Time perception impairment following thalamic stroke: A case study

Impaired time perception is considered to be a relatively unusual and poorly understood consequence of brain injury. This paper presents a case study of altered time perception in JB, a 50-year-old woman who in 2011 had a small thalamic stroke affecting the right anteromedian region. We report on her subjective experience and present results from studies of retrospective timing (i.e., estimating how much time has passed and the clock time) and prospective timing (i.e., producing and reproducing intervals). The results showed that relative to neurologically healthy and brain-injured controls, JB had impaired retrospective timing and impaired prospective time reproduction. However, her prospective time production did not differ significantly from either of the control groups. We interpret this to mean that JB's essential timing functions are intact, and that rather, her time perception impairment stems from a problem in anterograde memory for time intervals. Further, we argue that unlike other cognitive domains, time perception alteration is neither anticipated nor evaluated in most patients, yet these impairments can have a remarkably serious impact on daily life. We encourage further investigation of this topic.

The 2015 ENFSI Fingerprint Working Group testing programme

As early as 2004, the Fingerprint Working Group (EFP-WG) of the European Network of Forensic Science Institutes (ENFSI) has organised proficiency tests (PT's), as well as collaborative exercises (CE's), as a way of raising standards within the fingerprint profession. This article provides an overview of the three collaborative exercises carried out in 2015. The characteristics of the testing programme are summarised, followed by an overview of the knowledge that has been gained, including depicting what lessons have been learnt.

Using Virtual Reality to investigate multitasking ability in individuals with frontal lobe lesions

Individuals with lesions in the prefrontal cortex often show impairments with the organisation of their behaviour in everyday life. These difficulties can be hard to detect using structured formal tests. The objective of this study was to use Virtual Reality (VR) to explore the multitasking performance of individuals with focal frontal lobe lesions, specifically using the Jansari assessment of Executive Functions (JEF^©). Nineteen individuals with frontal lobe lesions were compared with 19 matched controls on the test and a group of commonly used clinical measures of neuropsychological functioning, as well as questionnaire measures of everyday activity, anxiety and depression. There was a significant difference between groups on the overall JEF^© score and on five of the eight individual constructs, namely the planning, creative thinking, adaptive thinking, event-based Prospective Memory (PM) and time-based PM constructs. There were no differences between groups on the non-VR EF individual measures apart from on one EF control measure, Trail Making A. These results demonstrate the potential clinical utility of the JEF^© and highlight the value of ecologically valid VR measures in detecting impairments in EF in individuals with frontal lobe lesions.

The Cognitive Remediation in Bipolar (CRiB) pilot study: study protocol for a randomised controlled trial

Background

People with bipolar disorder often show difficulties with cognitive functioning, and though these difficulties are identified as important targets for intervention, few treatment options are available. Preliminary evidence suggests that cognitive remediation therapy (a psychological treatment proven beneficial for people diagnosed as having schizophrenia) is helpful for people with bipolar disorders. We are conducting a pilot trial to determine whether individual, computerised, cognitive remediation therapy (CRT) for people with bipolar disorder 1) increases cognitive function; 2) improves global functioning, goal attainment and mood symptoms; 3) is acceptable and feasible for participants; and 4) can be addressed in a comprehensive, larger, randomised, controlled trial.

Methods/design

The study is designed as a two-arm, randomised, controlled trial comparing cognitive remediation therapy with treatment-as-usual (TAU) for euthymic bipolar patients. Participants are eligible to take part if aged between 18 and 65 with a diagnosis of bipolar disorder (type I) and currently in euthymic state, and no neurological, substance or personality disorder diagnoses. Sixty participants will be recruited (mainly through secondary and tertiary care) and will be block-randomised to receive either treatment-as-usual alone or in addition to a 12-week course of cognitive remediation therapy totalling 20–40 therapy hours. The intervention will comprise regular sessions with a therapist and computer-based training. Research assessments will take place before and after the intervention period and at a 12-week follow-up, and will include evaluation of neuropsychological, symptom-related, demographic and social factors, as well as collecting qualitative data regarding CRT expectations and satisfaction. Intention-to-treat analyses will examine the efficacy of cognitive remediation therapy primarily on cognition and additionally on functioning, quality of life and mood symptoms. Furthermore, we will examine the acceptability of CRT and undertake a preliminary health economics analysis to ascertain the cost of delivering the intervention.

Discussion

The results of this trial will provide valuable information about whether cognitive remediation therapy may be beneficial for people diagnosed with bipolar disorder in a euthymic state.

Trial Registration

ISRCTN registry, ISRCTN32290525. Registered on 2 March 2016

Exploring lesbian, gay and bisexual patients' accounts of their experiences of cancer care in the UK

Despite greater recognition of rights and responsibilities around the care of cancer patients who identify as lesbian, gay or bisexual (LGB) within healthcare systems in the United Kingdom, recent quantitative evidence suggests that they experience poorer care than heterosexual counterparts and qualitative findings are limited. Therefore, in the present study, we present an analysis of the accounts of fifteen British LGB cancer patients (diagnosed with different forms of the disease) of the care received. Data were collected through in-depth individual interviews and analysed using thematic analysis. Three of the emerging themes are discussed. These include an examination of what we conceptualise as the 'awkward choreography around disclosure' opportunities and dilemmas for LGB patients, we describe 'making sense of sub-optimal care' which included instances of overt discrimination but was more frequently manifested through micro-aggressions and heteronormative systems and practices, and explore accounts of 'alienation from usual psychosocial cancer support'. We employ Meyer's Minority Stress Theory (2003) as a lens to interrogate the data and explore the ways in which actual or anticipated prejudice affected their experiences of treatment and support. We close with recommendations to enhance LGB-affirmative cancer care including enhanced training of healthcare professionals and explicit articulation of institutional commitment to LGB equality.

Using video ratings to assess multitasking performance in a naturalistic paradigm

BACKGROUND

Multitasking measures, in which a series of tasks must be completed within a naturalistic setting not fully under the experimenter's control, have been shown to be more sensitive than traditional measures in detecting organisational problems in people with difficulties in executive functioning. There are a number of drawbacks to such tasks however. They can take considerable time to administer and are demanding in terms of examiners noting and recording all relevant aspects of performance. This potentially leaves them more open to subtle bias. One method that could offset these limitations is to video record performance.

OBJECTIVES

The practicality and outcome of using video ratings to accurately score performance off-line is investigated here.

METHODS

Nineteen participants completed a Multiple Errands Task (MET) while wearing a body-worn camera. Their performance was scored "live" and by an independent rater who had only access to video footage of the task.

RESULTS

Significant relationships were seen on all variables of the MET between the live and video ratings. The inter-rater reliability of the measure appears strong.

CONCLUSION

We provide initial support for the use of a video rater when assessing performance on an MET.

Minimally invasive therapy for fetal sacrococcygeal teratoma: case series and systematic review of the literature

OBJECTIVE

Large solid sacrococcygeal teratomas (SCT) can cause high-output cardiac failure and fetal or neonatal death. The aim of this study was to describe the outcomes of minimally invasive antenatal procedures for the treatment of fetal SCT.

METHODS

A case review was performed of five fetuses with a large SCT treated antenatally using minimally invasive techniques, and a systematic literature review on fetal therapy for solid SCTs was carried out.

RESULTS

Five women were referred between 17 + 5 and 26 + 4 weeks' gestation for a large fetal SCT with evidence of fetal cardiac failure. Vascular flow to the tumors was interrupted by fetoscopic laser ablation (n = 1), radiofrequency ablation (RFA; n = 2) or interstitial laser ablation  ±  vascular coiling (n = 2). There were two intrauterine fetal deaths. The other three cases resulted in preterm labor within 10 days of surgery. One neonate died. Two survived without procedure-related complications but had long-term morbidity related to prematurity. The systematic literature review revealed 16 SCTs treated minimally invasively for (early) hydrops. Including our cases, six of 20 hydropic fetuses survived after minimally invasive therapy (30%). Survival after RFA or interstitial laser ablation was 45% (5/11). Of 12 fetuses treated for SCT without obvious hydrops and for which perinatal survival data were available, eight (67%) survived. Mean gestational age at delivery after minimally invasive therapy was 29.7 ± 4.0 weeks. Survival after open fetal surgery in hydropic fetuses was 6/11 (55%), with a mean gestational age at delivery of 29.8 ± 2.9 weeks.

CONCLUSIONS

Fetal therapy can potentially improve perinatal outcomes for hydropic fetuses with a solid SCT, but is often complicated by intrauterine death and preterm birth.

The NeuroPage system for children and adolescents with neurological deficits

OBJECTIVE

Several studies have demonstrated the effectiveness of a paging system, NeuroPage, in helping survivors of brain injury compensate for everyday memory and planning problems. This study examines the effectiveness of the paging system in the sub-group of 12 children and adolescents with neurological deficits who took part in a larger study.

METHODS

Twelve participants aged 8-17 years took part in a randomized controlled crossover trial in which their completion of everyday goals was monitored prior to and during use of the NeuroPage system, where participants were sent reminder messages regarding tasks they should complete.

RESULTS

All 12 young people showed significant improvements in carrying out everyday tasks between the baseline and treatment phases.

CONCLUSIONS

The NeuroPage system can be successfully used by children and adolescents with neurological deficits and can alleviate some of the everyday difficulties caused by their memory and planning difficulties.

The assessment and rehabilitation of prospective memory problems in people with neurological disorders: a review

People with neurological disorders often report difficulty with prospective memory (PM), that is, remembering to do things they had intended to do. This paper briefly reviews the literature regarding the neuropsychology of PM function, concluding that from the clinical perspective, PM is best considered in terms of its separable but interacting mnemonic and executive components. Next, the strengths and limitations in the current clinical assessment of PM, including the assessment of component processes, desktop analogues of PM tasks, and naturalistic PM tasks, are outlined. The evidence base for the rehabilitation of PM is then considered, focusing on retraining PM, using retrospective memory strategies, problem-solving training, and finally, electronic memory aids. It is proposed that further research should focus on establishing the predictive validity of PM assessment, and refining promising rehabilitation techniques.

Alleviation of carer strain during the use of the NeuroPage device by people with acquired brain injury

BACKGROUND

Previous studies have demonstrated the efficacy of a paging system, NeuroPage (Cambridgeshire Primary Care Trust Corporation, Fulbourn, Cambridgeshire, UK), in compensating for memory and planning dysfunctions in people with acquired brain injury (ABI; mainly stroke or traumatic brain injury). In this study, the degree to which this efficacy is accompanied by a reduced experience of strain among carers of patients with ABI was investigated.

METHODS

Carers of 99 people with ABI completed a questionnaire concerning strain resulting from caring for the injured individual. The questionnaire was completed at the following three time points: before the use of NeuroPage, at the end of a 7-week period of use, and, for one subgroup, a further 7 weeks after withdrawal of NeuroPage.

RESULTS

There were significant reductions in strain reported by carers following the 7-week period of NeuroPage use (Cohen's d = 0.3-0.4). This finding persisted when the carer was a spouse or a parent. The reduced strain among carers continued even after withdrawal of NeuroPage.

CONCLUSION

The efficacy of the NeuroPage paging system for people with ABI appears to result in reduced strain for their carers.

The Ribosomal Database Project: improved alignments and new tools for rRNA analysis

The Ribosomal Database Project (RDP) provides researchers with quality-controlled bacterial and archaeal small subunit rRNA alignments and analysis tools. An improved alignment strategy uses the Infernal secondary structure aware aligner to provide a more consistent higher quality alignment and faster processing of user sequences. Substantial new analysis features include a new Pyrosequencing Pipeline that provides tools to support analysis of ultra high-throughput rRNA sequencing data. This pipeline offers a collection of tools that automate the data processing and simplify the computationally intensive analysis of large sequencing libraries. In addition, a new Taxomatic visualization tool allows rapid visualization of taxonomic inconsistencies and suggests corrections, and a new class Assignment Generator provides instructors with a lesson plan and individualized teaching materials. Details about RDP data and analytical functions can be found at http://rdp.cme.msu.edu/.