The Relationship Between Emotion Dysregulation and Error Monitoring in Adolescents with ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is emblematic of the limitations of existing diagnostic categories. One potential solution, consistent with the Research Domain Criteria (RDoC) initiative, is to interrogate psychological mechanisms at the behavioral and physiological level together to try and identify meaningful subgroups within existing categories. Such approaches provide a way to revise diagnostic boundaries and clarify individual variation in mechanisms. Here, we illustrate this approach to help resolve heterogeneity in ADHD using a combination of behaviorally-rated temperament measures from the Early Adolescent Temperament Questionnaire; cognitive performance on three difference conditions of an emotional go/no-go task; and electroencephalogram (EEG)-measured variation in multiple stages of error processing, including the error-related negativity (ERN) and positivity (Pe). In a large (N = 342), well-characterized sample of adolescents with ADHD, latent profile analysis identified two ADHD temperament subgroups: 1) emotionally regulated and 2) emotionally dysregulated (with high negative affect). Cognitive and EEG assessment in a subset of 272 adolescents (nADHD = 151) found that the emotionally dysregulated group showed distinct patterns of change in early neural response to errors (ERN) across emotional task conditions as compared to emotionally-regulated ADHD adolescents and typically-developing controls. Both ADHD groups showed blunted later response to errors (Pe) that was stable across emotional task conditions. Overall, neural response patterns identified important differences in how trait and state emotion interact to affect cognitive processing. Results highlight important temperament variation within ADHD that helps clarify its relationship to the ERN, one of the most prominent putative neural biomarkers for psychopathology.

Assessing professional competence in optometry - a review of the development and validity of the written component of the competency in optometry examination (COE).

BACKGROUND: Credentialing assessment for overseas-educated optometrists seeking registration in Australia and New Zealand is administered by the Optometry Council of Australia and New Zealand. The aim was to review the validation and outcomes of the written components of this exam to demonstrate credentialing meets entry-level competency standards. METHODS: The Competency in Optometry Examination consists of two written and two clinical parts. Part 1 of the written exam comprises multiple choice questions (MCQ) covering basic and clinical science, while Part 2 has 18 short answer questions (SAQ) examining diagnosis and management. Candidates must pass both written components to progress to the clinical exam. Validity was evaluated using Kane's framework for scoring (marking criteria, item analysis), generalization (blueprint), extrapolation (standard setting), and implications (outcome, including pass rates). A competency-based blueprint, the Optometry Australia Entry-level Competency Standards for Optometry 2014, guided question selection with the number of items weighted towards key competencies. A standard setting exercise, last conducted in 2017, was used to determine the minimum standard for both written exams. Item response theory (Rasch) was used to analyse exams, produce reliability metrics, apply consistent standards to the results, calibrate difficulty across exams, and score candidates. RESULTS: Data is reported on 12 administrations of the written examination since 2014. Of the 193 candidates who sat the exam over the study period, 133 (68.9%) passed and moved on to the practical component. Ninety-one (47.2%) passed both the MCQ and SAQ exams on their first attempt. The MCQ exam has displayed consistently high reliability (reliability index range 0.71 to 0.93, average 0.88) across all 12 administrations. Prior to September 2017 the SAQ had a set cutscore of 50%, and the difficulty of the exam was variable. Since the introduction of Rasch analysis to calibrate difficulty across exams, the reliability and power of the SAQ exam has been consistently high (separation index range 0.82 to 0.93, average 0.86). CONCLUSIONS: The findings from collective evidence support the validity of the written components (MCQ and SAQ) of the credentialing of the competency of overseas-educated optometrists in Australia and New Zealand.

Evaluating a treatment without extinction for elopement maintained by access to stereotypy.

Elopement is a common and potentially dangerous form of problem behavior. Results of a functional analysis found that the elopement of a child with autism was maintained by access to stereotypy in the form of door play. We implemented functional communication training and contingency-based delays dependent on the absence of elopement and increased the amount of time the participant waited prior to engaging in stereotypy. We also conducted treatment-extension probes, with the participant waiting up to 10 min without elopement.

The relationship between alpha asymmetry and ADHD depends on negative affect level and parenting practices.

Atypical frontal alpha asymmetry is associated with the approach/withdrawal and affective processes implicated in many psychiatric disorders. Rightward alpha asymmetry, associated with high approach, is a putative endophenotype for attention deficit/hyperactivity disorder (ADHD). However, findings are inconsistent, likely because of a failure to consider emotional heterogeneity within the ADHD population. In addition, how this putative risk marker interacts with environmental factors known to increase symptom severity, such as parenting practices, has not been examined. The current study examined patterns of alpha asymmetry in a large sample of adolescents with and without ADHD, including the moderating role of negative affect and inconsistent discipline. Resting-state EEG was recorded from 169 well-characterized adolescents (nADHD = 79). Semi-structured clinical interviews and well-validated rating scales were used to create composites for negative affect and inconsistent discipline. The relationship between alpha asymmetry and ADHD diagnosis was moderated by negative affect. Right asymmetry was present only for those with ADHD and low levels of negative affect. In addition, greater right alpha asymmetry predicted severity of ADHD symptoms for those with the disorder, but only in the context of inconsistent parenting practices. Results confirm right alpha asymmetry is a possible endophenotype in ADHD but highlight the need to consider emotional heterogeneity and how biological risk interacts with child environment in order to fully characterize its relationship to disorder liability and severity.

Perceived Neighborhood Environmental Factors That Maximize the Effectiveness of a Multilevel Intervention Promoting Physical Activity Among Latinas.

PURPOSE: This study tested whether a multilevel physical activity (PA) intervention had differential effects on PA according to participants' perceptions of their neighborhood environment. DESIGN: Two-group cluster randomized controlled trial. SETTING: San Diego, California. SUBJECTS: Analytical sample included 319 Latinas (18-65 years) from churches randomized to the following conditions: PA (n = 8 churches, n = 157 participants) or attention control (n = 8 churches, n = 162 participants). INTERVENTION: Over 12 months, PA participants were offered free PA classes (6/wk), while attention control participants were offered cancer prevention workshops. MEASURES: Baseline and 12-month follow-up measures included self-report and accelerometer-based moderate to vigorous physical activity (MVPA), sociodemographics, and perceived neighborhood environment variables. ANALYSIS: Mixed-effects models examined each PA outcome at 12-month follow-up, adjusted for church clustering, baseline PA, and sociodemographics. We tested interactions between 7 baseline perceived environment variables and study condition. RESULTS: Neighborhood esthetics was the only significant moderator of intervention effects on accelerometer-based MVPA and self-report leisure-time MVPA. Participants in the PA intervention had significantly higher PA at follow-up than attention control participants, only when participants evaluated their neighborhood esthetics favorably. CONCLUSION: Perceived neighborhood esthetics appeared to maximize the effectiveness of a multilevel PA intervention among Latinas. For sustainable PA behavior change, the environments in which Latinas are encouraged to be active may need to be evaluated prior to implementing an intervention to ensure they support active lifestyles.

Where and when adolescents are physically active: Neighborhood environment and psychosocial correlates and their interactions.

Female adolescents are less active than male peers in certain contexts including the neighborhood. Adolescents' physical activity can be explained by interactions between environmental and psychosocial factors, but few studies have tested such interactions in relation to context-specific behaviors. This study tested interactions between neighborhood environmental and psychosocial factors in relation to adolescents' context-specific physical activity. Data were collected in 2009-11 from 910 adolescents and a parent/guardian residing in the Baltimore/Seattle regions. Measures included adolescent-reported neighborhood leisure-time physical activity (LTPA) and non-neighborhood LTPA, accelerometer-based non-school moderate-to vigorous-physical activity (MVPA), psychosocial factors, and objective and parent-perceived neighborhood environmental factors. Gender-stratified mixed effects linear models tested associations of 6 environmental and 4 psychosocial factors and their interactions in relation to each physical activity outcome. The psychosocial factors had consistent associations with the physical activity outcomes but the environmental correlates were context-specific. Decisional balance (weighing of pros and cons of physical activity) moderated the association between recreation facility density and neighborhood LTPA among females, with a negative association only among those with high decisional balance (pros outweighed cons). Decisional balance also moderated associations of neighborhood walkability with non-school MVPA among females and non-neighborhood LTPA among males, with positive associations only among those with high decisional balance. Results support context-specific ecological models of physical activity. Targeting environmental factors that may promote opportunities for physical activity in specific contexts as well as adolescent decision-making may help promote their physical activity in those contexts, potentially leading to increased overall physical activity.

Diabetic and idiopathic gastroparesis is associated with loss of CD206-positive macrophages in the gastric antrum.

BACKGROUND: Animal studies have increasingly highlighted the role of macrophages in the development of delayed gastric emptying. However, their role in the pathophysiology of human gastroparesis is unclear. Our aim was to determine changes in macrophages and other cell types in the gastric antrum muscularis propria of patients with diabetic and idiopathic gastroparesis. METHODS: Full thickness gastric antrum biopsies were obtained from patients enrolled in the Gastroparesis Clinical Research Consortium (11 diabetic, 6 idiopathic) and 5 controls. Immunolabeling and quantitative assessment was done for interstitial cells of Cajal (ICC) (Kit), enteric nerves protein gene product 9.5, neuronal nitric oxide synthase, vasoactive intestinal peptide, substance P, tyrosine hydroxylase), overall immune cells (CD45) and anti-inflammatory macrophages (CD206). Gastric emptying was assessed using nuclear medicine scintigraphy and symptom severity using the Gastroparesis Cardinal Symptom Index. RESULTS: Both diabetic and idiopathic gastroparesis patients showed loss of ICC as compared to controls (Mean [standard error of mean]/hpf: diabetic, 2.28 [0.16]; idiopathic, 2.53 [0.47]; controls, 6.05 [0.62]; P=.004). Overall immune cell population (CD45) was unchanged but there was a loss of anti-inflammatory macrophages (CD206) in circular muscle (diabetic, 3.87 [0.32]; idiopathic, 4.16 [0.52]; controls, 6.59 [1.09]; P=.04) and myenteric plexus (diabetic, 3.83 [0.27]; idiopathic, 3.59 [0.68]; controls, 7.46 [0.51]; P=.004). There was correlation between the number of ICC and CD206-positive cells (r=.55, P=.008). Enteric nerves (PGP9.5) were unchanged: diabetic, 33.64 (3.45); idiopathic, 41.26 (6.40); controls, 46.80 (6.04). CONCLUSION: Loss of antral CD206-positive anti-inflammatory macrophages is a key feature in human gastroparesis and it is associates with ICC loss.

Childhood obesity prevention and control in city recreation centres and family homes: the MOVE/me Muevo Project.

BACKGROUND: Interventions to prevent and control childhood obesity have shown mixed results in terms of short- and long-term changes. OBJECTIVES: 'MOVE/me Muevo' was a 2-year family- and recreation centre-based randomized controlled trial to promote healthy eating and physical activity among 5- to 8-year-old children. It was hypothesized that children in the intervention group would demonstrate lower post-intervention body mass index (BMI) values and improved obesity-related behaviours compared with the control group children. METHODS: Thirty recreation centres in San Diego County, California, were randomized to an intervention or control condition. Five hundred forty-one families were enrolled and children's BMI, diet, physical activity and other health indicators were tracked from baseline to 2 years post-baseline. Analyses followed an intent-to-treat approach using mixed-effects models. RESULTS: No significant intervention effects were observed for the primary outcomes of child's or parent's BMI and child's waist circumference. Moderator analyses, however, showed that girls (but not boys) in the intervention condition reduced their BMI. At the 2-year follow-up, intervention condition parents reported that their children were consuming fewer high-fat foods and sugary beverages. CONCLUSIONS: Favourable implementation fidelity and high retention rates support the feasibility of this intervention in a large metropolitan area; however, interventions of greater intensity may be needed to achieve effects on child's BMI. Also, further research is needed to develop gender-specific intervention strategies so that both genders may benefit from such efforts.

Physical activity for children in special school environment.

1. We assessed children's physical activity (PA) in structured (physical education) and unstructured (recess, lunch, before and after school) periods in special schools and examined its association with modifiable area contextual characteristics. 2. Children with disabilities were not highly active, but were more active during recess and lunch periods than at other times including physical education classes. 3. Areas were often not accessible during unstructured settings. Children were more active in areas when supervision and organised activities were provided. 4. Providing an interactive game during free play did not significantly increase group's PA. 5. Children's PA accrual is influenced by contextual characteristics of the school environment. There is a need to make areas more accessible and to use social marketing and programming to attract more users. School and health professionals should modify contextual characteristics by providing more direct supervision and organised activities during free play.

Use of neighbourhood parks: does socio-economic status matter? A four-city study.

OBJECTIVES: To determine if neighbourhood socio-economic status (SES) is associated with park use and park-based physical activity. STUDY DESIGN: Cross-sectional study. METHODS: The use and characteristics of 24 neighbourhood parks in Albuquerque, Chapel Hill/Durham, Columbus and Philadelphia were observed systematically in three seasons (spring, summer and autumn), with nearly 36,000 park users observed. Twelve parks were in high-poverty neighbourhoods and 12 parks were in low-poverty neighbourhoods. In total, 3559 park users and 3815 local residents were surveyed. Park incivilities were assessed and park administrators were interviewed about management practices. RESULTS: The size and number of facilities in parks in high-poverty neighbourhoods were similar to those in parks in low-poverty neighbourhoods, but the former had more hours of programming. Neighbourhood poverty level, perception of safety and the presence of incivilities were not associated with the number of park users observed. However, programmed activities and the number of activity facilities were strongly correlated with park use and energy expended in the park. CONCLUSIONS: The finding that park programming is the most important correlate of park use and park-based physical activity suggests that there are considerable opportunities for facilitating physical activity among populations of both high- and low-poverty areas.

A novel interaction between HER2/neu and cyclin E in breast cancer.

HER2/neu (HER2) and cyclin E are important prognostic indicators in breast cancer. As both are involved in cell cycle regulation we analyzed whether there was a direct interaction between the two. HER2 and cyclin E expression levels were determined in 395 breast cancer patients. Patients with HER2-overexpression and high levels of cyclin E had decreased 5-year disease-specific survival compared with low levels of cyclin E (14% versus 89%, P<0.0001). In vitro studies were performed in which HER2-mediated activity in HER2-overexpressing breast cancer cell lines was downregulated by transfection with HER2 small interfering RNA or treatment with trastuzumab. Cyclin E expression levels were determined by western blot analysis, and functional effects analyzed using kinase assays, MTT assays were used to assess cell viability as a marker of proliferation and fluorescence-activated cell sorting analysis was used to determine cell cycle profiles. Decreased HER2-mediated signaling resulted in decreased expression of cyclin E, particularly the low molecular weight (LMW) isoforms. Decreased HER2 and LMW cyclin E expression had functional consequences, including decreased cyclin E-associated kinase activity and decreased proliferation, because of increased apoptosis and an increased accumulation of cells in the G1 phase. In vivo studies performed in a HER2-overexpressing breast cancer xenograft model confirmed the effects of trastuzumab on cyclin E expression. Given the relationship between HER2 and cyclin E, in vitro clonogenic assays were performed to assess combination therapy targeting both proteins. Isobologram analysis showed a synergistic interaction between the two agents (trastuzumab targeting HER2 and roscovitine targeting cyclin E). Taken together, these studies show that HER2-mediated signaling effects LMW cyclin E expression, which in turn deregulates the cell cycle. LMW cyclin E has prognostic and predictive roles in HER2-overexpressing breast cancer, warranting further study of its potential as a therapeutic target.

A single-institution review of portosystemic shunts in children: an ongoing discussion.

PURPOSE: Review the safety and long-term success with portosystemic shunts in children at a single institution. METHODS: An IRB-approved, retrospective chart review of all children ages 19 and undergoing surgical portosystemic shunt from January 1990-September 2008. RESULTS: Ten patients were identified, 8 females and 2 males, with a mean age of 15 years (range 5-19 years). Primary diagnoses were congenital hepatic fibrosis (5), hepatic vein thrombosis (2), portal vein thrombosis (2), and cystic fibrosis (1). Primary indications were repeated variceal bleeding (6), symptomatic hypersplenism (2), and significant liver dysfunction (2). Procedures performed were distal splenorenal bypass (4), side-to-side portocaval shunt (3), proximal splenorenal shunt (2), and an interposition H-graft portocaval shunt (1). There was no perioperative mortality and only minor morbidity. Seventy percent of patients had improvement of their symptoms. Eighty percent of shunts remained patent. Two were occluded at a median follow-up of 50 months (range 0.5-13.16 years). Two patients underwent subsequent liver transplantation. Two patients died at 0.5 and 12.8 years postoperatively, one from multisystem failure with cystic fibrosis and one from post-operative transplant complications. CONCLUSIONS: The need for portosystemic shunts in children is rare. However, in the era of liver transplantation, portosystemic shunts in selected patients with well-preserved liver function remains important. We conclude that portosystemic shunts are safe and efficacious in the control of variceal hemorrhage and symptoms related to hypersplenism.

Association of LY9 in UK and Canadian SLE families.

Systemic lupus erythematosus (SLE) is a complex disease trait of unknown aetiology. Genome-wide linkage studies in human SLE identified several linkage regions, including one at 1q23, which contains multiple susceptibility genes, including the members of the signalling lymphocyte activation molecule (SLAM) locus. In mice there is a syntenic linkage region, Sle1. The SLAM genes are functionally related cell-surface receptors, which regulate signal transduction of cells in the immune system. Family-based association study in UK and Canadian SLE families identified variants in the promoter and coding region of SLAMF7 and LY9 contributing to SLE disease susceptibility. The strongest association was from rs509749, in exon 8 of LY9 (P=0.00209). rs509749 encodes a Val/Met nonsynonymous change in amino acid 602 in the cytoplasmic domain of LY9. In the parents and affected individuals from the Canadian SLE families, the risk allele of rs509049 skews the T-cell population by increasing the number of CD8+ memory T cells, while decreasing the proportion of CD4+ naïve T cells and activated T cells. Since rs509749 lies within the consensus binding site for SAP/SH2D1a, which influences downstream signalling events from LY9, the mechanism for increased CD8+ memory T cells may include differential binding SAP/SH2D1a to the cytoplasmic domain of LY9.

Physical activity assessment options within the context of the Canadian Physical Activity, Fitness, and Lifestyle Appraisal.

The Canadian Physical Activity, Fitness, and Lifestyle Appraisal (CPAFLA) is a standardized battery of tests that is commonly used to assess asymptomatic individuals. This paper reviews evidence concerning the reliability, validity, and utility of the procedure currently used to assess habitual physical activity in the CPAFLA and surveys available physical activity assessment options. Special considerations related to age, gender, ethnicity, seasonal variations, and within-week variance are discussed. The potential assessment options are discussed with consideration given to the logistical and pragmatic constraints inherent in the CPAFLA. New technologies for future assessment of physical activity are briefly presented and recommendations for future research forwarded.

Effects of the CATCH physical education intervention: teacher type and lesson location.

BACKGROUND: Substantial differences exist in how and where physical education (PE) is conducted in elementary schools throughout the United States. Few effectiveness studies of large-scale interventions to improve PE have been reported. DESIGN: Multicenter randomized trial. SETTING/ PARTICIPANTS: The Child and Adolescent Trial for Cardiovascular Health (CATCH) was implemented in PE classes in 96 schools (56 intervention, 40 control) in four study centers: California, Louisiana, Minnesota, and Texas. INTERVENTION: The 2.5-year PE intervention consisted of professional development sessions, curricula, and follow-up consultations. MAIN OUTCOME MEASURES: Intervention effects on student physical activity and lesson context in PE were examined by teacher type (PE specialists and classroom teachers) and lesson location (indoors and outdoors). RESULTS: Differential effects by teacher type and lesson location were evidenced for both physical activity and lesson context. Observations of 2016 lessons showed that intervention schools provided more moderate-to-vigorous physical activity (p=0.002) and vigorous physical activity (p=0.02) than controls. Classroom teachers improved physical activity relatively more than PE specialists, but PE specialists still provided longer lessons and more physical activity. Classroom teachers increased lesson length (p=0.02) and time for physical fitness (p=0.03). CONCLUSIONS: The intervention improved PE of both specialists' and classroom teachers' lessons. States and districts should ensure that the most qualified staff teaches PE. Interventions need to be tailored to meet local needs and conditions, including teacher type and location of lessons.

Parental provision of transportation for adolescent physical activity.

BACKGROUND: Physical activity (PA) is important to adolescents' health. Parent transportation to activity locations is a practical strategy for increasing youth PA that has rarely been examined. DESIGN: Cross-sectional surveys of students and parents. SETTING/PARTICIPANTS: Ethnically diverse students (N=1678; 712 boys, 966 girls; M age=13.0 years) from 24 middle schools (grades six to eight) and their parents completed surveys (response rate=72%). MAIN OUTCOME MEASURES: Frequency of parents transporting adolescents to PA locations was studied in relation to adolescents' reported participation in PA during the previous week and their involvement in sports and activity lessons during the past year. RESULTS: Parents transported adolescents to PA locations 2.13 times per week, with boys being transported more often than girls (p=0.03). Ethnic/racial differences in frequency of transport were evidenced (p=0.002). Parent transportation for PA significantly contributed to girls' total PA (p=0.001) and their participation in sports/activity lessons (p=0.001). Transportation contributed marginally (p=0.06) to boys' total PA, but significantly to their participation in sports/activity lessons (p=0.001). CONCLUSIONS: Parent provision of transportation to activity locations is associated with out-of-school PA in a diverse adolescent population. This variable should be targeted for intervention.

The association of school environments with youth physical activity.

OBJECTIVES: This study assessed the association of school environmental characteristics with student physical activity on campus. METHODS: Physical activity areas (n = 137) at 24 public middle schools were assessed for area type, size, and improvements (e.g., basketball courts). Student physical activity and the presence of equipment and supervision were directly observed before school, after lunch, and after school. RESULTS: Environmental characteristics explained 42% of the variance in the proportion of girls who were physically active and 59% of the variance for boys. CONCLUSIONS: School environments with high levels of supervision and improvements stimulated girls and boys to be more physically active.

A community health promotion partnership model: the South Carolina health connection.

Over a five year period, the South Carolina Health Connection Project has evolved to multi-site, multi-organization community-base collaborative initiative. From this project over $60,000.00 in funds have been secured. However, when costing the human resources and many other in-kind contributions involved in the SCHC Projects activities, the Project can modestly be valued at nearly $200,000.00. The efforts of a few have been shared with others, who also shared the resources with others, and the health promotion empowerment cycle continues. We believe the South Carolina Health Connection is an exemplary of a Community Health Promotion Partnership Model. We hope you will agree!

Changes and tracking of physical activity across seven years in Mexican-American and European-American mothers.

Longitudinal changes in physical activity among 129 Mexican-American (mean age 30.8; SD = 5.6) and 97 European-American (mean age 31.2; SD = 5.4) women were studied. Two physical activity recall interviews were administered at baseline and 7 years later. At baseline, European-American women reported more vigorous leisure activity (p < .005) than Mexican-Americans, and Mexican-Americans reported more moderate work activity (p < .02) than European-Americans. Virtually all components of physical activity increased significantly over the 7 years. Pearson tracking correlations for total energy expenditure were about r = 0.30. The finding that both groups increased physical activity overtime was unexpected and was unrelated to a reduction in the number of preschool children in the homes over time.

Injuries and injury risk factors among men and women in U.S. Army Combat Medic Advanced individual training.

No previous reports have evaluated injuries or injury risk factors during the advanced individual training (AIT) that follows the Army's initial or basic combat training (BCT). This study examined injuries and injury risk factors among 439 men and 287 women participating in combat medic AIT. A questionnaire addressing demographic and lifestyle characteristics (age, race, tobacco and alcohol use, physical activity, etc.) was administered to all subjects. Stature and body mass were obtained from battalion records. Injuries occurring during both BCT and AIT were transcribed from subject medical records. Results indicated that cumulative injury incidence (subjects with one or more injuries) in BCT was 26% for men and 52% for women (p < 0.01), in consonance with previous investigations. In AIT, injury incidence was 24% for men and 30% for women (p = 0.08). In both BCT and AIT, overuse injuries and lower body injuries accounted for the largest proportions of injuries by diagnosis and anatomical location. Logistic regression revealed that older age (> 25 years), split option (a break in service between BCT and AIT), and higher body mass were independent risk factors for AIT injuries among women. None of the examined variables were independent risk factors for AIT injuries among men.