Beyond literal depiction: Children's flexible understanding of pictures.

Pictures can represent more than one entity, and they can also represent literal or nonliteral concepts associated with a referent. In two studies, we examined whether 4-year-olds, 6-year-olds, and adults can view pictures as both literal and nonliteral when they are presented with different contextual cues, which would indicate representational flexibility. In Study 1, children and adults were asked to name iconic pictures after hearing a story explaining how a fictional character had created or used a picture in, for instance, a literal context (e.g., a girl used a picture of a crown to represent what she wanted for Christmas) and a second story on how the same artist produced or used an identical picture in a nonliteral context (e.g., the same girl used the picture of a crown to represent what she wanted to be when she grew up). After each story, the picture was shown and participants were asked "What does this mean?" The 6-year-olds and adults, but not the 4-year-olds, showed representational flexibility in their interpretations of pictures across contexts. Study 2 provided evidence of flexible pictorial interpretations, even for the younger age group, when children were presented with a game in which they were asked to select a suitable picture to represent a nonliteral referent. Taken together, our results suggest that the conditions under which representational flexibility is elicited influence the developmental progression observed.

Combined Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Reconstruction for Recurrent Lateral Patellar Instability in Patients With Multiple Anatomic Risk Factors.

PURPOSE: To report the outcomes for combined tibial tubercle osteotomy (TTO) and medial patellofemoral ligament (MPFL) reconstruction and assess for potential risk factors for recurrent instability and/or poor outcomes. METHODS: The medical record at our institution was reviewed for patients treated with MPFL reconstruction and TTO for recurrent lateral patellar instability from 1998 to 2014. Preoperative imaging was assessed for trochlear dysplasia according to the Dejour classification (high grade = B, C, D) and the presence of patella alta using the Caton-Deschamps ratio (>1.2). The indication for combined MPFL reconstruction and TTO was MPFL insufficiency and a lateralized tibial tubercle. Outcomes were determined by recurrent instability, return to sport, and Kujala and International Knee Documentation Committee (IKDC) scores. RESULTS: Thirty knees in 28 patients (14 M, 14 F) with a mean age of 22.6 ± 9.1 years (range, 13-51 years) were included with a mean follow-up of 48 ± 28 months (24-123 months). Seventy-three percent (22/30) had high-grade trochlear dysplasia, and 63% (19/30) had patella alta. One patient had a postoperative dislocation and 1 had a subluxation event. The Caton-Deschamps ratio decreased by a mean of 0.2 (P = .001), leaving 30% with postoperative patella alta. The mean postoperative scores were as follows: Tegner = 5 ± 2, Kujala = 89 ± 16 (45-100), and IKDC = 85 ± 17 (44-100). Eighty-three percent (15/18) returned to their preoperative sport. Female gender was a risk factor for lower IKDC (77.3 vs. 92.6, P = .01) and Kujala (82.2 vs. 95.0, P = .03) scores. Medialization greater than 10 mm was directly correlated to lower IKDC (P = .02) and Kujala (P = .01) scores. CONCLUSIONS: The combination of MPFL reconstruction and TTO in patients with trochlear dysplasia results in low recurrence of instability. Patients on average had good subjective outcomes and were able to return to sport. Female gender and tibial tubercle medialization greater than 10 mm were associated with worse outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Religiosity in Acute Psychiatric Inpatients: Relationship With Demographics, Clinical Features, and Length of Stay.

This study examined the relationship between religiosity in 175 psychiatric inpatients as measured by the subscales of the Duke University Religion Index (DUREL) and sociodemographic (age, sex, and race), clinical (primary diagnosis, suicidality, and psychotic symptoms), and outcome (length of stay [LOS] and readmission rates) measures. Psychosis was assessed by Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale. Bivariate and multivariate analyses were used to examine the association between the DUREL subscales and the outcome measures. High scorers on the nonorganized religiosity subscale were less likely to have psychosis (47% vs. 52%; p < 0.05) but had greater psychosis severity (mean ± SD, 14.5 ± 5 vs.12.4 ± 6; p < 0.05), as measured by the CRDPSS scale, and significantly longer LOS (mean ± SD, 8.3 ± 3.8 vs. 6.9 ± 3.4; p < 0.05). Conversely, they were less likely to report previous suicide attempts than low scorers (p < 0.05). These results suggest that a brief measure of religious activities may identify psychiatric inpatients at greater risk for psychosis, suicidality, and longer hospitalizations.

Detection of pleiotropy through a Phenome-wide association study (PheWAS) of epidemiologic data as part of the Environmental Architecture for Genes Linked to Environment (EAGLE) study.

We performed a Phenome-wide association study (PheWAS) utilizing diverse genotypic and phenotypic data existing across multiple populations in the National Health and Nutrition Examination Surveys (NHANES), conducted by the Centers for Disease Control and Prevention (CDC), and accessed by the Epidemiological Architecture for Genes Linked to Environment (EAGLE) study. We calculated comprehensive tests of association in Genetic NHANES using 80 SNPs and 1,008 phenotypes (grouped into 184 phenotype classes), stratified by race-ethnicity. Genetic NHANES includes three surveys (NHANES III, 1999-2000, and 2001-2002) and three race-ethnicities: non-Hispanic whites (n = 6,634), non-Hispanic blacks (n = 3,458), and Mexican Americans (n = 3,950). We identified 69 PheWAS associations replicating across surveys for the same SNP, phenotype-class, direction of effect, and race-ethnicity at p<0.01, allele frequency >0.01, and sample size >200. Of these 69 PheWAS associations, 39 replicated previously reported SNP-phenotype associations, 9 were related to previously reported associations, and 21 were novel associations. Fourteen results had the same direction of effect across more than one race-ethnicity: one result was novel, 11 replicated previously reported associations, and two were related to previously reported results. Thirteen SNPs showed evidence of pleiotropy. We further explored results with gene-based biological networks, contrasting the direction of effect for pleiotropic associations across phenotypes. One PheWAS result was ABCG2 missense SNP rs2231142, associated with uric acid levels in both non-Hispanic whites and Mexican Americans, protoporphyrin levels in non-Hispanic whites and Mexican Americans, and blood pressure levels in Mexican Americans. Another example was SNP rs1800588 near LIPC, significantly associated with the novel phenotypes of folate levels (Mexican Americans), vitamin E levels (non-Hispanic whites) and triglyceride levels (non-Hispanic whites), and replication for cholesterol levels. The results of this PheWAS show the utility of this approach for exposing more of the complex genetic architecture underlying multiple traits, through generating novel hypotheses for future research.

Predictors of psychiatric readmission among patients with bipolar disorder at an academic safety-net hospital.

OBJECTIVE: Even with treatment, approximately one-third of patients with bipolar disorder relapse into depression or mania within 1 year. Unfavorable clinical outcomes for patients with bipolar disorder include increased rates of psychiatric hospitalization and functional impairment. However, only a few studies have examined predictors of psychiatric hospital readmission in a sample of patients with bipolar disorder. The purpose of this study was to examine predictors of psychiatric readmission within 30 days, 90 days and 1 year of discharge among patients with bipolar disorder using a conceptual model adapted from Andersen's Behavioral Model of Health Service Use. METHODS: In this retrospective study, univariate and multivariate logistic regression analyses were conducted in a sample of 2443 adult patients with bipolar disorder who were consecutively admitted to a public psychiatric hospital in the United States from 1 January to 31 December 2013. RESULTS: In the multivariate models, several enabling and need factors were significantly associated with an increased risk of readmission across all time periods examined, including being uninsured, having ⩾3 psychiatric hospitalizations and having a lower Global Assessment of Functioning score. Additional factors associated with psychiatric readmission within 30 and 90 days of discharge included patient homelessness. Patient race/ethnicity, bipolar disorder type or a current manic episode did not significantly predict readmission across all time periods examined; however, patients who were male were more likely to readmit within 1 year. The 30-day and 1-year multivariate models showed the best model fit. CONCLUSION: Our study found enabling and need factors to be the strongest predictors of psychiatric readmission, suggesting that the prevention of psychiatric readmission for patients with bipolar disorder at safety-net hospitals may be best achieved by developing and implementing innovative transitional care initiatives that address the issues of multiple psychiatric hospitalizations, housing instability, insurance coverage and functional impairment.

Lipid trait-associated genetic variation is associated with gallstone disease in the diverse Third National Health and Nutrition Examination Survey (NHANES III).

BACKGROUND: Gallstone disease is one of the most common digestive disorders, affecting more than 30 million Americans. Previous twin studies suggest a heritability of 25% for gallstone formation. To date, one genome-wide association study (GWAS) has been performed in a population of European-descent. Several candidate gene studies have been performed in various populations, but most have been inconclusive. Given that gallstones consist of up to 80% cholesterol, we hypothesized that common genetic variants associated with high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) would also be associated with gallstone risk. METHODS: To test this hypothesis, the Epidemiologic Architecture for Genes Linked to Environment (EAGLE) study as part of the Population Architecture using Genomics and Epidemiology (PAGE) study performed tests of association between 49 GWAS-identified lipid trait SNPs and gallstone disease in non-Hispanic whites (446 cases and 1,962 controls), non-Hispanic blacks (179 cases and 1,540 controls), and Mexican Americans (227 cases and 1,478 controls) ascertained for the population-based Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: At a liberal significance threshold of 0.05, five, four, and four SNP(s) were associated with disease risk in non-Hispanic whites, non-Hispanic blacks, and Mexican Americans, respectively. No one SNP was associated with gallstone disease risk in all three racial/ethnic groups. The most significant association was observed for ABCG5 rs6756629 in non-Hispanic whites [odds ratio (OR) = 1.89; 95% confidence interval (CI) = 1.44-2.49; p = 0.0001). ABCG5 rs6756629 is in strong linkage disequilibrium with rs11887534 (D19H), a variant previously associated with gallstone disease risk in populations of European-descent. CONCLUSIONS: We replicated a previously associated variant for gallstone disease risk in non-Hispanic whites. Further discovery and fine-mapping efforts in diverse populations are needed to fully describe the genetic architecture of gallstone disease risk in humans.

Effects of smoking on the genetic risk of obesity: the population architecture using genomics and epidemiology study.

BACKGROUND: Although smoking behavior is known to affect body mass index (BMI), the potential for smoking to influence genetic associations with BMI is largely unexplored. METHODS: As part of the 'Population Architecture using Genomics and Epidemiology (PAGE)' Consortium, we investigated interaction between genetic risk factors associated with BMI and smoking for 10 single nucleotide polymorphisms (SNPs) previously identified in genome-wide association studies. We included 6 studies with a total of 56,466 subjects (16,750 African Americans (AA) and 39,716 European Americans (EA)). We assessed effect modification by testing an interaction term for each SNP and smoking (current vs. former/never) in the linear regression and by stratified analyses. RESULTS: We did not observe strong evidence for interactions and only observed two interactions with p-values <0.1: for rs6548238/TMEM18, the risk allele (C) was associated with BMI only among AA females who were former/never smokers (ß = 0.018, p = 0.002), vs. current smokers (ß = 0.001, p = 0.95, p(interaction) = 0.10). For rs9939609/FTO, the A allele was more strongly associated with BMI among current smoker EA females (ß = 0.017, p = 3.5 x 10(-5)), vs. former/never smokers (ß = 0.006, p = 0.05, p(interaction) = 0.08). CONCLUSIONS: These analyses provide limited evidence that smoking status may modify genetic effects of previously identified genetic risk factors for BMI. Larger studies are needed to follow up our results. CLINICAL TRIAL REGISTRATION: NCT00000611.

Educating the design stance: issues of coherence and transgression.

Bullot & Reber (B&R) put forth a design stance to fuse psychological and art historical accounts of visual thinking into a single theory. We argue that this aspect of their proposal needs further fine-tuning. Issues of transgression and coherence are necessary to provide stability to the design stance. We advocate looking to Art Education for such fundamentals of picture understanding.

Longitudinal Analysis of Mental Health in Autistic University Students Across an Academic Year.

BACKGROUND: Autistic people have worse mental health (MH) than non-autistic people. This proof-of-concept study explored feasibility of longitudinal research with autistic university students, focusing on their MH and coping styles across an academic year. METHODS: Twenty-two students took part at all timepoints. They completed four rounds of online MH questionnaires. RESULTS: Over 80% of students were retained. They started the year with high levels of all MH issues, which remained stable across the year. Network Change analysis showed the connections between MH and coping style changed over time. CONCLUSIONS: Autistic students are engaged participants who are likely to take part in longitudinal research. While MH levels were stable, it may be that coping styles are a useful target for intervention.

Spatiotemporal Parameters of Gait Among Adolescent Athletes with Concussion When Performing a Visuospatial Cognitive Task.

Background: Adolescent athletes aged 10 to 19 years are at the highest risk of experiencing sport-related concussions (SRCs). Despite the known deficits and battery of assessments following concussion, postural stability during dual-task gait remains understudied in this population. Purpose: The purpose of this study was to evaluate the dual-task cost (DTC) in adolescents with an acute or chronic SRC compared to reference values from healthy athlete peers for spatiotemporal parameters of gait during walking with and without a concurrent visuospatial memory task presented on a hand-held tablet. Researchers hypothesized that adolescents during the acute phase of concussion would be likely to experience a greater DTC compared to healthy peers in at least one spatiotemporal parameter of gait when walking within the dual-task paradigm. Study Design: Cross-sectional, observational cohort design. Methods: Adolescents with concussion were recruited to participate. Subjects were divided into acute and chronic categories based on significant differences in the neuropsychological function after a period of 28 days. They walked at a self-selected speed along the 5.186-meter GAITRite® Walkway System with and without a concurrent visuospatial cognitive task presented on a hand-held tablet. Outcomes included normalized velocity (m/s), step length (m), and double limb (DLS) and single limb support (SLS) (defined as the percent of a gait cycle [%GC]). The data were then compared to the previously published reference values established using the same methods in the healthy athlete participants for all spatiotemporal parameters of gait. Results: Data was collected on 29 adolescent athletes with SRC. Among males (15.53+/-1.12 years) with SRC, 20% of acute and 10% of chronic cases experienced a greater DTC compared to healthy athlete reference values. A similarly increased DTC was experienced by 83% of acute and 29% of chronic SRC cases for females (15.58+/-1.16 years). Conclusions: Adolescent athletes with concussion may continue demonstrating deficits in gait capabilities even in the chronic phase, and compensatory gait strategies were not the same between males and females. Dual-task cost assessment using the GAITRite® may be a valuable adjunct to comprehensive analysis of gait following SRC. Level of Evidence: 2.

The Effects of Wearing a Portable Media Armband on Muscle Activation of the Biceps Brachii.

Portable media armbands are commonly used among the physically active population. Their effect on muscle function has not been established. The purpose of this study was to determine if muscle activation of the biceps brachii is influenced by wearing a portable media armband during an elbow flexion exercise. Eighteen participants (11 males: age = 22.5 ± 2.1 years, height = 178.3 ± 5.2 cm, mass = 85.0 ± 6.5 kg; 7 females: age = 22.9 ± 2.5 years, height = 168.3 ± 5.7 cm, mass = 72.3 ± 12.2 kg) with no history of upper extremity injury volunteered for the study. Participants performed elbow flexion trials with a hand-held dumbbell with and without wearing a portable media armband. Dumbbell weight was determined by an 8-10 repetition maximum, and the condition was counterbalanced. The average concentric and eccentric phases for five trials for each condition were normalized to a maximum voluntary isometric contraction using electromyography. The independent variable was condition (with-PMAB and without-PMAB). The dependent variable was the muscle activation of the biceps brachii. Mean data for each condition were analyzed using separate paired-samples t-tests for the concentric and eccentric phases (p < 0.05). Statistical analysis revealed a significant difference for the concentric phase (t17 = 2.905; p = 0.010). The with-PMAB condition elicited greater muscle activation (72.57 ± 36.31%) compared to the without-PMAB (63.67 ± 26.2%), with a medium effect size (d = 0.69). There was no statistical difference for the eccentric phase (t17 = 1.964; p = 0.066), and a small effect size (d = 0.46). The increase in muscle activation during the concentric phase is likely due to a change in the muscle properties due to the compressive force applied to the muscle fibers by the portable media armband.

The generation of the first chromosome-level de novo genome assembly and the development and validation of a 50K SNP array for the St. John River aquaculture strain of North American Atlantic salmon.

Atlantic salmon (Salmo salar) in Northeastern US and Eastern Canada has high economic value for the sport fishing and aquaculture industries. Large differences exist between the genomes of Atlantic salmon of European origin and North American (N.A.) origin. Given the genetic and genomic differences between the 2 lineages, it is crucial to develop unique genomic resources for N.A. Atlantic salmon. Here, we describe the resources that we recently developed for genomic and genetic research in N.A. Atlantic salmon aquaculture. Firstly, a new single nucleotide polymorphism (SNP) database for N.A. Atlantic salmon consisting of 3.1 million putative SNPs was generated using data from whole-genome resequencing of 80 N.A. Atlantic salmon individuals. Secondly, a high-density 50K SNP array enriched for the genic regions of the genome and containing 3 sex determination and 61 putative continent of origin markers was developed and validated. Thirdly, a genetic map composed of 27 linkage groups with 36K SNP markers was generated from 2,512 individuals in 141 full-sib families. Finally, a chromosome-level de novo genome assembly from a male N.A. Atlantic salmon from the St. John River aquaculture strain was generated using PacBio long reads. Information from Hi-C proximity ligation sequences and Bionano optical mapping was used to concatenate the contigs into scaffolds. The assembly contains 1,755 scaffolds and only 1,253 gaps, with a total length of 2.83 Gb and N50 of 17.2 Mb. A BUSCO analysis detected 96.2% of the conserved Actinopterygii genes in the assembly, and the genetic linkage information was used to guide the formation of 27 chromosome sequences. Comparative analysis with the reference genome assembly of the European Atlantic salmon confirmed that the karyotype differences between the 2 lineages are caused by a fission in chromosome Ssa01 and 3 chromosome fusions including the p arm of chromosome Ssa01 with Ssa23, Ssa08 with Ssa29, and Ssa26 with Ssa28. The genomic resources we have generated for Atlantic salmon provide a crucial boost for genetic research and for management of farmed and wild populations in this highly valued species.

Serum vitamins A and E as modifiers of lipid trait genetics in the National Health and Nutrition Examination Surveys as part of the Population Architecture using Genomics and Epidemiology (PAGE) study.

Both environmental and genetic factors impact lipid traits. Environmental modifiers of known genotype-phenotype associations may account for some of the "missing heritability" of these traits. To identify such modifiers, we genotyped 23 lipid-associated variants identified previously through genome-wide association studies (GWAS) in 2,435 non-Hispanic white, 1,407 non-Hispanic black, and 1,734 Mexican-American samples collected for the National Health and Nutrition Examination Surveys (NHANES). Along with lipid levels, NHANES collected environmental variables, including fat-soluble macronutrient serum levels of vitamin A and E levels. As part of the Population Architecture using Genomics and Epidemiology (PAGE) study, we modeled gene-environment interactions between vitamin A or vitamin E and 23 variants previously associated with high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels. We identified three SNP × vitamin A and six SNP × vitamin E interactions at a significance threshold of p < 2.2 × 10(-3). The most significant interaction was APOB rs693 × vitamin E (p = 8.9 × 10(-7)) for LDL-C levels among Mexican-Americans. The nine significant interaction models individually explained 0.35-1.61% of the variation in any one of the lipid traits. Our results suggest that vitamins A and E may modify known genotype-phenotype associations; however, these interactions account for only a fraction of the overall variability observed for HDL-C, LDL-C, and TG levels in the general population.

Risk factors for early symptomatic femoroacetabular impingement following in situ fixation of slipped capital femoral epiphysis.

In situ fixation of slipped capital femoral epiphysis (SCFE) results in residual deformity that can cause femoroacetabular impingement (FAI). It is unknown what factors could help differentiate patients who are more likely to become symptomatic. We performed a retrospective review of 55 hips treated with in situ pinning for SCFE and subsequent secondary deformity correction procedure for symptomatic FAI and compared them to 39 asymptomatic hips with SCFE deformity using multivariable analysis. Case patients were slightly older than controls (12.6 vs 11.3 years, p = 0.0002) but had similar BMI. The mean epiphyseal-diaphyseal angle was 56° in cases versus 44° in controls (p = 0.0019). Cases were significantly more likely to have obligate external rotation with hip flexion, external foot progression, flexion <90°, antalgic limp, and Trendelenburg lurch. On radiographs, most cases had a head-neck offset ≤0 mm, a distinct metaphyseal corner prominence, acetabular retroversion, and an alpha angle ≥60°. Most controls also had head-neck offset ≤0 mm. Pre-pinning, older age (OR = 1.98 per year, p = 0.0016) and initial epiphyseal-diaphyseal angle (OR = 1.04 per degree, p = 0.018) significantly increased the odds of having symptomatic FAI. Post-pinning, external foot progression increased the odds of symptomatic FAI by 10.48 (p = 0.017), and an alpha angle ≥60° resulted in 11.4 times higher odds of symptomatic FAI (p = 0.011). The linear correlation between epiphyseal-diaphyseal and alpha angle was poor (r = 0.28). Older age and initial epiphyseal-diaphyseal pre-pinning mildly increased the odds of eventual symptomatic FAI. This information can help the surgeon to predict which patients may develop symptomatic FAI.

Evidence for syntactic alignment in children with autism.

We report an experiment that examined whether children with Autistic Spectrum Disorder (ASD) spontaneously converge, or align, syntactic structure with a conversational partner. Children with ASD were more likely to produce a passive structure to describe a picture after hearing their interlocutor use a passive structure to describe an unrelated picture when playing a card game. Furthermore, they converged syntactic structure with their interlocutor to the same extent as did both chronological and verbal age-matched controls. These results suggest that the linguistic impairment that is characteristic of children with ASD, and in particular their difficulty with interactive language usage, cannot be explained in terms of a general deficit in linguistic imitation.