETROSPECTIVE STUDY OF SURGICAL TREATMENT OF REFRACTIVE OSTEOMYELITIS AND INFECTIOUS ARTHRITIS IN THE FLIPPERS OF SEALS IN THE NETHERLANDS.

Amputation surgery in pinniped rehabilitation centers is a feasible procedure when animals are presented with open fractures, osteomyelitis, and/or infectious arthritis of the flippers that appear to be refractory to medical treatment. From 2011 to 2017, the Sealcentre Pieterburen in The Netherlands admitted 3,775 seals for rehabilitation. Of these, 37 individuals presented clinical and radiologic signs of bone abnormalities indicative of osteomyelitis or infectious arthritis refractory to medical treatment. Seven cases resulted in euthanasia, and 30 cases underwent amputation surgery. The surgical procedure involved amputation of part of a flipper (24; two animals twice) or of a complete flipper (eight). All procedures were done under general anesthesia except one that was performed with local anesthesia, and all 30 animals were released. In two cases, the osteomyelitis presented with the rare Totenlade phenomenon, a sequestrum surrounded by new periosteal bone formation. The purpose of this retrospective study was to evaluate the outcome of the operative treatment of osteomyelitis and infectious arthritis in the flippers of harbor (Phoca vitulina) and grey seals (Halichoerus grypus) during this 6-yr period.

Correction to: Does executive function capacity moderate the outcome of executive function training in children with ADHD?

The original version of this article unfortunately contained a mistake. The captions of Figures 1 and 2 were swapped.

Does executive function capacity moderate the outcome of executive function training in children with ADHD?

Executive functioning (EF) training interventions aimed at ADHD-symptom reduction have limited results. However, EF training might only be effective for children with relatively poor EF capacity. This randomized double-blind placebo-controlled study examined whether pre-training EF capacity moderates the outcome of an EF-training intervention on measures of near transfer (EF performance) and far transfer (ADHD symptoms and parent-rated EF behavior) immediately after treatment and at 3-month follow-up. Sixty-one children with ADHD (aged 8-12) were randomized either to an EF-training condition where working memory, inhibition and cognitive flexibility were trained, or to a placebo condition. Single moderation models were used. All significant moderation outcomes had small effect sizes. After Bonferroni correction, there were no significant moderators of treatment outcome. Children with poor EF capacity do not benefit more from EF training than from placebo training. Training only EF-impaired children will probably not improve outcomes of EF training studies.

Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial.

BACKGROUND: Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants' motivation to train. OBJECTIVE: This study aimed to evaluate whether adding game elements to the training could help improve adolescents' motivation to train while improving cognition. METHODS: A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training. RESULTS: Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline. CONCLUSIONS: We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time.

Executive Function Computerized Training in Very Preterm-Born Children: A Pilot Study.

OBJECTIVE: Attention problems are one of the most pronounced and documented consequences of very preterm birth (gestational age ≤32 weeks). However, up to now, there is no research published on suitable interventions at school age aimed to overcome these problems. Research in this population did show that executive functions (EFs) are strongly associated with inattention. BrainGame Brian is a newly developed computerized training, in which, in 25 training sessions, the core EFs, including working memory, impulse control, and cognitive flexibility, are trained. This pilot study aimed to examine the feasibility of studying BrainGame Brian in very preterm-born children with attention problems. DESIGN: Pilot feasibility intervention study with one baseline and one follow-up assessment. MATERIALS AND METHODS: Feasibility was measured by the participation rate, dropout rate, and user experiences with regard to effort, training characteristics, and recommendation to others. From a larger cohort study, 15 very preterm-born children at age 10 years with parent-reported attention problems on the Child Behavior Checklist/6-18 years were invited to participate in this pilot study. BrainGame Brian was performed for a period of 6 weeks. Training outcome measures included visual working memory, impulse control, cognitive flexibility, speed variability, and parent-rated attention, for which pre- and post-training differences were examined at the group level by the Wilcoxon signed-rank test as well as for each individual child separately by the reliable change index. RESULTS: Twelve of 15 children and their parents agreed to participate and 11 children successfully completed BrainGame Brian in the 6-week period. Parents were positive about training characteristics and lack of interference with schooling, but scored the effort as high. We found clinically significant changes in visual working memory and speed variability in post-training assessments. CONCLUSION: BrainGame Brian is a feasible intervention for very preterm-born children with attention problems.

Do Extremely Violent Juveniles Respond Differently to Treatment?

This study increases knowledge on effectiveness of treatment for extremely violent (EV) youth by investigating their response to multisystemic therapy (MST). Using data of a randomized controlled trial on effectiveness of MST, we investigated differences in treatment response between EV youth and not extremely violent (NEV) youth. Pre- to post-treatment comparison indicated MST was equally effective for EV and NEV youth, whereas treatment as usual was not effective for either group. Growth curves of within-treatment changes indicated EV youth responded differently to MST than NEV youth. The within-treatment change was for EV youth non-linear: Initially, they show a deterioration; however, after one month, EV juveniles respond positively to MST, indicating longer lasting, intensive programs may be effective in treating extreme violence.

Exploring possible predictors and moderators of an executive function training for children with an autism spectrum disorder.

Previously, a total of 121 children with an autism spectrum disorder (ASD) performed an adaptive working memory (WM)-training, an adaptive flexibility-training, or a non-adaptive control (mock)-training. Despite overall improvement, there were minor differences between the adaptive and mock-training conditions. Moreover, dropout was relatively high (26%). In the current study we explored potential predicting and moderating factors to clarify these findings. The effects of intelligence, autism traits, WM, flexibility, reward sensitivity and Theory of Mind on dropout, improvement during training, and improvement in everyday executive functioning (EF), ASD-like behavior, and Quality of Life (QoL) were studied. None of the predictors influenced dropout or training improvement. However, 1) more pre-training autism traits related to less improvement in EF and QoL, and 2) higher reward sensitivity was related to more improvement in QoL and ASD-like behavior. These findings suggest that these EF-training procedures may be beneficial for children with fewer autism traits and higher reward sensitivity. However, the exploratory nature of the analyses warrant further research before applying the findings clinically.

Qualitative Treatment-Subgroup Interactions in a Randomized Clinical Trial of Treatments for Adolescents with ADHD: Exploring What Cognitive-Behavioral Treatment Works for Whom.

OBJECTIVE: This study explored qualitative treatment-subgroup interactions within data of a RCT with two cognitive behavioral treatments (CBT) for adolescents with ADHD: a planning-focused (PML) and a solution-focused CBT (SFT). Qualitative interactions imply that which treatment is best differs across subgroups of patients, and are therefore most relevant for personalized medicine. METHODS: Adolescents with ADHD (N = 159) received either PML or SFT. Pre-, post- and three-month follow-up data were gathered on parent-rated ADHD symptoms and planning problems. Pretreatment characteristics were explored as potential qualitative moderators of pretest to follow-up treatment effects, using an innovative analyses technique (QUINT; Dusseldorp & Van Mechelen, 2014). In addition, qualitative treatment-subgroup interactions for the therapeutic changes from pre- to posttest and from post- to follow-up test were investigated. RESULTS: For the entire time span from pretest to follow-up only a quantitative interaction was found, while from posttest to follow-up qualitative interactions were found: Adolescents with less depressive symptoms but more anxiety symptoms showed more improvement when receiving PML than SFT, while for other adolescents the effects of PML and SFT were comparable. DISCUSSION: Whereas subgroups in both treatments followed different trajectories, no subgroup was found for which SFT outperformed PML in terms of the global change in symptoms from pretest to three months after treatment. This implies that, based on this exploratory study, there is no need for personalized treatment allocation with regard to the CBTs under study for adolescents with ADHD. However, for a subgroup with comorbid anxiety symptoms but low depression PML clearly appears the treatment of preference. TRIAL REGISTRATION: Nederlands Trial Register NTR2142.

One-year follow-up of two novel CBTs for adolescents with ADHD.

Long-term effects of two CBTs for adolescents with ADHD are explored: One aimed at improving planning skills (Plan My Life; PML), the other a solution-focused therapy (SFT) without focusing on planning skills. In a RCT, adolescents with ADHD (n = 159) were assigned to PML or SFT and improved significantly between pre- and posttest with large effect sizes Boyer et al (Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-014-0661-5 ), with marginal differences in favor of PML. One-year follow-up data were gathered. Initial improvements remained stable or continued to improve from posttest to 1-year follow-up. 25.9 % of adolescents showed normalized functioning. However, no treatment differences were found. These results are consistent with the finding that treatment of ADHD improves long-term outcomes, but not to the point of normalization. Earlier found differences at 3-month follow-up in favor of PML disappeared, indicating that focusing treatment on planning skills is not necessary for improvement or that a more prolonged planning-focused treatment is needed.

SURGICAL TREATMENT OF OSTEOARTHRITIS IN HARBOR SEALS (PHOCA VITULINA).

In 2012, 543 harbor seals (Phoca vitulina) and 124 grey seals (Halichoerus grypus) were admitted to the Seal Rehabilitation and Research Centre in Pieterburen, The Netherlands. In 19 seals (3%), signs of infection in a hind flipper were observed. Initial treatment consisting of antibiotics and anti-inflammatory drugs resolved the symptoms in 15 animals. In four harbor seals, estimated to be 3 to 4 mo old, a necrotizing infection developed that resulted in osteoarthritis of the tarsus or tibiotarsal joint or both. Bacterial culture revealed the presence of polymicrobial infection in three of the four animals. Treatment consisted of amputation of the hind flipper under general anesthesia combined with tumescent anesthesia in the operation field. Amputations were done at the diaphysis of the tibia and fibula. After resecting these bones, the flipper was discarded, leaving a good muscle-skin cuff to cover the edges of the bones and close the skin without tension. The estimated blood loss varied between <50 to 150 ml. Healing was uneventful, and both antibiotics and analgesics were gradually reduced according to the individual response. The seals did not show any functional impairment 1 mo postoperatively. After release to the sea, scrutinous revision of all radiographs showed signs of osteomyelitis in at least one animal in the proximal part of the tibia, also present preoperatively. It is concluded that tumescent anesthesia in seals may reduce perioperative blood loss and that a lower leg amputation is a surgically easy and clean approach for the treatment of osteoarthritis of the hind flipper of seals, giving good functional results (diving, catching fish, exiting a pool, and moving on land).

Cognitive Bias Modification for adolescents with substance use problems--Can serious games help?

BACKGROUND AND OBJECTIVES: Excessive use of psychoactive substances and resulting disorders are a major societal problem, and the most prevalent mental disorder in young men. Recent reviews have concluded that Cognitive Bias Modification (CBM) shows promise as an intervention method in this field. As adolescence is a critical formative period, successful early intervention may be key in preventing later substance use disorders that are difficult to treat. One issue with adolescents, however, is that they often lack the motivation to change their behavior, and to engage in multisession cognitive training programs. The upcoming use of serious games for health may provide a solution to this motivational challenge. METHODS: As the use of game-elements in CBM is fairly new, there are very few published studies in this field. This review therefore focuses on currently available evidence from similar fields, such as cognitive training, as well as several ongoing CBM gamification projects, to illustrate the general principles. RESULTS: A number of steps in the gamification process are identified, starting with the original, evidence-based CBM task, towards full integration in a game. While more data is needed, some steps seem better suited for CBM gamification than others. Based on the current evidence, several recommendations are made. LIMITATIONS: As the field is still in its infancy, further research is needed before firm conclusions can be drawn. CONCLUSIONS: Gamified CBM may be a promising way to reach at risk youth, but the term "game" should be used with caution. Suggestions are made for future research.

Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. a randomized double-blind placebo controlled trial.

INTRODUCTION: Executive functions (EFs) training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility). However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms. METHODS: Eighty-nine children with a clinical diagnosis of ADHD (aged 8-12) were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months) effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains. RESULTS: During training compliance was high (only 3% failed to meet compliance criteria). After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM) and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings. CONCLUSIONS: Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF training conditions). As such, in this multiple EF-training, mainly nonspecific treatment factors - as opposed to the specific effects of training EFs-seem related to far transfer effects found on EF and behavior. TRIAL REGISTRATION: trialregister.nl NTR2728. Registry name: improving executive functioning in children with ADHD: training executive functions within the context of a computer game; registry number: NTR2728.

Two novel CBTs for adolescents with ADHD: the value of planning skills.

Adolescents with ADHD have planning problems, often affecting school- and social functioning. Evidence-based treatments for adolescents with ADHD are scarce and treatment drop-out rates are substantial. The effectiveness of two new, individual, short-term cognitive behavioral therapies (CBT) was investigated: One with an aim on improving planning skills and one solution-focused treatment (SFT) without such an aim. Motivational Interviewing elements were added to both treatments to enhance treatment compliance. In a multi-center randomized clinical trial, 159 adolescents (12-17 years) with ADHD were randomly assigned to one of both treatments. Pre-, post- and 3-month follow-up data were gathered on five domains: Parent-rated ADHD, planning problems and executive functioning (primary outcomes), neuropsychological measures of planning, comorbid symptoms, general functioning, and teacher measures. Attrition was low in both treatments (5%). Adolescents improved significantly between pre- and post-test with large effect sizes on all domains. Improvements remained stable or continued to improve from post-test to follow-up, also when controlling for medication use. Marginally significant differences were found in favor of the planning-focused treatment: parents and therapists evaluated this treatment more positively than SFT and the planning-focused treatment showed more reduction of parent-rated planning problems. Two new CBTs with integrated motivational components were feasible and attrition was low. ADHD symptoms and co-existing problems of the adolescents improved from pre-test to 3 months after treatment. As the planning-focused treatment was evaluated more positive and had marginal additional beneficial effects to SFT, especially planning-focused CBT seems promising to fill the gap in available treatments for adolescents with ADHD.

Working memory and cognitive flexibility-training for children with an autism spectrum disorder: a randomized controlled trial.

BACKGROUND: People with autism spectrum disorders (ASDs) experience executive function (EF) deficits. There is an urgent need for effective interventions, but in spite of the increasing research focus on computerized cognitive training, this has not been studied in ASD. Hence, we investigated two EF training conditions in children with ASD. METHODS: In a randomized controlled trial, children with ASD (n = 121, 8-12 years, IQ > 80) were randomly assigned to an adaptive working memory (WM) training, an adaptive cognitive flexibility-training, or a non-adaptive control training (mock-training). Braingame Brian, a computerized EF-training with game-elements, was used. Outcome measures (pretraining, post-training, and 6-week-follow-up) were near-transfer to trained EFs, far-transfer to other EFs (sustained attention and inhibition), and parent's ratings of daily life EFs, social behavior, attention deficit hyperactivity disorder (ADHD)-behavior, and quality of life. RESULTS: Attrition-rate was 26%. Children in all conditions who completed the training improved in WM, cognitive flexibility, attention, and on parent's ratings, but not in inhibition. There were no significant differential intervention effects, although children in the WM condition showed a trend toward improvement on near-transfer WM and ADHD-behavior, and children in the cognitive flexibility condition showed a trend toward improvement on near-transfer flexibility. CONCLUSION: Although children in the WM condition tended to improve more in WM and ADHD-behavior, the lack of differential improvement on most outcome measures, the absence of a clear effect of the adaptive training compared to the mock-training, and the high attrition rate suggest that the training in its present form is probably not suitable for children with ASD.

Prevalence and diagnostic validity of motivational impairments and deficits in visuospatial short-term memory and working memory in ADHD subtypes.

Deficits in working memory (WM) and reinforcement sensitivity are thought to give rise to symptoms in the combined (ADHD-C) and inattentive subtype (ADHD-I) of ADHD. Children with ADHD are especially impaired on visuospatial WM, which is composed of short-term memory (STM) and a central executive. Although deficits in visuospatial WM and reinforcement sensitivity appear characteristic of children with ADHD on a group-level, the prevalence and diagnostic validity of these impairments is still largely unknown. Moreover, studies investigating this did not control for the interaction between motivational impairments and cognitive performance in children with ADHD, and did not differentiate between ADHD subtypes. Visuospatial WM and STM tasks were administered in a standard (feedback-only) and a high-reinforcement (feedback + 10 euros) condition, to 86 children with ADHD-C, 27 children with ADHD-I (restrictive subtype), and 62 typically developing controls (aged 8-12). Reinforcement sensitivity was indexed as the difference in performance between the reinforcement conditions. WM and STM impairments were most prevalent in ADHD-C. In ADHD-I, only WM impairments, not STM impairments, were more prevalent than in controls. Motivational impairments were not common (22% impaired) and equally prevalent in both subtypes. Memory and motivation were found to represent independent neuropsychological domains. Impairment on WM, STM, and/or motivation was associated with more inattention symptoms, medication-use, and lower IQ scores. Similar results were found for analyses of diagnostic validity. The majority of children with ADHD-C is impaired on visuospatial WM. In ADHD-I, STM impairments are not more common than in controls. Within both ADHD subtypes only a minority has an abnormal sensitivity to reinforcement.

ADHD Subtype Differences in Reinforcement Sensitivity and Visuospatial Working Memory.

Both cognitive and motivational deficits are thought to give rise to the problems in the combined (ADHD-C) and inattentive subtype (ADHD-I) of attention-deficit hyperactivity disorder (ADHD). In both subtypes one of the most prominent cognitive weaknesses appears to be in visuospatial working memory (WM), which is composed of short-term memory (STM) and a central executive (CE). In children with ADHD-C, both STM and the CE seem impaired, and together with motivational impairments, give rise to their deficits in visuospatial WM. In children with ADHD-I, no studies investigated these WM components and their interplay with motivational impairments. Effects of a standard (feedback only) and a high level of reinforcement (feedback + 10 euros) on visuospatial WM-, STM-, and CE performance were examined in 27 children with ADHD-I (restrictive-subtype), 70 children with ADHD-C, and 40 typically developing controls (aged 9-12). In both ADHD-subtypes CE and WM performance was worse than in controls. STM performance of children with ADHD-I was, in contrast to that of children with ADHD-C, not different from controls. STM and WM performance was worse in ADHD-C than in ADHD-I, whereas CE-related performance did not differ. High reinforcement improved STM and WM performance in both subtypes but not in controls. This improvement was equally pronounced in both subtypes. High reinforcement did not improve CE-related performance. Both subtypes have equally pronounced motivational deficits, which have detrimental effects on their visuospatial STM and WM performance. In contrast to children with ADHD-C, children with ADHD-I seem unimpaired on visuospatial STM; only an impaired CE and motivational impairments give rise to their deficits in visuospatial WM.

The anxiety severity interview for children and adolescents: an individualized repeated measure of anxiety severity.

The Anxiety Severity Interview for Children and Adolescents (ASICA) was developed for the repeated assessment of the impact of anxiety and control over anxiety symptoms. The ASICA incorporates three main components of anxiety: physical response, avoidant behaviour and anxious thoughts. The objective of this study was to evaluate the psychometric properties of the ASICA in children with anxiety disorder (n = 139, age 8-18 years) and a non-anxious control group (n = 40, age 8-18 years). A confirmatory factor analysis confirmed the intended factor structure. Internal reliability was moderate to good; inter-rater reliability was excellent. Four-week test-retest reliability was good. The ASICA discriminated between anxious and non-anxious children and appeared sensitive to treatment change. A cut-off score of 13 was determined. Convergent validity with anxiety symptoms was moderate; discriminant validity with depressive symptoms was less strong. The results suggest that the ASICA is a reliable instrument that could be used in clinical practice to repeatedly monitor anxiety severity.

Mediators of cognitive behavioral therapy for anxiety-disordered children and adolescents: cognition, perceived control, and coping.

The purpose is to investigate whether a change in putative mediators (negative and positive thoughts, coping strategies, and perceived control over anxious situations) precedes a change in anxiety symptoms in anxiety-disordered children and adolescents receiving cognitive behavioral therapy (CBT). Participants were 145 Dutch children (8-18 years old, M = 12.5 years, 57% girls) with a primary anxiety disorder. Assessments were completed pretreatment, in-treatment, posttreatment, and at 3-month follow-up. Sequential temporal dependencies between putative mediators and parent- and child-reported anxiety symptoms were investigated in AMOS using longitudinal Latent Difference Score Modeling. During treatment an increase of positive thoughts preceded a decrease in child-reported anxiety symptoms. An increase in three coping strategies (direct problem solving, positive cognitive restructuring, and seeking distraction) preceded a decrease in parent-reported anxiety symptoms. A reciprocal effect was found for perceived control: A decrease in parent-reported anxiety symptoms both preceded and followed an increase in perceived control. Using a longitudinal design, a temporal relationship between several putative mediators and CBT-outcome for anxious children was explored. The results suggest that a change in positive thoughts, but not negative thoughts, and several coping strategies precedes a change in symptom reduction and, therefore, at least partly support theoretical models of anxiety upon which the anxiety intervention is based.