Exploring the use of individualised patient-reported outcome measures in eating disorders: Validation of the Psychological Outcome Profiles.

RATIONALE: Psychotherapies for eating disorders (EDs) are routinely assessed using standardised patient-reported outcome measures (PROMs). PROMs have been criticised for their lack of patient centeredness and clinical utility. The Psychological Outcome Profiles (PSYCHLOPS) is an individualised PROM that allows patients to specify their own outcomes. AIMS: (1) To validate the use of the PSYCHLOPS in ED treatment, and (2) to identify patient concerns beyond those measured by common ED PROMs. METHODS: Two hundred and seventy-eight emerging adult patients, presenting with a first-episode ED (aged 16-25, illness duration <3 years) completed the PSYCHLOPS and two standardised ED PROMs (the EatingDisorder Examination Questionnaire [EDE-Q] and the Clinical Impairment Assessment Questionnaire [CIA]) at four time points across 12 months. Psychometrics of the PSYCHLOPS were assessed quantitatively against the EDE-Q and CIA. Content analysis assessed unique patient concerns identified by PSYCHLOPS. RESULTS: The PSYCHLOPS had adequate to good psychometric properties. A total of 53.3% of participants reported a concern not addressed by the EDE-Q or the CIA, the most common being depression/anxiety, academic problems, treatment concerns and disturbed sleep. DISCUSSION: PROMs can be complemented by the PSYCHLOPS to identify problems specific to an individual's context. As ED patients are typically ambivalent about change, understanding their concerns is vital in building motivation for change.

Quantifying hydrologic controls on local- and landscape-scale indicators of coastal wetland loss.

BACKGROUND AND AIMS: Coastal wetlands have evolved to withstand stressful abiotic conditions through the maintenance of hydrologic feedbacks between vegetation production and flooding. However, disruption of these feedbacks can lead to ecosystem collapse, or a regime shift from vegetated wetland to open water. To prevent the loss of critical coastal wetland habitat, we must improve understanding of the abiotic-biotic linkages among flooding and wetland stability. The aim of this research was to identify characteristic landscape patterns and thresholds of wetland degradation that can be used to identify areas of vulnerability, reduce flooding threats and improve habitat quality. METHODS: We measured local- and landscape-scale responses of coastal wetland vegetation to flooding stress in healthy and degrading coastal wetlands. We hypothesized that conversion of Spartina patens wetlands to open water could be defined by a distinct change in landscape configuration pattern, and that this change would occur at a discrete elevation threshold. KEY RESULTS: Despite similarities in total land and water cover, we observed differences in the landscape configuration of vegetated and open water pixels in healthy and degrading wetlands. Healthy wetlands were more aggregated, and degrading wetlands were more fragmented. Generally, greater aggregation was associated with higher wetland elevation and better drainage, compared with fragmented wetlands, which had lower elevation and poor drainage. The relationship between vegetation cover and elevation was non-linear, and the conversion from vegetated wetland to open water occurred beyond an elevation threshold of hydrologic stress. CONCLUSIONS: The elevation threshold defined a transition zone where healthy, aggregated, wetland converted to a degrading, fragmented, wetland beyond an elevation threshold of 0.09 m [1988 North American Vertical Datum (NAVD88)] [0.27 m mean sea level (MSL)], and complete conversion to open water occurred beyond 0.03 m NAVD88 (0.21 m MSL). This work illustrates that changes in landscape configuration can be used as an indicator of wetland loss. Furthermore, in conjunction with specific elevation thresholds, these data can inform restoration and conservation planning to maximize wetland stability in anticipation of flooding threats.

Early microglial activation and peripheral inflammation in dementia with Lewy bodies.

Inflammation is increasingly recognized as part of the pathology of neurodegenerative conditions such as Alzheimer's disease and Parkinson's disease, but its role in dementia with Lewy bodies remains unclear. Using multimodal imaging and peripheral cytokine analysis, we therefore investigated central and peripheral inflammation in this common form of dementia. Nineteen participants with probable dementia with Lewy bodies and 16 similarly aged controls underwent 3 T MRI and PET imaging with 11C-PK11195, a marker of microglial activation in vivo. Peripheral blood inflammatory cytokines were also measured in all subjects, as well as in an additional 10 controls, using the Mesoscale Human Cytokine 36 plex panel and additional assays for high sensitivity c-reactive protein, tumour necrosis factor receptor 1, IL-34, YKL-40 (chitinase-3-like protein 1) and colony stimulating factor 1. To test for the presence of in vivo amyloid, 11C-Pittsburgh compound B PET imaging was also performed in 16 of the dementia with Lewy body participants. Microglial activation was elevated in dementia with Lewy bodies subjects with mild disease when compared to those with moderate/severe impairment, where disease severity was indexed by cognitive performance on the revised Addenbrooke's Cognitive Examination. In patients, strong correlations were found between cognitive performance and 11C-PK11195 non-displaceable binding potential in several regions including the caudate nucleus (R = 0.83, P = 0.00008) and cuneus (R = 0.77, P = 0.0005). Several inflammatory cytokines were altered in the patients compared to controls, with elevated macrophage inflammatory protein-3 (P = 0.001), IL-17A (P = 0.008) and IL-2 (P = 0.046) and reduced IL-8 (P = 0.024). There was no correlation between cortical 11C-Pittsburgh compound B standardized uptake value ratio and clinical features, regional 11C-PK11195 binding or peripheral cytokine levels. Nor was there any regional correlation between 11C-PK11195 non-displaceable binding potentials and 11C-Pittsburgh compound B standardized uptake value ratios. Our findings provide evidence for both central and peripheral inflammatory changes in dementia with Lewy bodies, with microglial activation occurring early in the disease in key regions known to be associated with pathology, before declining as cognition declines. Raised peripheral cytokines associated with T cell function further suggest a role for the adaptive immune system in the pathogenesis of the disease.

Mangrove expansion and contraction at a poleward range limit: climate extremes and land-ocean temperature gradients.

Within the context of climate change, there is a pressing need to better understand the ecological implications of changes in the frequency and intensity of climate extremes. Along subtropical coasts, less frequent and warmer freeze events are expected to permit freeze-sensitive mangrove forests to expand poleward and displace freeze-tolerant salt marshes. Here, our aim was to better understand the drivers of poleward mangrove migration by quantifying spatiotemporal patterns in mangrove range expansion and contraction across land-ocean temperature gradients. Our work was conducted in a freeze-sensitive mangrove-marsh transition zone that spans a land-ocean temperature gradient in one of the world's most wetland-rich regions (Mississippi River Deltaic Plain; Louisiana, USA). We used historical air temperature data (1893-2014), alternative future climate scenarios, and coastal wetland coverage data (1978-2011) to investigate spatiotemporal fluctuations and climate-wetland linkages. Our analyses indicate that changes in mangrove coverage have been controlled primarily by extreme freeze events (i.e., air temperatures below a threshold zone of -6.3 to -7.6°C). We expect that in the past 121 yr, mangrove range expansion and contraction has occurred across land-ocean temperature gradients. Mangrove resistance, resilience, and dominance were all highest in areas closer to the ocean where temperature extremes were buffered by large expanses of water and saturated soil. Under climate change, these areas will likely serve as local hotspots for mangrove dispersal, growth, range expansion, and displacement of salt marsh. Collectively, our results show that the frequency and intensity of freeze events across land-ocean temperature gradients greatly influences spatiotemporal patterns of range expansion and contraction of freeze-sensitive mangroves. We expect that, along subtropical coasts, similar processes govern the distribution and abundance of other freeze-sensitive organisms. In broad terms, our findings can be used to better understand and anticipate the ecological effects of changing winter climate extremes, especially within the transition zone between tropical and temperate climates.

Knowledge and attitudes of psychiatrists towards eating disorders.

OBJECTIVE: This study examined the eating disorder mental health literacy of psychiatrists. METHOD: A sample of psychiatrists completed a questionnaire measuring knowledge of and attitudes towards eating disorders. Knowledge questions were based on the academic literature, standard diagnostic criteria and national guidelines on the management of eating disorders. Attitude items covered beliefs about the aetiology and treatment of eating disorders, confidence levels in diagnosis and management and the use of compulsory measures in anorexia nervosa. RESULTS: Psychiatrists' knowledge of eating disorders was variable with specific gaps in both diagnosis and management. Psychiatrists felt more confident in diagnosing eating disorders than managing these conditions. Attitudes towards eating disorders were less stigmatizing than those seen in other health professionals. DISCUSSION: There is a clear need for greater education of psychiatrists regarding the diagnosis and management of eating disorders. Implementing training programmes and making information readily available could contribute to addressing these issues.

Eructophilia in bulimia nervosa: a clinical feature.

This report offers the first detailed description of repetitive eructation (belching) in a patient with bulimia nervosa. The case was a man in his 30's with bulimia nervosa characterized by daily bingeing and purging behavior. Detailed assessment revealed repetitive eructation which was construed as a learned behavior precipitated and maintained by aerophagia (air swallowing) secondary to regular binge-eating. Eructation was associated with a strong sense of "relief" that shared a common phenomenology with other purging behaviors. Repetitive eructation was addressed as part of outpatient treatment using a cognitive-therapy approach. Eructation became less frequent during outpatient treatment but the patient disengaged after six sessions. We define a new term "eructophilia" where repetitive eructation takes on an ego-syntonic, self-contained, and autonomous quality which serves as a reinforcing stimulus in itself. Issues of phenomenology and motivating factors are further discussed.

Extreme Precipitation and Flooding Contribute to Sudden Vegetation Dieback in a Coastal Salt Marsh.

Climate extremes are becoming more frequent with global climate change and have the potential to cause major ecological regime shifts. Along the northern Gulf of Mexico, a coastal wetland in Texas suffered sudden vegetation dieback following an extreme precipitation and flooding event associated with Hurricane Harvey in 2017. Historical salt marsh dieback events have been linked to climate extremes, such as extreme drought. However, to our knowledge, this is the first example of extreme precipitation and flooding leading to mass mortality of the salt marsh foundation species, Spartina alterniflora. Here, we investigated the relationships between baseline climate conditions, extreme climate conditions, and large-scale plant mortality to provide an indicator of ecosystem vulnerability to extreme precipitation events. We identified plant zonal boundaries along an elevation gradient with plant species tolerant of hypersaline conditions, including succulents and graminoids, at higher elevations, and flood-tolerant species, including S. alterniflora, at lower elevations. We quantified a flooding threshold for wetland collapse under baseline conditions characterized by incremental increases in flooding (i.e., sea level rise). We proposed that the sudden widespread dieback of S. alterniflora following Hurricane Harvey was the result of extreme precipitation and flooding that exceeded this threshold for S. alterniflora survival. Indeed, S. alterniflora dieback occurred at elevations above the wetland collapse threshold, illustrating a heightened vulnerability to flooding that could not be predicted from baseline climate conditions. Moreover, the spatial pattern of vegetation dieback indicated that underlying stressors may have also increased susceptibility to dieback in some S. alterniflora marshes.Collectively, our results highlight a new mechanism of sudden vegetation dieback in S. alterniflora marshes that is triggered by extreme precipitation and flooding. Furthermore, this work emphasizes the importance of considering interactions between multiple abiotic and biotic stressors that can lead to shifts in tolerance thresholds and incorporating climate extremes into climate vulnerability assessments to accurately characterize future climate threats.

Dissociable effects of acute SSRI (escitalopram) on executive, learning and emotional functions in healthy humans.

Serotonin is implicated in multiple executive functions including goal-directed learning, cognitive flexibility, response inhibition and emotional regulation. These functions are impaired in several psychiatric disorders, such as depression and obsessive-compulsive disorder. We tested the cognitive effects of the selective serotonin reuptake inhibitor escitalopram, using an acute and clinically relevant dose (20 mg), in 66 healthy male and female volunteers in a double-blind, placebo-controlled study. Participants performed a cognitive test battery including a probabilistic and reversal learning task, the CANTAB intra-dimensional/extra-dimensional shift test of cognitive flexibility, a response inhibition task with interleaved stop-signal and No-Go trials and tasks measuring emotional processing. We showed that acute escitalopram administration impaired learning and cognitive flexibility, but improved the ability to inhibit responses in stop-signal trials while leaving unaffected acute emotional processing. Our findings suggest a dissociation of effects of acute escitalopram on cognitive functions, possibly mediated by differential modulation of brain serotonin levels in distinct functional neural circuits.

Restructured Pork From Hot Processed Sow Meat: Effect of Mechanical Tenderization and Liquid Smoke.

A 2 × 2 factorial design was used to study the effect of tenderization and liquid smoke on sensory and physical attribution of a fully cooked restructured pork item. The lean and fat mass was removed intact within 30 min postmortem from sow carcasses and assigned to a tenderized or non-tenderized treatment with and without liquid smoke. The four treatment groups were: non-tenderized, no liquid smoke (NTNS); non-tenderized with liquid smoke (NTS); tenderized, no liquid smoke (TNS); and tenderized with liquid smoke (TS). Mechanical tenderization was accomplished 1 h postmortem and the two original portions were subdivided for a 1% acid-neutralized liquid smoke treatment. Total processing time from exsanguination to a fully cooked product was 8 h. There were no differences (P>0.05) among any of the treatments for cohesiveness, juiciness, flavor or connective tissue scores or cooking loss. The TNS treatment had higher (P<0.06) tension values as determined by Instron measurements than the NTNS treatment. There were initially no practical differences between TBA values for fresh-frozen and cooked-frozen restructured pork. However, after 30 d of storage (-23°C), the cooked-frozen product had significantly higher TBA values than fresh-frozen product.

Effects of Electrical Stimulation and Kidney-Pelvic Fat Removal Before Chilling on Microbial Quality of Beef Tenderloins 1.

Twenty-four steers (435-567 kg) were used to study the effects of electrical stimulation (50 V for 120 s) and of kidney-pelvic fat removal before chilling (3-4°C) on microbial populations of beef tenderloins on days 1, 4 and 7 post-mortem. Kidney-pelvic fat was stripped from one side of each carcass; the other side remained intact for later fat removal. On each respective chill-day, kidney-pelvic fat was aseptically removed from intact sides, tenderloins were swabbed at two anatomically referenced locations (3rd and 5th lumbar vertebra) and microbial load was determined. The statistical model for data analysis included the effects of electrical stimulation, chill-day, animal within chill-day X stimulation, fat removal, location, and all main effect interactions. Removal of kidney-pelvic fat before chilling resulted in a significantly higher bacterial load on the surface of exposed tenderloins after 24 h of chill. Electrical stimulation produced significantly lower bacterial counts for fat-intact surfaces on chill-day 7 and for fat-removed surfaces on chill-day 4. Kidney-pelvic fat removal allowed for significantly higher bacterial counts on the tail portion of tenderloins (3rd lumbar vertebra) for surfaces from non-stimulated carcasses than the butt portion (5th lumbar vertebra). Mean bacterial counts from electrically stimulated carcasses at the fifth and third lumbar vertebra locations did not differ (P>.10) between fat treatments.