Faculty Bibliography

Because of their high prevalence and their negative long-term consequences, child anxiety disorders have become an important focus of interest. Whether pathological anxiety and normal fear are similar processes continues to be controversial. Comparative studies of child anxiety disorders are scarce, but there is some support for the current classification of anxiety disorders in children and adolescents, except for generalized anxiety disorder. The greatly differing rates of anxiety disorders in child population studies, and of specific disorders in clinical samples, inconsistent findings regarding course, and disparate placebo response rates all suggest a need for more precise, validated, criteria for symptoms, distress, and impairment. Several treatments have documented efficacy, and promising prevention efforts are encouraging

BACKGROUND:Hand-assisted laparoscopic surgery (HALS) requires a larger incision compared with standard laparoscopic surgery (SLS). Whether this leads to more longterm complications, such as incisional hernia (IH) and small bowel obstruction (SBO), has not been studied to date. This study compares the rates of SBO and IH after HALS and SLS in patients undergoing operations for colon and rectal diseases. STUDY DESIGN/METHODS:From a colorectal database, 536 consecutive patients were identified who underwent bowel resection using HALS (n = 266) and SLS (n = 270) between 2001 to 2006. All medical records were reviewed, and all subjects were contacted by telephone for accurate followup. Statistical analysis was performed using chi-square, Fisher's exact, and Mann-Whitney U tests, where appropriate. RESULTS:Median followup was 27 months (range 1 to 72 months). Overall conversion rate was 2.2% (SLS, n = 4; HALS, n = 8). Median incision size in HALS (75 mm; range 60 to 140 mm) was larger than SLS (45 mm; range 30 to 130 mm; p < 0.01). Despite the larger wound, the incidence of IH was similar between both approaches (HALS, n = 16 [6.0%] versus SLS, n = 13 [4.8%]; p < 0.54). Rate of SBO was also comparable (HALS, n = 11 [4.1%] versus SLS, n = 20 [7.4%]; p = 0.11). Wound infections occurred similarly between both groups (HALS, n = 18 [6.8%]; SLS, n = 13 [4.8%]; p = 0.33). Converted patients had a higher rate of IH compared with nonconverted ones (25% versus 5%; p = 0.02), although the rate of SBO was similar (8.3% versus 5.7%; p = 0.51). CONCLUSIONS:HALS does not lead to more longterm complications of IH and SBO when compared with SLS for resections of the colon and rectum.

The continuity of social competence between 36 months and first grade was examined in a sample of children at risk due to prenatal exposure to cocaine (N = 92). Parent report data on social competence were collected at 36 months of age and both parent and teacher report data were collected when children were in first grade. Regression analyses indicated that 36-month social competence significantly predicted first-grade parent ratings of social competence, even after controlling for cognitive ability. Thirty-six month social competence also predicted first-grade teacher ratings of competence, but these relations were mediated by child gender and cognitive ability. Early social competence was also a significant predictor of first-grade language ability, after controlling for 36-month language. These findings emphasize the importance of early social competence for later development.

BACKGROUND: To evaluate the effect of atomoxetine (ATX) on attention-deficit/hyperactivity disorder (ADHD) and comorbid social anxiety disorder in adults. METHODS: Randomized, double-blind, placebo-controlled, conducted in adults with ADHD and social anxiety disorder. Patients received 40-100 mg ATX (n=224) or placebo (n=218) for 14 weeks following a 2-week placebo lead-in period. Efficacy measures included the Conners' Adult ADHD Rating Scale: Investigator-Rated: Screening Version (CAARS:Inv:SV), Liebowitz Social Anxiety Scale (LSAS), Clinical Global Impression-Overall-Severity (CGI-O-S), State-Trait Anxiety Inventory (STAI), Social Adjustment Scale-Self Report (SAS), and Adult ADHD Quality of Life Scale-29 (AAQoL). Safety and tolerability were also assessed. RESULTS: ATX mean change (-8.7+/-10.0) from baseline (29.6+/-10.4) on CAARS:Inv:SV Total ADHD Symptoms score was significantly greater than placebo mean change (-5.6+/-10.2) from baseline (31.2+/-9.4; P<.001). ATX mean change (-22.9+/-25.3) from baseline (85.3+/-23.6) on LSAS Total score was significant compared to placebo mean change (-14.4+/-20.3) from baseline (82.1+/-21.3; P<.001). The visit-wise analysis revealed greater improvement on the CAARS:Inv:SV Total ADHD Symptoms score and LSAS Total score for ATX at every time point throughout the study (P values </=.012). Mean changes in CGI-O-S, STAI-Trait Anxiety scores, and AAQoL Total score were significantly greater for ATX compared to placebo. Mean change for both groups on STAI-State Anxiety scores was comparable. Improvement on SAS for ATX compared to placebo was not significant. Rates of insomnia, nausea, dry mouth, and dizziness were higher with ATX than with placebo. Discontinuation rates due to treatment-emergent adverse events were similar between groups. CONCLUSIONS: ATX monotherapy effectively improved symptoms of ADHD and comorbid social anxiety disorder in adults and was well tolerated

It has been shown that brain structures in normal aging undergo significant changes attributed to neurodevelopmental and neurodegeneration processes as a lifelong, dynamic process. Modeling changes in healthy aging will be necessary to explain differences to neurodegenerative patterns observed in mental illness and neurological disease. Driving application is the analysis of brain white matter properties as a function of age, given a database of diffusion tensor images (DTI) of 86 subjects well-balanced across adulthood. We present a methodology based on constrained PCA (CPCA) for fitting age-related changes of white matter diffusion of fiber tracts. It is shown that CPCA applied to tract functions of diffusion isolates population noise and retains age as a smooth change over time, well represented by the first principal mode. CPCA is therefore applied to a functional data analysis (FDA) problem. Age regression on tract functions reveals a nonlinear trajectory but also age-related changes varying locally along tracts. Four tracts with four different tensor-derived scalar diffusion measures were analyzed, and leave-one-out validation of data compression is shown.

This study examined the factors that are important to successful implementation and sustainability of evidence-based interventions in school settings. Developers of interventions that have been designated as "evidence-based" in multiple vetted lists and registries available to schools participated in a structured interview. The interview focused on potential facilitators and barriers to implementation and sustainability of their intervention. The interviews were transcribed and coded to identify similarities and differences among the responses as well as themes that cut across participants. Results indicated that those concerned with effective implementation and sustainability need to address several areas: (a) development of principal and other administrator support; (b) development of teacher support; (c) development of financial resources to sustain practice; (d) provision of high-quality training and consultation to ensure fidelity; (e) alignment of the intervention with school philosophy, goals, policies, and programs; (f) ensuring that program outcomes and impact are visible to key stakeholders; and (g) development of methods for addressing turnover in school staff and administrators.