Frightening Complex Visual Hallucinations in an Elderly Patient with Ophthalmological Pathology and Vascular Dementia.

A lady in her 90s was referred to the Later Life Team (LLT) in a rural area of the United Kingdom with complex visual hallucinations (VH). She had significant ophthalmological pathology, including cataracts, a branch retinal vein occlusion, and vitreous haemorrhage. The hallucinations included seeing monkeys ripping the heads off of her cats and lions prowling the garden. The patient was distressed by the hallucinations and believed them to be real events. Her management involved low dose olanzapine and requesting that her ophthalmological surgery be expedited. The surgery resulted in a significant reduction in VH. A diagnosis of vascular dementia went on to be made following cognitive testing and imaging. The cognitive impairment may have contributed to the patient's inability to identify her experiences as hallucinations and thus render her without insight. A review of the computed tomography (CT) scans performed prior to the patient's presentation to our service confirmed significant vascular pathology including small vessel disease and lacunar infarcts. Cognitive testing confirmed a cognitive impairment which had gone unnoticed by her family. This case leads to an interesting discussion regarding diagnosis in complex VH in cases of significant ophthalmological pathology but a lack of insight. Various authors have proposed theories to explain VH; cortical release and the Perception and Attention Deficit (PAD) model are explored as possible explanations for the experiences of this patient.

Differentiating anxiety forms and their role in academic performance from primary to secondary school.

INTRODUCTION: Individuals with high levels of mathematics anxiety are more likely to have other forms of anxiety, such as general anxiety and test anxiety, and tend to have some math performance decrement compared to those with low math anxiety. However, it is unclear how the anxiety forms cluster in individuals, or how the presence of other anxiety forms influences the relationship between math anxiety and math performance. METHOD: We measured math anxiety, test anxiety, general anxiety and mathematics and reading performance in 1720 UK students (year 4, aged 8-9, and years 7 and 8, aged 11-13). We conducted latent profile analysis of students' anxiety scores in order to examine the developmental change in anxiety profiles, the demographics of each anxiety profile and the relationship between profiles and academic performance. RESULTS: Anxiety profiles appeared to change in specificity between the two age groups studied. Only in the older students did clusters emerge with specifically elevated general anxiety or academic anxiety (test and math anxiety). Our findings suggest that boys are slightly more likely than girls to have elevated academic anxieties relative to their general anxiety. Year 7/8 students with specifically academic anxiety show lower academic performance than those who also have elevated general anxiety. CONCLUSIONS: There may be a developmental change in the specificity of anxiety and gender seems to play a strong role in determining one's anxiety profile. The anxiety profiles present in our year 7/8 sample, and their relationships with math performance, suggest a bidirectional relationship between math anxiety and math performance.

The Modified Abbreviated Math Anxiety Scale: A Valid and Reliable Instrument for Use with Children.

Mathematics anxiety (MA) can be observed in children from primary school age into the teenage years and adulthood, but many MA rating scales are only suitable for use with adults or older adolescents. We have adapted one such rating scale, the Abbreviated Math Anxiety Scale (AMAS), to be used with British children aged 8-13. In this study, we assess the scale's reliability, factor structure, and divergent validity. The modified AMAS (mAMAS) was administered to a very large (n = 1746) cohort of British children and adolescents. This large sample size meant that as well as conducting confirmatory factor analysis on the scale itself, we were also able to split the sample to conduct exploratory and confirmatory factor analysis of items from the mAMAS alongside items from child test anxiety and general anxiety rating scales. Factor analysis of the mAMAS confirmed that it has the same underlying factor structure as the original AMAS, with subscales measuring anxiety about Learning and Evaluation in math. Furthermore, both exploratory and confirmatory factor analysis of the mAMAS alongside scales measuring test anxiety and general anxiety showed that mAMAS items cluster onto one factor (perceived to represent MA). The mAMAS provides a valid and reliable scale for measuring MA in children and adolescents, from a younger age than is possible with the original AMAS. Results from this study also suggest that MA is truly a unique construct, separate from both test anxiety and general anxiety, even in childhood.

Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study.

Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3-4 for non-sepsis and 4 IQR 3-6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36-85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality.

Consensus and experience trump leadership, suppressing individual personality during social foraging.

Whether individual behavior in social settings correlates with behavior when individuals are alone is a fundamental question in collective behavior. However, evidence for whether behavior correlates across asocial and social settings is mixed, and no study has linked observed trends with underlying mechanisms. Consistent differences between individuals in boldness, which describes willingness to accept reward over risk, are likely to be under strong selection pressure. By testing three-spined sticklebacks (Gasterosteus aculeatus) in a risky foraging task alone and repeatedly in shoals, we demonstrate that the expression of boldness in groups is context-specific. Whereas personality is repeatable in a low-risk behavior (leaving a refuge), the collectively made consensus decision to then cross the arena outweighs leadership by bolder individuals, explaining the suppression of personality in this context. However, despite this social coordination, bolder individuals were still more likely to feed. Habituation and satiation over repeated trials degrade the effect of personality on leaving the refuge and also whether crossing the arena is a collective decision. The suppression of personality in groups suggests that individual risk-taking tendency may rarely represent actual risk in social settings, with implications for the evolution and ecology of personality variation.

Math anxiety and developmental dyscalculia: A study on working memory processes.

INTRODUCTION: Although many children encounter difficulties in arithmetic, the underlying cognitive and emotive factors are still not fully understood. This study examined verbal and visuospatial short-term memory (STM) and working memory (WM) performance in children with developmental dyscalculia (DD) and high mathematics anxiety (MA) compared with typically developing (TD) children. METHOD: Groups were matched on reading comprehension performance and IQ as well as on general anxiety. We aimed to test whether children with DD and MA were differently impaired in verbal and visuospatial STM and WM. Children were individually tested with four computerized tasks: two STM tasks (forward verbal and visuospatial recall) and two WM tasks (backward verbal and visuospatial recall). RESULTS: Relative to children with TD, those with DD did not show impairments on the forward or backward verbal tasks, but showed specific impairments in the visuospatial WM task. In contrast, children with MA were particularly impaired in the verbal WM task. CONCLUSIONS: Knowing the underlying cognitive processes that differentiate why children with DD and MA fail in math could have both educational and clinical implications.

The Chicken or the Egg? The Direction of the Relationship Between Mathematics Anxiety and Mathematics Performance.

This review considers the two possible causal directions between mathematics anxiety (MA) and poor mathematics performance. Either poor maths performance may elicit MA (referred to as the Deficit Theory), or MA may reduce future maths performance (referred to as the Debilitating Anxiety Model). The evidence is in conflict: the Deficit Theory is supported by longitudinal studies and studies of children with mathematical learning disabilities, but the Debilitating Anxiety Model is supported by research which manipulates anxiety levels and observes a change in mathematics performance. It is suggested that this mixture of evidence might indicate a bidirectional relationship between MA and mathematics performance (the Reciprocal Theory), in which MA and mathematics performance can influence one another in a vicious cycle.

A new FISH assay to simultaneously detect structural and numerical chromosomal abnormalities in mouse sperm.

De novo aberrations in chromosome structure represent important categories of paternally transmitted genetic damage. Unlike numerical abnormalities, the majority of de novo structural aberrations among human offspring are of paternal origin. We report the development of a three-color fluorescence in situ hybridization (FISH) assay (CT8) to detect mouse sperm carrying structural and numerical chromosomal abnormalities. The CT8 assay uses DNA probes for the centromeric and telomeric regions of chromosome 2, and a probe for the subcentromeric region of chromosome 8. The CT8 assay was used to measure the frequencies of sperm carrying certain structural aberrations involving chromosome 2 (del2ter, dup2ter, del2cen, dup2cen), disomy 2, disomy 8, and sperm diploidy. Analysis of approximately 80,000 sperm from eight B6C3F1 mice revealed an average baseline frequency of 2.5 per 10,000 sperm carrying partial duplications and deletions of chromosome 2. Extrapolated to the entire haploid genome, approximately 0.4% of mouse sperm are estimated to carry structural chromosomal aberrations, which is more than fivefold lower than the spontaneous frequencies of sperm with chromosome structural aberrations in man. We validated the CT8 assay by comparing the frequencies of abnormal segregants in sperm of T(2;14) translocation carriers detected by this assay against those detected by chromosome painting cytogenetic analysis of meiosis II spermatocytes. The CT8 sperm FISH assay is a promising method for detecting structural chromosome aberrations in mouse sperm with widespread applications in genetics, physiology, and genetic toxicology.

Numerical chromosomal abnormalities in rat epididymal spermatozoa following chronic cyclophosphamide exposure.

Chronic, low-dose treatment of male rats with cyclophosphamide, a chemotherapeutic agent, is known to affect progeny outcome adversely in a dose-dependent and time-specific manner, resulting in increased pre- and postimplantation loss as well as malformations. Concern exists regarding the genetic quality of mature gametes exposed to cyclophosphamide during mitosis and meiosis. The goal of the present study was to determine the effect of chronic cyclophosphamide treatment during spermatogenesis on the frequency of numerical chromosomal anomalies in epididymal spermatozoa. Male rats were treated with either saline or cyclophosphamide (6 mg kg-1 day-1) for 6 or 9 wk, and cauda epididymal spermatozoa were collected. The rat sperm Y-4 fluorescence in situ hybridization assay was used to assess the induction of spermatozoal disomy, nullisomy, and diploidy involving chromosomes Y and 4. The overall frequency of numerically abnormal spermatozoa was elevated approximately 2-fold (P < 0.001) after 9 wk of cyclophosphamide treatment. Exposure for 9 wk, but not for 6 wk, significantly increased the frequency of spermatozoa with chromosome 4 disomy (P < 0.02) and nullisomy (P < 0.05), but disomy Y and diploidy were not significantly increased with treatment compared to corresponding controls. Independent of treatment, only 27% of aneuploid spermatozoa presented with morphological abnormalities, but all diploid spermatozoa were approximately twice the size of normal cells. Thus, cyclophosphamide disrupts meiotic events before pachynema during spermatogenesis, emphasizing the potential for adverse progeny outcomes following genotoxic damage.