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The Course of Neurocognition and Social Functioning in Individuals at Ultra High
Risk for Psychosis
Tara A. Niendam1,2, Carrie E. Bearden3, Jamie Zinberg2,
Jennifer K. Johnson4, Mary O'Brien3, and
Tyrone D. Cannon2,3
1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563;
California, Los Angeles, Box 956968, Los Angeles, CA 90095-6968;
4Department of Psychiatry, Stanford University School of
Medicine, 701A Welch Road, Suite 3325, Stanford, CA 94304
Objective: This study evaluates longitudinal neuropsy-
chological performance and its association with clinical
symptomatology and psychosocial outcome in individuals
identified asultra high risk (UHR) forpsychosis. Methods:
Thirty-five UHR individuals completed neurocognitive,
clinical, and social/role functioning assessments at baseline
and, on average, 8.3 months later. Results: UHR subjects
showed significant cognitive deficits at baseline and 2 dis-
tinct profiles of cognitive change over time. On average,
ing over the follow-up period, while the other half showed
either stability or decline in functioning. Functional im-
provement was associated with improved processing speed
and visual memory, as well as improvement in clinical
symptoms over the follow-up period. In contrast, patients
who did not improve functionally showed stable clinical
symptoms and cognitive performance over time. Conclu-
sions: Although the degree of neurocognitive deficit at
baseline in UHR patients does not predict psychosocial
outcome, the course of neurocognitive change over the first
8 months of follow-up does differentiate patients with good
and poor functional outcomes.
Key words: prodrome/cognition/high risk/social
functioning/functional outcome/psychosis
The prodromal phase of schizophrenia is hypothesized to
deterioration coincident with emergence of subthreshold
psychotic symptoms. While most individuals with schizo-
phrenia experience onset during late adolescence and
early adulthood, deficits in cognition are evident years
before the development of psychotic symptoms, during
childhood and adolescence.1–5These cognitive deficits
are hypothesized to accelerate during the prodromal pe-
riod in association with changes in brain functioning that
may lead to the development of psychotic symptoms6,7as
well as functional decline in a variety of domains.8
Recent studies have shown that individuals thought
to be at ultra high risk (UHR) for developing psychosis
demonstrate neuropsychological deficits that are associ-
ated with poor social and role functioning. Dysfunction
in multiple cognitive domains has been reported in inves-
tigations of UHR samples,8–18with the most pronounced
deficits observed on measures of visual attention and
working memory, processing speed, verbal learning and
memory, and executive functioning, including measures
of verbal fluency and set shifting. In addition, we recently
demonstratedthatdeficits inverballearningandmemory
are predictive of current social functioning in UHR
individuals, irrespective of negative or positive symptom
severity.18UHR individuals do not show the level of
cognitive impairment reported in studies of patients with
first-episode9,10,13,15or chronic schizophrenia,15and such
differences in cognitive performance between UHR and
processes in the period prior to psychosis onset. However,
very little empirical evidence is available to address this
question,19and it remains unclear whether any deteriora-
tion that does occur is specific to the prodromal period.
While these studies of UHR individuals confirm that
neuropsychological deficits and functional impairment
are detectable before the onset of psychosis, such inves-
tigations do not account for the clinical heterogeneity
that exists within UHR populations. As described by
Yung and colleagues,20UHR populations are a mixture
of 3 subgroups: at-risk individuals who will subsequently
do not transition to psychosis because of resiliency, treat-
ment, or protective factors (false false positives); and
those individuals whose at-risk state actually represents
a vulnerability for another type of psychological disorder
As a result of this inherent clinical heterogeneity,
UHR studies have begun to examine change in clinical
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Page 2
symptoms and cognitive performance over follow-up
periods with the hope of identifying those individuals
at highest risk for subsequent conversion to psychosis.
While a few studies have highlighted a pattern of greater
baselinecognitiveimpairment thatis associatedwithsub-
sequent conversion,8,9,16no study to date has examined
the effects of cognitive and clinical change on psychoso-
cial functioning in UHR individuals.
with the previously delineated UHR subgroups by inves-
tigating the interrelated patterns of change in cognition,
clinical symptoms, and functioning that may occur for
UHR individuals over the critical period following ascer-
tainment. Specifically, we chose to focus on predictors of
sion to psychosis, in order to understand factors asso-
ciated with impairment in social and role functioning
at follow-up independent of final diagnostic outcome.
Based on previous findings in UHR8–18and first-episode
samples,21we predicted that a subgroup of UHR individ-
uals would show baseline cognitive deficits and that such
deficits would be associated with severity of negative
symptoms as well as poorer role and social functioning,
independent of positive symptom severity, at follow-up.
Furthermore, we hypothesized that this subset of UHR
individuals would show deterioration in cognitive per-
formance over the follow-up period and that such decline
would be associated with the deterioration in clinical
and functional status thought to predate the onset of
Participants in this study are part of a larger longitudinal
prospective study of adolescents and young adults en-
rolled in research at the Center for the Assessment and
Prevention of Prodromal States (CAPPS) at the Univer-
sity of California, Los Angeles (UCLA). Eligible individ-
application of the assessment instruments. Participants
also must meet criteria for 1 of the 3 prodromal syn-
dromes, as assessed by the Structured Interview for Pro-
dromal Syndromes (SIPS22), based on presence of (1)
attenuated psychotic symptoms (Attenuated Positive
Symptom Syndrome); (2) transient psychotic symptoms
(Brief Intermittent Psychotic Syndrome, BIPS); or (3)
a substantial drop in social/role functioning in conjunc-
tion with schizotypal personality disorder diagnosis or
presence of psychotic disorder in first-degree relative
(Genetic Risk & Deterioration Syndrome). For cases
in which the frequency of psychotic symptoms was diffi-
cult to determine, such individuals were included within
the BIPS category if their psychotic symptoms began
within the past 3 months and they did not meet criteria
for a schizophrenia-spectrum diagnosis.
At baseline, adolescents aged 15 and older also com-
pleted the Structured Clinical Interview for Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edi-
tion (DSM-IV) Axis I Disorders23while participants 14
years and younger were administered the Kiddie Sched-
ule for Affective Disorders and Schizophrenia24,25. Par-
ticipants were excluded from the study if they met
DSM-IV criteria for an Axis I schizophrenia-spectrum
diagnosis, such as schizophrenia, schizoaffective disor-
der, schizophreniform disorder, or delusional disorder.26
Additional exclusion criteria include the presence of
a neurological disorder, DSM-IV diagnosis of drug or al-
viduals with a Wechsler Abbreviated Scale of Intelligence
IQ was determined by a complete WISC-III28/WAIS-
previous assessment by a qualified professional. Detailed
information regarding SIPS prodromal criteria, interrat-
er reliability, and case consensus procedures have been
described in detail elsewhere.30
The participantscompletedinformed consentor assent
for the intake screening and were compensated for their
participation in all assessments. Parental informed con-
sent for minors was also obtained. Study protocol and
informed consent procedures were approved by the
UCLA Institutional Review Board.
Demographic data for UHR individuals included in
these analyses (n = 35) are shown in Table 1. Eighty per-
cent of study participants received psychotropic medica-
tion as part of their usual care at baseline, and 89% were
taking at least 1 medication at follow-up. These medica-
and SSRI antidepressants (34%, 40%). Over the follow-
up period, participants also received a variety of psycho-
social treatments that were provided in an unstructured
format by both CAPPS and community treatment
providers. These treatments included individual psycho-
therapy (83%), family therapy (34%), group therapy
(37%), and school-based therapy or counseling (57%).
Seventy-four percent of the participants received 2 or
more forms of psychotherapy (eg, individual therapy
plus group therapy) over the follow-up period. Ninety-
seven percent of the participants also received case man-
agement services from a CAPPS staff member.
In the SIPS interview,22,31symptoms are rated on 4 main
scales of the Scale of Prodromal Symptoms (SOPS): pos-
itive, negative, disorganized, and general symptoms. To
reduce the number of statistical comparisons, our hy-
potheses in the current investigation focus on the positive
Course of Neurocognition & Functioning in Prodrome
Page 3
and negative symptom scales. The SOPS Positive Symp-
tom Scale assesses symptoms related to unusual thought
content, suspiciousness, perceptual disturbances/halluci-
nations, grandiosity, and disorganized communication.
Symptoms of anhedonia, avolition, flat affect, decreased
role functioning, and decreased verbal comprehension/
for use with the SIPS31,32,is also administered at intake.
At the time of the baseline interview, social and role
functioning were assessed with the Global Functioning:
Social Scale (GF:Social33), the Global Functioning: Role
Table 1. Demographics and Clinical Characteristics of Participants
Characteristic Participants (n = 35)
Age at examination, mean (6SD), [range] 17.26 (4.32), [12.5–29.00]
Average time (y) to follow-up, mean (6SD), [range] 0.68 (0.21), [0.34–1.33]
Years of education, mean (6SD), [range]
Estimated WASI IQ, mean (6SD), [range]
10.23 (2.97), [6–17]
105.49 (16.29), [73–135]
Gender, n (%)
21 (60)
14 (40)
Race, n (%)
African American
22 (63)
1 (3)
7 (20)
3 (8)
2 (6)
Handedness, n (%)
4 (11)
31 (89)
Primary SIPS-defined prodromal status, n (%)
Brief Intermittent Psychotic Syndrome
Attenuated Positive Symptom Syndrome
Genetic Risk & Deterioration Syndrome
8 (23)
27 (77)
0 (0)
Diagnosis of schizotypal personality disorder, n (%) 3 (9)
First-degree family history of psychotic disorder, n (%) 8 (23)
Clinical characteristics of sample
GAF score, mean (6SD), [range]
42.43 (11.66), [17–70]
53.57 (11.68), [20–80]
SOPS Positive Symptom Total, mean (6SD), [range]
13.06 (4.37), [3–22]
9.06 (4.38), [1–18]
SOPS Negative Symptom Total, mean (6SD), [range]
13.66 (6.99), [2–30]
11.29 (8.12), [0–32]
Strauss-Carpenter Total Score, mean (6SD), [range]
8.57 (2.43), [4–12]
9.63 (2.77), [0–12]
Social Attainment Survey Total Score, mean (6SD), [range]
16.26 (5.14), [7–29]
19.14 (7.60), [7–33]
Global Functioning: Role Scale score, mean (6SD), [range]
5.00 (1.83), [1–8]
5.80 (1.88), [2–9]
Global Functioning: Social Scale score, mean (6SD), [range]
5.60 (1.68), [2–8]
6.09 (1.58), [2–9]
Note: WASI, Wechsler Abbreviated Scale of Intelligence; SIPS, Structured Interview for Prodromal Syndromes; GAF, Global
Assessment of Functioning; SOPS, Scale of Prodromal Symptoms.
T. A. Niendam et al.
Page 4
Scale (GF:Role34), the Strauss-Carpenter Outcome Scale
(SCOS35), and the UCLA Social Attainment Survey
(SAS36). The GF:Social and GF:Role scales provide
ratings of functioning in both social and role domains
on 2 separate 10-point Likert scales, which are scored in-
dependently of symptom severity. The GF:Social and
GF:Role scales are 2 new measures (see Cornblatt et al
[2007], this issue) that are designed to provide a global
measure of psychosocial functioning in younger popula-
tions. The SCOS contains three 4-point items assessing
duration and frequency of hospitalizations, social con-
tacts with individuals outside of the family, and useful
seven 5-point items evaluating peer and romantic rela-
tionships and participation in activities and organiza-
tions. Scores for each item on the SCOS and SAS were
summed into 1 total score for each measure. Ratings
for all scales described were based on the past month.
A comprehensive neuropsychological examination
assessing multiple domains of cognitive functioning
(Table 2) was also administered at baseline and follow-
up by supervised clinical psychology doctoral students or
forms for specific cognitive measures, when statistically
comparable versions were available, and raw scores
were converted to age-matched scaled scores before
z score transformation was completed using published
normative data. In order to reduce the number of statis-
tical comparisons, the measures were combined into 5
dimensions of cognitive functioning (processing speed,
reasoning and problem solving, visual learning and mem-
ory, verbal working memory, and verbal learning and
memory) that have been identified as domains of impair-
sure assessing the domain of motor speed was included in
the battery.
Statistical Analysis
The demographic variables of age, gender, handedness,
and parental education were examined to determine
if these variables showed a significant relationship to
WASI IQ at baseline. Preliminary analyses revealed that
based on gender [40% female; F(1, 34) = 0.32, P = .58],
handedness [89% right-handed; F(1, 34) = 0.89, P = .35]
or parental education [58% college educated; F(6,
32) = 2.24,P=.07].Participants'agewasnotsignificantly
To analyze the nature and severity of cognitive deficits
at baseline and follow-up, UHR participants' average
performance within the 6 cognitive domains (speed
of processing, working memory, verbal learning and
memory, visual learning and memory, reasoning and
problem solving, and motor speed) was analyzed using
one-sample t tests, contrasting the observed score at
each time point with the normative mean of 0. Change
in participants' performance on the 6 cognitive domains
from baseline to follow-up was analyzed in a paired-sam-
ples t test.
Independent-samples t tests were used to analyze dif-
ferences in the baseline cognitive performance of individ-
uals who demonstrated improvement in functioning by
Table 2. Neuropsychological Measures and Published Normative Data
Cognitive Domain Test Used Norms Used in z Score Transformation
Processing speedTrail-Making Test A and B63
Trail-Making Test: ages 12–1464; ages 15–39
(Tombaugh, Rees, & McIntyre 1996
as cited in Spreen & Srauss65)
Digit Symbol Coding: ages 12–15, WISC-III27;
ages 16þ, WAIS-III28
FAS Verbal Fluency: ages 12–1366; ages 15–4067
Ages 16 and over only: WMS-III68
WISC-III/WAIS-III Digit Symbol Coding
FAS subtest of the Verbal Fluency Test
Reasoning and problem solving WASI Matrix Reasoning
Visual learning and memoryWMS-III Visual Reproduction Immediate
and Delayed Recall
Verbal working memoryWISC-III/WAIS-III Digit Span Backward WISC-III27; WAIS-III28
Ages 12–15: CVLT-C69; ages 16þ: CVLT-II70
Ages 12–15: CMS71; ages 16þ: WMS-III68
Verbal learning and memoryCVLT-II/CVLT-C 1–5 Total
CMS Stories/WMS-III Logical Memory
Immediate and Delayed Recall
Motor speedFinger Tapping Test, Average of dominant
and nondominant hand scores
Ages 12–1563; Ages 15–3972
Note: WISC-III, Wechsler Intelligence Scale for Children-III; WAIS-III, Wechsler Adult Intelligence Scale-III; WASI, Wechsler
Abbreviated Scale of Intelligence; CVLT-II, California Verbal Learning Test-II; CVLT-C, California Verbal Learning
Test—Children's Edition Trials; CMS, Children's Memory Scale; WMS-III, Wechsler Memory Scale-III.
Course of Neurocognition & Functioning in Prodrome
Page 5
or declined in functioning. In concordance with the stan-
dard level of change consideredto be clinically significant
in clinical trials, improvement in functioning was defined
score on the SCOS, SAS, GF:Social, or GF:Role func-
tioning scales. Group differences in performance on
the 6 cognitive domains and SOPS Positive and Neg-
ative Symptom Total scores at baseline were examined
using independent t tests for each of the functioning
To address the relationship between change in cogni-
tive performance and change in functioning over the
follow-up period, independent-samples t tests were
used to examine differences in the profile of cognitive
change scores for individuals who demonstrated 20%
improvement in functioning by follow-up when com-
ate cognitive change scores, UHR participants' baseline
performance on each of the 6 cognitive domains was sub-
tracted from their follow-up performance, so that a pos-
itive change score reflected improvement in cognitive
functioning for that domain. Similarly, change in so-
cial/role functioning was determined by subtracting the
baseline total score from the follow-up total score on
each of the 4 functioning measures, so that a positive
functioning change score reflected improvement in social
or role functioning. In contrast, change scores for SOPS
ing follow-up presentation from baseline severity, such
that a positive symptom change score reflected a decrease
in symptom severity. Post hoc analyses addressed poten-
tial confoundingvariables, such as the potential effects of
personality disorder, use of antipsychotic medications,
and participation in psychosocial treatment.
All analyses were univariate and 2-tailed with alpha set
at P ? .05 to allow for recognition of smaller effects due
to small sample size and possible power limitations. This
exploratory approach sought to generate hypotheses for
future studies and encourage additional work in this area
of research.
ipants' baseline performance revealed significant deficits
in speed of processing [t = ?3.59(33), P = .001] and motor
speed [t-= ?3.27(33), P = .003], with a trend toward
impaired verbal learning and memory [t-= ?1.82(31),
P = .08]. As shown in Figure 1, participants showed sig-
nificant improvement, on average, over the follow-up pe-
riod in the domains of processing speed [t = ?3.56(33),
P = .001], verbal learning and memory [t-= ?4.11(30),
P-< .001], visual learning and memory [t-= ?2.52(19),
P-= .02], and motor speed [t-= ?2.39(32), P = .02]. Par-
ticipants did not show significant change in performance
on measures of verbal working memory [t-= ?1.13(34),
P = .27] or reasoning and problem solving [t-= ?1.42(34),
On average, 50% of UHR individuals evidenced im-
provement in social and/or role functioning over the fol-
low-up period, with 37%–43% showing a 20% or greater
increase from their baseline functioning scores. Low to
moderate associations were observed between the base-
line and follow-up scores on each of the 4 functioning
measures (SAS r-= 0.63, P ? .001; SCOS r-= 0.25,
P = .15; GF:Social r- = 0.49, P = .003; GF:Role
r- = 0.51, P = .002), providing further evidence for
ing over time.
There were no significant relationships between base-
line cognitive functioning and level of clinical symptoms
or social/role functioning at follow-up. However, the rates
of improvement in symptoms and cognitive functioning
Profile of Change in Cognitive Functioning over Follow-up Period
0.40.30.20.100.8 0.70.60.5
Speed of Processing
Reasoning & Problem Solving
Visual Learning & Memory
Verbal Working Memory
Verbal Learning & Memory
Motor Speed
Mean Change in Z-score ± SEM
Fig. 1. Change in Patients' Mean Performance (z score 6 SEM) on 6 Cognitive Domains Between Baseline and Follow-up.
T. A. Niendam et al.
Page 6
differentiated those UHR individuals who improved
functionally from those who did not. As shown in Figure
2, a 20% or greater improvement in baseline GF:Social
functioning was associated with significant improvement
in processing speed [t-= ?2.26(32), P = .03] and Visual
Learning and Memory [t-= ?2.56(18), P = 0.02] as indi-
viduals who improved in social functioning also showed
improved processing speed [change mean z score (SD) =
0.73 (0.53)] and visual learning and memory [change
mean z score (SD) = 1.22 (1.07)] over the follow-up pe-
riod when compared with those individuals who did
not show improvement on the GF:Social [processing
speed change mean z score (SD) = 0.20 (0.77); visual
learning change mean z score (SD) = 0.21 (0.68)]. Addi-
tionally, a 20% or greater improvement in SAS Total
Score was associated with differential change in SOPS
Positive Symptom Score [t-= 2.43(32), P = .02] because
individuals who improved on the SAS showed a larger
decrease in positive symptomatology [positive symptom
change mean z score (SD) = 6.62 (4.03)] than those indi-
viduals who did not show improvement in social func-
tioning according to the SAS [positive symptom
change mean z score (SD) = 2.76 (4.75)].
Finally, a 20% or greater improvement in role func-
tioning, according to SCOS total score, was significantly
associated with change in the SOPS Negative Symptom
Total Score [t-= 3.26(24.56), P = .003] and SOPS Positive
Symptom Total Score [t-= 2.24(32), P = .03] because
those individuals who showed functional improvement
also showed a larger decline in negative [negative symp-
tom change mean z score (SD) = 6.07 (2.81)] and positive
symptoms [positive symptom change mean z score
(SD) = 5.93 (3.39)] when compared with those who did
not improve on the SCOS [negative symptom change
mean z score (SD) = ?0.40 (8.24); positive symptom
change mean z score (SD) = 2.55 (5.49)].
Post hoc analyses of possible confounding factors
illness, diagnosis of schizotypal personality disorder, or
use of antipsychotic medication on cognition, clinical
tion or social/role functioning, participation in 2 or more
forms of psychosocial treatment during the follow-up
period was significantly associated with a 20% decline in
SOPS positive symptoms (v2= 6.41, P = .04).
This study confirms the presence of baseline neuropsy-
chological deficits in individuals at UHR for psychosis
and provides the first evidence of longitudinal associa-
tions between neuropsychological functioning, clinical
symptomatology, and social/role functioning in this
population. At baseline, UHR individuals demonstrated
a pattern of deficit in measures of speeded information
processing, with a trend toward impaired verbal learning
and memory. This profile is similar to that observed in
Profile of Cognitive Change by GF:Social Functioning Improvement
Speed of processing
Mean Change in Z-score ± SEM
Improved on
by 20%
(n = 20)
(n = 15)
Reasoning & Problem Solving
Visual Learning & MemoryVerbal Working Memory
Verbal Learning & MemoryMotor Speed
Fig. 2. Profiles of Change in Patients' Mean Cognitive Performance (z score 6 SEM) associated with 20% Improvement on the Global
Functioning: Social scale.
Course of Neurocognition & Functioning in Prodrome
Page 7
other UHR samples8–18as well as individuals with estab-
that individuals showing emerging clinical signs of illness
are on a continuum with fully psychotic individuals.
Additionally, this investigation is one of the first to
demonstrate that a subset of UHR individuals show a
pattern of improvement in multiple cognitive domains,
specifically processing speed, verbal and visual learning
and memory, and motor speed at follow-up approxi-
mately 8 months later. Although there is some evidence
for short-term improvement in some cognitive domains
in first-episode schizophrenia as a result of pharmacolog-
ical interventions,43,44the overall degree of cognitive
impairment appears relatively stable across the lifetime
course of the illness.45–48The current findings suggest
that the pattern of cognitive deficits observed at baseline
in a subset of putatively prodromal individuals may re-
flect difficulties associated with generalized psychiatric
distress, as opposed to a stable, underlying trait specifi-
cally associated with risk for psychosis. Therefore, some
UHR individuals share certain phenotypic features with
those who progress to psychosis, but possibly for differ-
ent underlying reasons.
Additionally, results of the current study revealed that
UHR individuals' functional improvement at follow-up
was not predicted by their cognitive performance at base-
line, but functional improvement was associated with im-
provement in both cognition and clinical symptoms over
the follow-up period. In other words, those individuals
who showed improvement in social or role functioning
over the follow-up period also had improved cognitive
performance and decreased symptoms over time. Specif-
ically, improvement in social functioning was associated
with significant improvement in both processing speed
and visual learning and memory at follow-up. Given
that UHR participants in this sample show significant
cognitive improvement in many domains, these findings
reveal that it may be this pattern of change in cognition
over the follow-up period, rather than severity of cogni-
tive deficits at baseline, that is related to improvement in
functioning over time.
Furthermore, results showed that improvement in so-
cial functioning was associated with a larger decrease in
positive symptoms over the follow-up period, suggesting
that acute symptomatology may play a stronger role in
social functioning in UHR patients than is observed
ment in role functioning was associated with a larger
to the notion that negative symptoms have a notable
impact on role functioning in UHR individuals.
Several possible alternative explanations for the pat-
tern of cognitive improvement observed in this study
bear consideration. In particular, practice effects49and
the effects of interventions may arguably play a role. Re-
search shows improved functional outcome with earlier
intervention in the treatment of psychotic disorders,50–52
andmany ofthe studyparticipants receivedsomeform of
psychiatric or psychological treatment during the course
of the study. Such treatment is ethically necessary due to
the participants' level of distress and functional impair-
ment, but these interventions likely affect the natural
course of the disorderand contributeto clinical and func-
tional improvement. In the current study, participants
who received 2 or more types of psychotherapy over
the follow-up period were significantly more likely to
show a 20% decrease in positive symptoms, suggesting
that psychosocialinterventions mayhave astrong impact
on clinical distress in this at-risk population. However,
such treatment was not associated with changes in cog-
nitive or psychosocial functioning. Unfortunately, sam-
ple size and the high percentage of study participants
receiving treatment prohibited comparison of individuals
receiving vs those who declined treatment and be-
tween individuals receiving different forms of treatment.
Nevertheless, longitudinal analyses of patients with
schizophrenia typically show a pattern of stable cognitive
functioning across the lifespan course of illness, despite
improvement in psychotic symptom severity in response
to psychosocial treatment,53,54which is in contrast to
the pattern of cognitive, clinical, and functional im-
provement observed here. In order to address these issues
definitively, future studies will need to use matched non-
UHR samples to control for practice effects, as well as
UHR individuals receiving alternative types of treatment
to examine the effects of psychotherapy and medication
on cognition and social/role functioning.
of improvement were driven by the subset of ''false posi-
tives'' within this sample, additional analyses revealed
that individualswhosubsequentlyconvertedtopsychotic
disorder diagnoses (''true positives,'' n = 9, 25% of the
sample) showed the same patterns of baseline cognitive
symptoms, and functioning when compared with those
in first-episode treatment studies using novel atypical
antipsychotic compounds,43,44these results suggest that
early intervention may attenuate the effects of psychosis
on cognition and contribute to better outcome, even for
those who subsequently develop a psychotic disorder.
Many researchers have highlighted the potential of
pattern of cognitive improvement observed in this study
encourages critical examination of the potential utility
of baseline cognitive deficits as definitive markers for
heightened risk for psychotic illness in a clinical high-
risk sample. The observation of improvement in multiple
T. A. Niendam et al.
Page 8
cognitive domains in association with clinical and func-
tional improvement suggests that baseline cognitive defi-
cits in a subgroup of UHR individuals may represent
a state-specific factor, associated with diffuse psychologi-
Alternatively, the pattern of deficits observed here could
represent an interaction between psychological state at
These competing explanations warrant further investiga-
tion in future studies.
A previous analysis30of DSM-IV diagnoses in this
sample revealed that many of the UHR participants
met criteria for a mood or anxiety disorder diagnosis
at ascertainment, diagnoses which other studies61–63
have found to be associated with cognitive impairment
in the domains observed here. Given that UHR popula-
tions are a mixture of true and false positives, the cogni-
tive deficits observed in UHR samples at ascertainment
may represent the manifestation of impairment associ-
ated with generalized risk for a variety of psychological
disorders rather than a vulnerability that is specific to
psychosis. Therefore, the results of this study suggest
that the pattern of change in cognition and functioning
over time may provide a more accurate means of separat-
ing the false positives, who show improvement in state-
related deficits over time, from the true positives, who
show more stable trait-like deficits representing endophe-
notypic markers of underlying risk.
Therefore, these findings provide novel evidence sug-
decline. To the contrary, the demonstration of improve-
ment in multiple cognitive domains highlights the power
ulation. Overall, the results of this study suggest that
UHR individuals should be examined over time because
stability that may differentiate those individuals who are
at highest risk for further psychological deterioration.
While this study offers support for early identification
as a means of improving functional outcome, results
should be interpreted with caution due to the small sam-
ple size. These findings provide the first glimpse into rela-
tionships between cognition, symptoms, and functioning
over time and are presented to generate hypotheses and
be noted that the lack of statistical power may have re-
Additionally, small sample size precluded the inves-
tigation of the different patterns of association between
cognitive, clinical, and social/role functioning measures
presented in the current study. Further analyses should
be pursued in larger samples to validate these findings,
examine specificity of deficits observed here, and uncover
additional relationships that may have been obscured in
the current analysis.
As noted previously, this current study is limited by its
lack of a normal comparison group and resulting use of
published normative data for comparison to this clinical
sample. However, such published normal samples were
developed and published in order to provide adequate
comparisons for clinical data. Given the difficulty in
obtaining well-matched adolescent control samples, re-
searchers commonly utilize such published norms.15
Nonetheless, comparison to a demographically matched
control sample, assessed at similar time points, would
strengthen the current findings and should be a priority
for future studies. As a related issue, this investigation
tests of the domains of cognition sampled, and it is pos-
sible that deficits in other domains, such as working
memory, would have been observed had we employed
experimental paradigms designed to isolate particular
aspects of these functions.
Finally, it is important to note that some proportion of
individuals within this sample will not progress to de-
velop a diagnosable psychotic disorder, and these indi-
viduals would consequently be labeled false positives.
As noted previously, the inclusion of such false positives
in the group analyses may obscure the presence of signif-
icant cognitive deficits in some of the hypothesized
domains, and the relationship between such deficits
and functional outcome, that may be present if only
true positives were examined. Although additional anal-
yses suggested that the pattern of improvement was also
characteristic of a small sample of true positives, longi-
tudinal follow-up in larger samples is needed to deter-
mine the pattern of neurocognitive, symptomatic, and
functional change most predictive of conversion to a
full-blown psychotic disorder and to elucidate the com-
plex relationship between such cognitive change, clinical
severity, and functional outcome over time.
This research was supported by the following grants:
MH14584 (Ruth L. Kirschstein National Research
Service Award Postdoctoral Fellowship to Niendam),
National Alliance for Research on Schizophrenia and
Depression Young Investigator Award (Maxine and
Jack Zarrow Investigator Award to Bearden), National
Science Foundation Graduate Fellowship, as well as
donations from the Rutherford Charitable Foundation
and Staglin Music Festival for Mental Health. The
authors would like to thank the following individuals
for their contributions to this project: Cindy Akin,
Peter Bachman, PhD, Tammy Beran, MA, Nicole
P. Connolly, MA, Melita Daley, MD, Lauren Ellman,
MA, Alison Greiner, LCSW, Jacqueline Horwitz, MA,
Course of Neurocognition & Functioning in Prodrome
Page 9
Christopher Jetton, Tyler Lesh, MA, Rachel Loewy,
PhD, Sabrina Lux, Kristopher Mathis, Stephanie Meyer,
PhD, Caroline Miranda, LCSW, Keith Nuechterlein,
PhD, Leigh Sepeta, MA, David Shirinyan, MA, and
Natasha Thapar, MA.
K. Eberhart,MA, Michael Green,PhD,
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Course of Neurocognition & Functioning in Prodrome


text:
Discovery Parkway is the new name being pitched for the road that will connect Watertown Plank Road and Swan Boulevard on the Innovation Park campus.
After Wauwatosa officials deemed the name Technology Parkway uninspiring and too generic, city staff met with representatives from the University of Wisconsin-Milwaukee Real Estate Foundation to brainstorm some alternatives.
"As a compromise, they have suggested Discovery Parkway," Paulette Enders, city economic development director told Community Development Committee on Tuesday.
The committee, on a 6-1 vote, accepted the suggestion and forwarded it the Common Council for consideration next week.
"It really does a good job of encapsulating everything this development is going to be about," Alderman Bobby Pantuso said.
He recalls romping around the County Grounds discovering wildlife with his family. The word "discovery" bridges the nature aspect of the butterflies and green space wit the technology, specifically the research discoveries that will be made in the buildings.
Alderman Jason Wilke was the one holdout. He was interested in finding a fitting Native American name and had been consulting cultural experts at the university for suggestions.
"A lot of things in Wisconsin have been named in honor of the people who were first here," he said.
His fellow committee members liked the idea and believed names with historical and cultural meaning could be considered as more roads are installed on the campus or as the land that was donated to become a park gets named.
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subset: commoncrawl


text:
This section will feature stories organised under individual categories, providing a resource for in-depth study of particular topics. It will get richer as more stories are added to the website.
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Tehran, Monday, March 23, 2015
Iran urges world powers to find 'common position' for nuclear deal
A senior Iranian nuclear negotiator has urged world powers to find a "common position" to achieve a "balanced" final nuclear deal with the Islamic Republic as a deadline for negotiations looms.»More on missile systems AND: defence, nuclear weapons
HYDERABAD, Wednesday, March 18, 2015
Astra test-fired successfully against simulated target
The missile was tested to prove the manoeuvring capability against a simulated target and also to validate various subsystems. »
SEOUL, Monday, March 2, 2015
North Korea test fires 2 short range missiles
South Korea's military says rival North Korea has fired two short range missiles into the sea off its east coast. Such test firings aren't unusual, but Monday's morning launch comes as alli... »More on missile systems AND: North Korea
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Hi, I am working with java. I was wondering what to type in the start of a program so I can choose between all the classes in the program? How to choose to use only "class A" for example?
Thanks for a quick answer!


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text:
This is very clever, from beginning to end:
(via The Bold Italic)
This is very clever, from beginning to end:
(via The Bold Italic)
This year, the chair of ICALP decided to play an April Fool's prank three weeks early, and I received the following message:
"Dear author, we regret to inform you that the margins in your submission are too small, and hence we are rejecting it without review"
I was almost fooled. In my defense, the second time that I applied for a position in Italy, the hiring committee judged all my publications to be non-existent, because the (multiple) copies I had sent them had not been authenticated by a notary. So I am trained not to consider it too strange that a paper could be evaluated based on the width of its margins (or the stamps on its pages) rather than on the content of its theorem.
Paul Erdös would be 102 year old this year, and in celebration of this the Notices of the AMS have published a two-part series of essays on his life and his work: [part 1] and [part 2].
Of particular interest to me is the story of the problem of finding large gaps between primes; recently Maynard, Ford, Green, Konyagin, and Tao solved an Erdös $10,000 question in this direction. It is probably the Erdös open question with the highest associated reward ever solved (I don't know where to look up this information — for comparison, Szemeredi's theorem was a $1,000 question), and it is certainly the question whose statement involves the most occurrences of "".
The Bulletin of the AMS is going to publish a 57-page survey on growth in groups, which is already online, and which touches several topics of interest to readers of in theory, including the recent work of Bourgain and Gamburd on expander Cayley graphs of and the work of Helfgott and Seress on the diameter of permutation groups.
Alexander Grothendieck died on Thursday at age 86 in Saint-Girons.
Grothendieck, who started his work in functional analysis, is known for his far-reaching (and still incomplete) program of creating new foundations for algebraic geometry, a work that he led at IHES in the 50s and 60s and that is documented in the thousands of pages of EGA and SGA. If modern algebraic geometry is built on schemes, has applications to number theory, has definitions given in a category-theoretic language, and is completely incomprehensible to the novice, it is all thanks to Grothendieck's vision.
In his 40s, and the top of his game, Grothendieck left IHES over the issue of military funding, and progressively detached from the mathematical community, while embracing environmental and anti-war causes.
Grothendieck's life story, from his escaping Nazi Germany, to his revolution in mathematics, to his radical politics and later hermit life, is spellbinding. Some of it is told in a great two-part article in the Notices of the AMS (part 1, part 2) and I would also recommend this more technical essay and this more philosophical one.
Grothendieck has a flair for effective naming, he had a way with words, and he liked elaborate metaphors. Here is his famous "how to break a nut" analogy describing his style of mathematical research
I can illustrate the second approach with the same image of a nut to be opened. The first analogy that came to my mind is of immersing the nut in some softening liquid, and why not simply water? From time to time you rub so the liquid penetrates better, and otherwise you let time pass. The shell becomes more flexible
through weeks and months—when the time is ripe, hand pressure is enough, the shell opens like a perfectly ripened avocado!
[Update 10/24/14: there was a bug in the code I wrote yesterday night, apologies to the colleagues at Rutgers!]
[Update 10/24/14: a reaction to the authoritative study of MIT and the University of Maryland. Also, coincidentally, today Scott Adams comes down against reputation-based rankings]
Saeed Seddighin and MohammadTaghi Hajiaghayi have proposed a ranking methodology for theory groups based on the following desiderata: (1) the ranking should be objective, and based only on quantitative information and (2) the ranking should be transparent, and the methodology openly revealed.
Inspired by their work, I propose an alternative methodology that meets both criteria, but has some additional advantages, including having an easier implementation. Based on the same Brown University dataset, I count, for each theory group, the total number of letters in the name of each faculty member.
Here are the results (apologies for the poor formatting):
1 ( 201 ) Massachusetts Institute of Technology
2 ( 179 ) Georgia Institute of Technology
3 ( 146 ) Rutgers – State University of New Jersey – New Brunswick
4 ( 142 ) University of Illinois at Urbana-Champaign
5 ( 141 ) Princeton University
6 ( 139 ) Duke University
7 ( 128 ) Carnegie Mellon University
8 ( 126 ) University of Texas – Austin
9 ( 115 ) University of Maryland – College Park
10 ( 114 ) Texas A&M University
11 ( 111 ) Northwestern University
12 ( 110 ) Stanford University
13 ( 108 ) Columbia University
14 ( 106 ) University of Wisconsin – Madison
15 ( 105 ) University of Massachusetts – Amherst
16 ( 105 ) University of California – San Diego
17 ( 98 ) University of California – Irvine
18 ( 94 ) New York University
19 ( 94 ) State University of New York – Stony Brook
20 ( 93 ) University of Chicago
21 ( 91 ) Harvard University
22 ( 91 ) Cornell University
23 ( 87 ) University of Southern California
24 ( 87 ) University of Michigan
25 ( 85 ) University of Pennsylvania
26 ( 84 ) University of California – Los Angeles
27 ( 81 ) University of California – Berkeley
28 ( 78 ) Dartmouth College
29 ( 76 ) Purdue University
30 ( 71 ) California Institute of Technology
31 ( 67 ) Ohio State University
32 ( 63 ) Brown University
33 ( 61 ) Yale University
34 ( 54 ) University of Rochester
35 ( 53 ) University of California – Santa Barbara
36 ( 53 ) Johns Hopkins University
37 ( 52 ) University of Minnesota – Twin Cities
38 ( 49 ) Virginia Polytechnic Institute and State University
39 ( 48 ) North Carolina State University
40 ( 47 ) University of Florida
41 ( 45 ) Rensselaer Polytechnic Institute
42 ( 44 ) University of Washington
43 ( 44 ) University of California – Davis
44 ( 44 ) Pennsylvania State University
45 ( 40 ) University of Colorado Boulder
46 ( 38 ) University of Utah
47 ( 36 ) University of North Carolina – Chapel Hill
48 ( 33 ) Boston University
49 ( 31 ) University of Arizona
50 ( 30 ) Rice University
51 ( 14 ) University of Virginia
52 ( 12 ) Arizona State University
53 ( 12 ) University of Pittsburgh
I should acknowledge a couple of limitations of this methodology: (1) the Brown dataset is not current, but I believe that the results would not be substantially different even with current data, (2) it might be reasonable to only count the letters in the last name, or to weigh the letters in the last name by 1 and the letters in the first name by 1/2. If there is sufficient interest, I will post rankings according to these other methodologies.
When he was 14, Joshua Wong cofounded Scholarism, the Hong Kong student movement that successfully protested the introduction of a "patriotic" curriculum. Now he is one of the student leaders of the Hong Kong pro-democracy movement.
Despite facing continued violence from triad-affiliated gangsters, the occupation continues, always in a uniquely Hong Kong manner.
Today Joshua Wong turns 18, and he gains the right to vote. May he be able to use this right freely!
[Photo by Anthony Kwan, video by the New York Times]
When Hong Kong was "handed over" to China on July 1st, 1997, the plan was that the city, now a Special Administrative Region, would retain its independent laws and institutions for 50 years, and it would have elections with universal suffrage (one person one vote). In 2007, it was decided that universal suffrage would start in 2017.
Discussion on how to regulate the 2017 elections has been going on for the last several months. A coalition of pro-democracy groups ran an informal referendum on the preferred system of election, gathering about 800,000 votes, or a fifth of the registered electorate. All the options in the referendum assumed no vetting process for the candidate, contrary to Beijing's stance that any system for the 2017 election would only allow candidates pre-approved by the mainland government.
Afterwards (this happened during the summer), the pro-democracy groups organized an enormous rally, which had hundreds of thousands of participants, and announced plans to "occupy Central with love and peace" (Central contains the financial district) on October 1st if the Hong Kong legislature passed an election law in which candidates could run only with Beijing's approval.
This was followed by an anti-democracy rally, partly attended by people bused in from across the border, which is a rather surreal notion; it's like people are saying "we want our voices heard about the fact that we do not want our voices heard."
A few days in advance of October 1st, a group of university students, some of them associated with group scholarism started a sit-in at a government building. Scholarism made news three years ago, when it (successfully) fought the proposal to introduce a "patriotic education" curriculum in grade school.
People have been facing the police with umbrellas and goggles to protect themselves from pepper spray.
The plaza in front of the government building, where the sit-in started, has been cleared, but for the whole weekend both Central and the neighboring district of Admiralty have been filled by thousands of protesters, day and night.
There is a petition at whitehouse.gov that has already exceeded the threshold required to receive a response, but that people might want to sign on.
Considering how the Chinese government feels about students rallying for democracy, there is reason to be worried.
[photos taken from Facebook, credits unknown]


text:
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Content Strategies from Entrepreneur and Columnist, John Rampton
At the San Francisco PR Summit this year many fascinating and successful people from the fields of public relations, marketing, small business and entrepreneurship spoke. Some of these speakers included past mentioned marketing experts, Ben Parr and Jill Rowley. The RingCentral team was honored to attend and listen to such industry innovators and thought leaders in their respective fields. Another presentation we enjoyed at the SF PR Summit was by John Rampton—founder ofRead More »


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Paul Curtman
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Rep. Paul Curtman, a Republican, represents parts of Franklin County (District 109) in the Missouri House of Representatives. He was elected to his first two-year term in November 2010.
Rep. Curtman served from 1999 to 2003 on active duty in the United States Marine Corps, attaining the rank of Sergeant. While on active duty he participated in operations in support of Operation Enduring Freedom and the Global War on Terror. After leaving active duty, he served as a Marines Reservist until 2009.
Rep. Curtman is a member of Cornerstone Baptist Church where he also serves as the assistant youth director.
Rep. Curtman is a 1999 graduate of Pacific High School and a received his B.A. in Political Science from the University of Missouri - St. Louis. After graduating from the university, he became a licensed Series 7 Financial Advisor.
Born April 21, 1981 in Flint, Michigan, Rep. Curtman currently resides in Pacific.


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Reaction To Lopinavir/Ritonavir
Here's a taste of what TheBody.com has to offer on this topic:
Ask the Experts
Is this a good PEP regimen for 28 daysDear Dr. Young,Is this a considered an optimum PEP regimem for 28 days?1 pill of Epzicom, taken with 4 pills of Kaletra , taken all at the same time once a day.That's 5 giant horse pills at once.
Response from Benjamin Young, M.D., Ph.D.
Rocky Mountain CARES...of the US and European population (less in Africa and parts of Asia) are at risk of developing a sometimes serious allergic reaction.Lopinavir/ritonavir (Kaletra, Aluvia) is an often prescribed component of PEP. Perhaps not as well tolerated as... Read more »
RE: Second line regimenDear Dr. Joe, many thanks for the concern and well-thought answer to my inquiry about regarding... Read more »
treatment for side effects of tenofavir|+3TC and lopinavir with ritonavirDear dr.I was recently started 2nd line medication from indian govt.Started on 24/10/2010. i had... Read more »
Kaletra (Lopinavir/Ritonavir) Package Insert Revision Regarding Drug-Drug Interaction Information...revised to state: If they are receiving sildenafil, tadalafil, or vardenafil they may be at increased risk of associated adverse reactions including hypotension, visual changes, and sustained erection, and should promptly report any symptoms to... Read more »
New Kaletra (Lopinavir/Ritonavir) Tablets and Oral Solution Once Daily Dosing Regimen in Certain Adult Patients...tablets once daily compared to 7.0% in patients receiving KALETRA tablets twice daily. A table for the treatment-emergent adverse reactions of moderate or severe intensity and grade 3-4 laboratory abnormalities can be found in the revised... Read more »
An Overview of Kaletra (Lopinavir/Ritonavir)low-PIN-a-veer, rit-ON-uh-veer Brand Name: Kaletra Other Name(s): Aluvia, LPV/RTV, LPV/r Drug Class: Protease Inhibitors Lopinavir/ritonavir, also known as Kaletra, is a type of medicine called a protease inhibitor (PI). PIs... Read more »
Kaletra (Lopinavir and Ritonavir) Labeling Revisions...The Kaletra (lopinavir and ritonavir), Soft Gel Capsules and Oral Solution, labeling has been revised to include long-term (week 144-204) efficacy and safety results Read more »
Connect With Others
my strange reaction
Posted by midwestguy143, 2 Replies...I tested positive on March 24, 2009. The thing that surprised me, and my friends was my reaction -- none really. Just something else in my life. I had lost my job many months ago, and with the job market being so tough, Read more »
Posted by Anonymous, 1 Reply...also cause inflammation of the pancreas and painful nerve damage. There have been reports of complications and other severe reactions, including death, to some of the antiretroviral nucleoside analogs when used alone or in combination. Therefore,... Read more »
New Drug - TMC114
Posted by Survivor, 1 ReplyDon't Let TMC114 Cost More Than Kaletra, Advocates Urge We may be only days away from an announcement that the U.S. has approved a new HIV medication: TMC114 (darunavir), a protease inhibitor that may be especially helpful for people with... Read more »
allergic reactions
Posted by TRex, 2 Replies...Has anyone who is HIV positive had a lot of allergic reactiosn to antibiotics? I had two allergic reactions (the Bactrim one was the one who made me ask for the HIV test).the other one is Keflex. I am on Augmentin now and woke up with Read more »
Resource Centers
Guides for People With HIV


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|MON 24 Hours
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DexKnows Mobile profile for Evans-Nordby Funeral Home in Brooklyn Center, MN


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Owners' Reviews
1997 Ford Contour Reviews and Owner Comments
2 ReviewsWrite Your Review
Overall Score (2 reviews)
1997 Ford ContourVisitor, Higginsport, OH, October 20, 2013 08:19My car got stuck in park . rocking back and fourth got it out of park , but I lost turn signals ,heat , cruise control and back up lights. I replaced the thermostat , but still no heat !1 the blower works fine !!
1997 Ford Contourrjrosenow, Independence, OH, September 15, 2009 17:39Love it.Enthusiast


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QR Code Press » Entries tagged with "social media marketing"
4 Tips for Mobile Marketing
October 4th, 2014 | Add a Comment
(adsbygoogle = window.adsbygoogle || []).push({}); Mobile marketing has become a very important thing for many businesses. There are more people that use smartphones and tablets on a daily basis now than at any point in the past decade. People have become inseparable from their mobile devices and this means that marketing has had to shift to accommodate the demand for dynamic engagement. There are many ways that businesses can connect with mobile consumers and not all … Read entire article »
Filed under: Mobile Marketing, Social Media Marketing
Social media marketing strategies at Facebook and Twitter freshen up stale ads
September 22nd, 2014 | 1 Comment
These two networks are working to come up with new ways to generate profit from their current successes. Twitter, Facebook, and other platforms are now working on enhancing their social media marketing experience so that they will be able to bring in greater profits based on their ability to successfully reach millions of consumers. Facebook already has over one billion users and it has been working very hard to boost its income via marketing. Twitter has been doing … Read entire article »
Filed under: Mobile Commerce, Mobile Marketing, Social Media Marketing, Trends
Social media marketing at Twitter tests "buy" button
September 10th, 2014 | Add a Comment
The network is testing out online and mobile commerce plans for the future with this new option. A tweet at Twitter could soon be much more than a short blip of communication or social media marketing, but it could also become a way for a consumer to be able to purchase what is being discussed. The social network is now testing out a new e- and m-commerce opportunity with a "buy"button. Though this is not being rolled out … Read entire article »
Filed under: Mobile Commerce, Mobile Marketing, Social Media Marketing, Trends, United States
Social media marketing experts use ALS Ice Bucket Challenge as a lesson
August 29th, 2014 | Add a Comment
While there is no formula for success, the campaign is being studied and broken down in order to learn from it. Regardless of whether you agree that social media marketing is a powerful opportunity or not, there is no denying that the ALS Ice Bucket Challenge is a tremendously successful awareness campaign and it has managed to take advantage of everything this channel has to offer. The videos of friends, family, and celebrities pouring ice water on … Read entire article »
Filed under: Mobile Marketing, Social Media Marketing
Technology news is getting exciting for the hitchhiking robot
August 18th, 2014 | Add a Comment
The Hitchbot has nearly reached its final destination through the sheer kindness of strangers. In Canada, technology news is starting to buzz ahead of the arrival of the Hitchbot hitchhiking robot that has made its way across the country and is now nearing the end of its trek from Halifax, Nova Scotia to Victoria, British Columbia. The creators have stated that the last reports from its mobile devices showed it passed Kelowna B.C. At that time, the technology … Read entire article »
Filed under: Gadgets, International, Social Media Marketing, Technology News
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Kevin of Devinely Designed creates beautiful soap and shares his creations via his YouTube channel, Devinely Designed. With over 100 videos, Kevin has made a name for himself in the community for providing creative and educational soap making videos. From a Dandelion Zebra Swirl Tutorial to his first experience making liquid soap, Kevin's videos are fun and […]
The post Interview with Kevin of Devinely Designed appeared first on Soap Queen.


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I am Daniel Zanchetta, an IT professional living in Philadelphia, PA, USA. Traveling for me is how I spend the little spare time that I have, over weekends or vacation, with one or more friends.
I am originally from Sao Paulo, Brazil, but lived in Copenhagen, Denmark for 4 years and I've been in the USA since 2009.
I am excited to find great places to stay at on this website for the many trips I do throughout the year!


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You may also like
Rate Dr. David B. Seifer
Dr. David B. Seifer's Ratings
Comment on oct 13th, 2014 is out of line and ridiculous. I cannot speak to Dr Grazi's merits but Dr Seifer have us out son and was kind and patient every step of the way. Ludicrous!
Was this rating useful? 0 [[ userState['ratings'][2675628].votes_count ]]
The person that wrote 2 spaces below me is obviously irrational and I would disregard their ratings. Dr Seifer is a brilliant man and from someone that experienced multiple clinics, he is by far the most competent doctor we have experienced.
Was this rating useful? 0 [[ userState['ratings'][2642862].votes_count ]]
I had the privilege to be Dr. Seifer's patient. I had low ovarian reserve, was in my mid 30's and never been pregnant. With his knowledge and help we were able to have a family. Thank you Dr. David Seifer.
Was this rating useful? 0 [[ userState['ratings'][2633170].votes_count ]]
Prior to hiring Dr David Seifer and Dr. Richard Grazi at Genesis Fertility, I thoroughly reviewed other patients' experiences. I noticed, one patient, in particular, referred to Dr. Seifer as a "mensch." I could not disagree more! As a matter of fact, the word I would choose to use to describe Seifer is, "Gonif." Their modus operandi is Seifer lies and Grazi swears. I cannot stress to you enough, how we absolutely regret ever having dealt with these disgusting and atrocious men. They are both rude, nasty, and belligerent, to say the least. I have never, ever been so disrespected, as a woman, as I have personally experienced firsthand by Seifer and Grazi at Genesis Fertility. Not to make mention of the fact, that they are single handedly at fault for a myriad of costly mistakes for the failed IVF procedures I endured at their hand. It should not appear as a surprise that I have since "FIRED" these incompetent and unprofessional low-minded thieves.
It is critical that anyone who may be considering treating with Genesis, be made fully aware of my horrific and horrendous experiences. As I pray, this may never happen to another unsuspecting patient. I only wish someone would have been as honest and forthcoming. It would have saved me and my family tremendous heartache and misery.
As a side note, for your reference, Genesis Fertility does not want you to know that their new state-of-the-art facility, was actually, in fact, a FUNERAL HOME.
Was this rating useful? 3 [[ userState['ratings'][2575777].votes_count ]]
Excellent doctor - his knowledge is unchallenged and he knows how to put you at ease
Was this rating useful? 1 [[ userState['ratings'][2551499].votes_count ]]
There are not enough kind words to say about Dr. Seifer. After my husband and I had a HORRIBLE experience at another fertility clinic, we felt so defeated after not conceiving after three embryo transfers. We decided to switch clinics and became patients of Dr. Seifer. He is INCREDIBLE. So knowledgable, does not waste your time and has a wonderful bedside manner. He makes you feel like you are his only patient and treats you with compassion and respect. Within two weeks he found our problem (other clinic did not find it after almost a YEAR and recommended I undergo an unnecessary surgery) and we are currently 8 weeks pregnant with twins after our FIRST round of IVF with Genesis. If all continues to go well, we will be leaving Dr. Seifer in a few weeks and moving onto an obgyn! My husband and I are so sad to leave Dr. Seifer! His knowledge and skills are unsurpassed and we will forever be grateful for the precious gift he has given us!
Was this rating useful? 0 [[ userState['ratings'][2444061].votes_count ]]
After 10 years of trying to get pregnant, and countless doctor visits, we decided to schedule an appointment with Dr. Seifer. Within a week of meeting Dr. Seifer, we were informed of all the underlying causes that have led to our infertility. For the first time in a while I felt like we finally met the right doctor. Once we knew the cause, Dr. Seifer provided us with different treatment options and identified the best option for our individual case. Most of all, what I liked about Dr. Seifer was that he was very proactive and direct about how to tackle each obstacle we faced, as well as very honest about what to expect. I'm proud to say that we are currently pregnant! I still can't believe it. I just wish I had met Dr. Seifer earlier. He has been the only doctor who found the root of our problem, addressed it, and helped us move forward towards creating the miracle of life. I can't even express the gratitude and happiness I currently feel in my heat. Thank you.
Was this rating useful? 0 [[ userState['ratings'][2444060].votes_count ]]
If you are having issues with fertility, this is the doctor to see. He is an absolute genius! My husband and I were referred to him by a friend of ours after we had gone to another fertility doctor who was a nightmare. Immediately Dr. Seifer knew the exact plan of action that would be right for us. My husband's sperm had very low motility and morphology and there was no other option for us than ICSI IVF. Dr. Seifer was there for us every step of the way. He treats you as if you are his only patient, and let me be clear you are definitely not. Dr. Seifer is extremely busy for a reason...because he's the BEST! He held my hand throughout my entire cycle. Also, I cannot speak more highly of his staff. The nurses are the best in the business. They are on call for you 24/7. I really cannot say enough great things about our experience. I am currently 10 weeks pregnant with twins and I owe it all to Dr. Seifer and his staff.
Was this rating useful? 0 [[ userState['ratings'][1168230].votes_count ]]
Dr. Seifer is very personable and friendly with great bedside manner. He made my husband and I feel very comfortable throughout the entire experience. It was the first time that we had visited a fertility doctor and really didn't know what to expect. Dr. Seifer made sure that all of our questions were answered and gave us all the time we needed – it made us feel very relaxed and not just rushed in and out of his office. We knew after our very first appointment that we had made the right decision in choosing Dr. Seifer to guide us through our journey of starting a family. I would highly recommend Dr. Seifer to a friend.
Was this rating useful? 0 [[ userState['ratings'][1168229].votes_count ]]
My experience with Dr. Seifer and his entire staff was absolutely wonderful. Dr. Seifer always kept me hopeful and positive. He is a brilliant doctor who truly knows his field. He never played games or sugarcoated anything..he always got right to the point. And what I appreciated so much was that every once in a while, he called me to make sure that I was okay and to reassure me that I was on the most effective path. The staff at Genesis was always so kind and accommodating. They always returned my calls promptly and helped me. The nurses were amazing. They were always available to answer my questions or give me support. The nurses were friendly and sensitive to my needs and they were highly knowledgeable.I did get pregnant a few months ago and so far, so good. Yay! God willing, everything will be great and my baby will be healthy and beautiful.I highly recommend Dr. Seifer and Genesis Fertility to anyone who is having fertility issues. SO THANKFUL
Was this rating useful? 0 [[ userState['ratings'][1168228].votes_count ]]
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Bontrager's Super Charger is a shop-worthy pump for the home mechanic. The base, barrel, handle and gauge are crafted from aluminum, so it's tough, durable and lightweight. Replaceable internals extend the life of the pump. It's also got an extra-long hose, an easy to read gauge, and an auto-select… [more]
Topeak's Road Morph G is the perfect answer for riders who've had trouble deciding if they want a frame or floor pump. The Road Morph is both! For maximum pumping power, it features a high-volume aluminum barrel, a fold-out base, a long hose with built-in gauge and a T-handle. Of course, it fits… [more]
The Ultraflate Plus is sleek, compact and uses compressed CO2 to fill tires fast. The thumb lever allows you to control airflow and it has a safety lock to prevent accidental discharge. The Ultraflate Plus comes with a 16-gram non-threaded CO2 cartridge, is compatible with a wide range of other… [more]
Planet Bike's Dial Gauge makes it easy to ensure you always have the right pressure in your tires, which makes the riding easy and helps prevent flats. Built to last, this quality gauge works on all valves and has a large easy-to-read dial. [more]
The Super Patch Kit is comprised of a small plastic case, a piece of sandpaper for roughing up the tube and 6 peel-and-stick patches so no gluing is required. The patches stick fast thanks to 3M technology and they're thin and flexy to stretch with the tube. There's no easier way to patch a tube. [more]
Topeak's SmartGauge D2 boasts a digital readout that goes up to 250 psi and it's compatible with Presta and Schrader valves, as well as shocks and suspension forks. The head rotates 180 degrees to get in tough spots, and an air release button helps you dial in the perfect pressure. [more]
Want a super-easy way to fix a flat? If you have tubeless tires on your mountain bike, all you need is Genuine Innovations' Tubeless Tire Repair Kit. No interior repair is needed, so you don't have to remove the tire. Just plug the hole with the self-vulcanizing plugs, inflate and ride away. The… [more]
Planet Bike's Ozone ATB AL Mini-Pump is a ride-saver. For easy pumping and fast fills, it boasts a sturdy aluminum barrel, a locking T handle, an easy pumping action and a thumblock head (with a cap to keep the mud out). This great inflator fits all valves and is small enough to carry in a pack or… [more]
You'll have a whole lotta love for this CO2 inflator on long rides. It fits Presta and Schrader valves and weighs next to nothing. The cartridge is insulated with a sleeve to prevent frozen fingers and the small size means the Red Zeppelin fits easily in bags, pockets and packs. Two 16-gram… [more]
Bontrager's Turbo Charger HP features an easy-to-read raised gauge, durable steel barrel, comfy co-molded handle, and an auto-select head that instantly fits both Presta and Schrader valves. A smaller diameter barrel reduces the effort needed to reach high pressures, making this great for road and… [more]
There's no reason to walk home when you have Bontrager's Air Rush CO2 Regulator. It's compact size stows away in your jersey pocket and it's light enough that you won't even notice it. Plus, it allows for safe, controlled inflation. [more]
The coolest pump design we have ever worked with, forget going to the shop to seat your tubless tires! Now you can safely do it from home or trailside parking lot. Awesome new piece. Inflate tubeless tires at home and on the road with Bontrager's Flash Charger TLR, a pump designed for efficient… [more]
Giant's Control Tower 1 boasts a steel barrel and base and an ergonomic handle for excellent pumping power. Plus, it has a thumb-lock head that fits all valve types, a long hose for extra reach and an easy-to-read gauge. [more]
Bontrager's Shock Pump keeps your suspension plush and right where it needs to be. It works with front forks and rear shocks and the angled head puts funky valves within easy reach. The gauge is dual sided so you can actually see what your pressure you're getting to and the precision bleed valve… [more]
Bontrager's Charger features a durable steel barrel, an extra-long hose, an easy to read gauge, and an auto-select head that instantly fits both Presta and Schrader valves. Plus, the large, stable base assists pumping and minimizes tipping, too. [more]
Bontrager's Flat Pack is one stop shopping for flat tire repair. You get a Bontrager Air Support mini pump, two exceptional Bontrager tire levers, a patch kit and Bontrager's PRO 75 seat pack to store all your gear. There's even a free tube coupon so you can get the right size for your bike. [more]
Bontrager's Air Support Road is a life-saver when you flat on the road. It has an easy-to-use thumblock, auto-selecting head that fits Presta and Schrader valves, plus a fold-out T handle and a dual action to inflate high-pressure tires quickly. The Air Support is compact and light and it comes… [more]
Bontrager's Turbo Charger features an easy-to-read raised gauge, durable steel barrel, comfy co-molded handle, and an auto-select head that instantly fits both Presta and Schrader valves. The handle locks in the barrel for easy transportation and storage. Plus, the large, stable base assists… [more]
The Air Tower 1 features Blackburn's tough steel barrel and stable base for easy pumping every time. There's also an ergonomic handle with storage, a long hose and Blackburn's reliable AnyValve head that fits all valves. Plus, the precision gauge makes it easy to get the pressure just right. Also,… [more]
Giant's Control Tower 2 is an affordable floor pump featuring a tough steel barrel, a sturdy base and an ergonomic handle for excellent pumping power. This great inflator automatically fits all valve types and has a long, durable hose. The handy high pressure/high volume switch makes sure you're… [more]
Show flats no fear with Bontrager's Air Support pump. Built for the lower-volume tires on your commuter, cruiser or town bike, but can handle road and mountain tires, the Air Support is great for topping off your pressures or fixing that unfortunate flat. The auto-select head uses a fold-out lever… [more]
Profile Design's CO2 Mounting Bracket is a small, light holder that attaches to any Profile rear-mounted drink system or under any bottle cage. Once in place, the bracket provides a handy place to carry a CO2 refill cartridge for your CO2 inflator (Profile drink system, bottles, CO2 cartridges and… [more]
The Airgun from SKS is an extremely small and lightweight CO2 inflator for racing or training. The aluminum head features a pressure control valve, insulation to protect your fingers, and a dustcap. It fits both Presta and Schrader valves and includes a frame clip that fits alongside your… [more]
Keep your suspension pressure dialed-in with RockShox's High-Pressure Fork/Shock Pump. It features an aluminum barrel with an ergonomic handle, a handy finger-tap bleed adjust button for fine-tuning settings, and a large gauge. The hose swivels 360-degrees to fit anywhere. And it handles an… [more]
Lezyne's Shock Digital Drive Pump is perfect for tuning your suspension at home or for a shop. It's a dedicated floor pump designed for faster shock tuning, with an ergonomic T-handle and an aluminum barrel for easy inflation up to 300 psi. Plus, with a digital readout, it's easier than ever to… [more]
Giant's Control Tower 3 is an affordable floor pump that features an efficient aluminum barrel, and a composite base and ergonomic handle for excellent pumping power. And, this great inflator fits all valves, has a thumb-lock head and a long, durable hose. Plus, you'll love the handy built-in… [more]
Giant's Shadow Repair Wallet lets you bring along your ID, some cash, a credit card and all the stuff you need to fix a flat in a compact, weather-resistant wallet. It includes a Control Blast inflator, a 16g CO2 cartridge, a patch kit, and tire levers. Slip it in your jersey pocket and go. [more]
Keep your suspension pressure dialed-in with Giant's Control Shock Pump. It sports an aluminum barrel with a comfy T-handle that easily handles even the highest pressures. And, it has a handy micro-adjust pressure-relief button for fine-tuning settings, an easy-to-read, removable gauge, and a… [more]
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I have Linq class that has StartTime and FinishTime properties. I'm trying to add a RunTime property to the class which is calculated as FinishTime - StartTime. My first approach was to add it as an unmapped property and do the calculation in the get():
[Table(Name = "Log")]
public partial class Log
[Column(Name = "Start_Time", DbType = "DateTime NOT NULL")]
public DateTime StartTime { get; set; }
[Column(Name = "Finish_Time", DbType = "DateTime NOT NULL")]
public DateTime FinishTime { get; set; }
public int RunTime
get { return ((TimeSpan) (this.FinishTime - this.StartTime)).Seconds; }
set { this.RunTime = value; }
This worked fine at first, but then when I try to use the column to sort in an OrderBy, I get the following error: "The member 'TestProject.Models.Log.RunTime' has no supported translation to SQL." This makes sense, since this property is not mapped to a database column, it has no way to sort it in the SQL.
My next approach was to try making it a Column with an "Expression" attribute (which I may not be using correctly):
[Column(Expression = "DATEDIFF(ss, Start_Time, Finish_Time) AS RunTime")]
public int RunTime { get; set; }
But this results in the error: "Invalid column name 'RunTime'." Which again make sense, because there is no Column named RunTime to map to.
In the current environment I'm working under, I can't alter the database. Is there a way to add this property to my class and use it in a sorting query?


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