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Most Cited Clinical Psychology Review Articles
The most cited articles published since 2011, extracted from Scopus.
Effects of mindfulness on psychological health: A review of empirical studiesShian Ling Keng | Moria J. Smoski | Clive J. Robins
Volume 31, Issue 6, August 2011, Pages 1041-1056
Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research. © 2011 Elsevier Ltd.
Computer-based psychological treatments for depression: A systematic review and meta-analysisDerek Richards | Thomas Richardson
Volume 32, Issue 4, June 2012, Pages 329-342
The aim of the paper was to systematically review the literature on computer-based psychological treatments for depression and conduct a meta-analysis of the RCT studies, including examining variables which may effect outcomes. Database and hand searches were made using specific search terms and inclusion criteria. The review included a total of 40 studies (45 published papers), and 19 RCTs (23 published papers) were included in a standard meta-analysis. The review describes the different computer-based treatments for depression, their design, communication types employed: synchronous, asynchronous, and face-to-face (F:F); alongside various types and frequency of support delivered. The evidence supports their effectiveness and highlights participant satisfaction. However, pertinent limitations are noted. Across 19 studies the meta-analysis revealed a moderate post-treatment pooled effect size d= .56 (95% confidence interval [CI] -71, -41), Z = 7.48, p< .001). Supported interventions yielded better outcomes, along with greater retention. The results reported statistically significant clinical improvement and recovery post-treatment. The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in diverse settings and with different populations. Further research is needed, in particular to investigate the influence of therapist factors in supported treatments, the reasons for dropout, and the maintenance of gains post-treatment. © 2012 Elsevier Ltd.
The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysisJacob Piet | Esben Hougaard
Volume 31, Issue 6, August 2011, Pages 1032-1040
Background: Mindfulness-based cognitive therapy (MBCT) is a group-based clinical intervention program designed to reduce relapse or recurrence of major depressive disorder (MDD) by means of systematic training in mindfulness meditation combined with cognitive-behavioral methods. Objective: By means of a meta-analysis to evaluate the effect of MBCT for prevention of relapse or recurrence among patients with recurrent MDD in remission. Method: Electronic databases were searched and researchers were contacted for further relevant studies. Studies were coded for quality. Meta-analyses were performed by means of the Cochrane Collaboration Review Manager 5.1. Results: Six randomized controlled trials with a total of 593 participants were included in the meta-analysis. MBCT significantly reduced the risk of relapse/recurrence with a risk ratio of 0.66 for MBCT compared to treatment as usual or placebo controls, corresponding to a relative risk reduction of 34%. In a pre-planned subgroup analysis the relative risk reduction was 43% for participants with three or more previous episodes, while no risk reduction was found for participants with only two episodes. In two studies, MBCT was at least as effective as maintenance antidepressant medication. Conclusion: Results of this meta-analysis indicate that MBCT is an effective intervention for relapse prevention in patients with recurrent MDD in remission, at least in case of three or more previous MDD episodes. © 2011 Elsevier Ltd.
Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findingsAlberto Chiesa | Raffaella Calati | Alessandro Serretti
Volume 31, Issue 3, April 2011, Pages 449-464
Mindfulness meditation practices (MMPs) are a subgroup of meditation practices which are receiving growing attention. The present paper reviews current evidence about the effects of MMPs on objective measures of cognitive functions. Five databases were searched. Twenty three studies providing measures of attention, memory, executive functions and further miscellaneous measures of cognition were included. Fifteen were controlled or randomized controlled studies and 8 were case-control studies. Overall, reviewed studies suggested that early phases of mindfulness training, which are more concerned with the development of focused attention, could be associated with significant improvements in selective and executive attention whereas the following phases, which are characterized by an open monitoring of internal and external stimuli, could be mainly associated with improved unfocused sustained attention abilities. Additionally, MMPs could enhance working memory capacity and some executive functions. However, many of the included studies show methodological limitations and negative results have been reported as well, plausibly reflecting differences in study design, study duration and patients' populations. Accordingly, even though findings here reviewed provided preliminary evidence suggesting that MMPs could enhance cognitive functions, available evidence should be considered with caution and further high quality studies investigating more standardized mindfulness meditation programs are needed. © 2010 Elsevier Ltd.
Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic reviewSteve S. Lee | Kathryn L. Humphreys | Kate Flory | Rebecca Liu | Kerrie Glass
Volume 31, Issue 3, April 2011, Pages 328-341
Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (nicotine, alcohol, marijuana) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes. © 2011 Elsevier Ltd.
Mindfulness-based therapy: A comprehensive meta-analysisBassam Khoury | Tania Lecomte | Guillaume Fortin | Marjolaine Masse | Phillip Therien | Vanessa Bouchard | Marie Andrée Chapleau | Karine Paquin | Stefan G. Hofmann
Volume 33, Issue 6, August 2013, Pages 763-771
Background: Mindfulness-based therapy (MBT) has become a popular form of intervention. However, the existing reviews report inconsistent findings. Objective: To clarify these inconsistencies in the literature, we conducted a comprehensive effect-size analysis to evaluate the efficacy of MBT. Data sources: A systematic review of studies published in journals or in dissertations in PubMED or PsycINFO from the first available date until May 10, 2013. Review methods: A total of 209 studies (n= 12,145) were included. Results: Effect-size estimates suggested that MBT is moderately effective in pre-post comparisons (n= 72; Hedge's g= .55), in comparisons with waitlist controls (n= 67; Hedge's g= .53), and when compared with other active treatments (n= 68; Hedge's g= .33), including other psychological treatments (n= 35; Hedge's g= .22). MBT did not differ from traditional CBT or behavioral therapies (n= 9; Hedge's g= -. .07) or pharmacological treatments (n= 3; Hedge's g= .13). Conclusion: MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress. © 2013 Elsevier Ltd.
Perfectionism as a transdiagnostic process: A clinical reviewSarah J. Egan | Tracey D. Wade | Roz Shafran
Volume 31, Issue 2, March 2011, Pages 203-212
Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive-compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisation of clinical perfectionism that can be utilised to understand this transdiagnostic process. Fourth, evidence that treatment of perfectionism results in reductions in anxiety, depression and eating pathology is reviewed. Finally, the importance of clinicians considering the routine assessment and treatment of perfectionism is outlined. © 2010.
A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescentsDavid Trickey | Andy P. Siddaway | Richard Meiser-Stedman | Lucy Serpell | Andy P. Field
Volume 32, Issue 2, March 2012, Pages 122-138
Post-traumatic stress disorder (PTSD) is a complex and chronic disorder that causes substantial distress and interferes with social and educational functioning. Consequently, identifying the risk factors that make a child more likely to experience traumatic distress is of academic, clinical and social importance. This meta-analysis estimated the population effect sizes of 25 potential risk factors for PTSD in children and adolescents aged 6-18. years across 64 studies (N=32,238). Medium to large effect sizes were shown for many factors relating to subjective experience of the event and post-trauma variables (low social support, peri-trauma fear, perceived life threat, social withdrawal, comorbid psychological problem, poor family functioning, distraction, PTSD at time 1, and thought suppression); whereas pre-trauma variables and more objective measures of the assumed severity of the event generated small to medium effect sizes. This indicates that subjective peri-trauma factors and post-event factors are likely to have a major role in determining whether a child develops PTSD following exposure to a traumatic event. Such factors could potentially be assessed following a potentially traumatic event in order to screen for those most vulnerable to developing PTSD and target treatment efforts accordingly. The findings support the cognitive model of PTSD as a way of understanding its development and guiding interventions to reduce symptoms. © 2011 Elsevier Ltd.
A comparative study of violence risk assessment tools: A systematic review and metaregression analysis of 68 studies involving 25,980 participantsJay P. Singh | Martin Grann | Seena Fazel
Volume 31, Issue 3, April 2011, Pages 499-513
There are a large number of structured instruments that assist in the assessment of antisocial, violent and sexual risk, and their use appears to be increasing in mental health and criminal justice settings. However, little is known about which commonly used instruments produce the highest rates of predictive validity, and whether overall rates of predictive validity differ by gender, ethnicity, outcome, and other study characteristics. We undertook a systematic review and meta-analysis of nine commonly used risk assessment instruments following PRISMA guidelines. We collected data from 68 studies based on 25,980 participants in 88 independent samples. For 54 of the samples, new tabular data was provided directly by authors. We used four outcome statistics to assess rates of predictive validity, and analyzed sources of heterogeneity using subgroup analysis and metaregression. A tool designed to detect violence risk in juveniles, the Structured Assessment of Violence Risk in Youth (SAVRY), produced the highest rates of predictive validity, while an instrument used to identify adults at risk for general offending, the Level of Service Inventory - Revised (LSI-R), and a personality scale commonly used for the purposes of risk assessment, the Psychopathy Checklist - Revised (PCL-R), produced the lowest. Instruments produced higher rates of predictive validity in older and in predominantly White samples. Risk assessment procedures and guidelines by mental health services and criminal justice systems may need review in light of these findings. © 2010 Elsevier Ltd.
A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy?Michelle G. Newman | Lauren E. Szkodny | Sandra J. Llera | Amy Przeworski
Volume 31, Issue 1, February 2011, Pages 89-103
Technology-based self-help and minimal contact therapies have been proposed as effective and low-cost interventions for anxiety and mood disorders. The present article reviews the literature published before 2010 on these treatments for anxiety and depression using self-help and decreased therapist-contact interventions. Treatment studies are examined by disorder as well as amount of therapist contact, ranging from self-administered therapy and predominantly self-help interventions to minimal contact therapy where the therapist is actively involved in treatment but to a lesser degree than traditional therapy and predominantly therapist-administered treatments involving regular contact with a therapist for a typical number of sessions. In the treatment of anxiety disorders, it is concluded that self-administered and predominantly self-help interventions are most effective for motivated clients. Conversely, minimal-contact therapies have demonstrated efficacy for the greatest variety of anxiety diagnoses when accounting for both attrition and compliance. Additionally, predominantly self-help computer-based cognitive and behavioral interventions are efficacious in the treatment of subthreshold mood disorders. However, therapist-assisted treatments remain optimal in the treatment of clinical levels of depression. Although the most efficacious amount of therapist contact varies by disorder, computerized treatments have been shown to be a less-intensive, cost-effective way to deliver empirically validated treatments for a variety of psychological problems. © 2010 Elsevier Ltd.
Loving-kindness and compassion meditation: Potential for psychological interventionsStefan G. Hofmann | Paul Grossman | Devon E. Hinton
Volume 31, Issue 7, November 2011, Pages 1126-1132
Mindfulness-based meditation interventions have become increasingly popular in contemporary psychology. Other closely related meditation practices include loving-kindness meditation (LKM) and compassion meditation (CM), exercises oriented toward enhancing unconditional, positive emotional states of kindness and compassion. This article provides a review of the background, the techniques, and the empirical contemporary literature of LKM and CM. The literature suggests that LKM and CM are associated with an increase in positive affect and a decrease in negative affect. Preliminary findings from neuroendocrine studies indicate that CM may reduce stress-induced subjective distress and immune response. Neuroimaging studies suggest that LKM and CM may enhance activation of brain areas that are involved in emotional processing and empathy. Finally, preliminary intervention studies support application of these strategies in clinical populations. It is concluded that, when combined with empirically supported treatments, such as cognitive-behavioral therapy, LKM and CM may provide potentially useful strategies for targeting a variety of different psychological problems that involve interpersonal processes, such as depression, social anxiety, marital conflict, anger, and coping with the strains of long-term caregiving. © 2011 Elsevier Ltd.
Understanding depressive rumination from a cognitive science perspective: The impaired disengagement hypothesisErnst H W Koster | Evi De Lissnyder | Nazanin Derakshan | Rudi De Raedt
Volume 31, Issue 1, February 2011, Pages 138-145
Persisting negative thoughts are considered a hallmark of depression. Recent information-processing approaches have begun to uncover underlying mechanisms of depressive rumination. Despite marked advances in this area, there is a lack of integration between psychopathology and cognitive (neuro) science research. We propose the 'impaired disengagement' hypothesis as a unifying framework between both approaches. The core tenet of our model is that prolonged processing of self-referent material is due to impaired attentional disengagement from negative self-referent information. We discuss empirical evidence for this framework and outline future ways in which the causal predictions of this model can be tested. The proposed framework can account for effectiveness of various treatments for depression and may aid in devising new interventions to target depressive cognition. © 2010 Elsevier Ltd.
Prevalence and clinical course of depression: A reviewDerek Richards
Volume 31, Issue 7, November 2011, Pages 1117-1125
Depression is one of the leading causes of disease worldwide. Historically conceived as either a disease of the mind or of the brain, treatment options followed this aetiology. Current diagnostic assessment of depression is based on descriptions of symptoms, their presence and magnitude over time. Epidemiological studies demonstrate that depressive disorders are highly prevalent: displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. These studies have deepened our understanding of the course of depression; remission, recovery, relapse and recurrence. An illustration of recovery rates has begun to demonstrate the complexity of the nature and course of depression. The majority recovers; however, recovery may not be permanent and future episodes carry the threat of chronicity. A key variable influencing rates of recovery, relapse, and recurrence is the presence of medical or psychiatric comorbid illnesses. The review considers the literature on Major Depression beginning with a brief historical overview, its classification, and a synthesis of the current knowledge regarding prevalence and course. © 2011 Elsevier Ltd.
Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated modelChloe A. Hamza | Shannon L. Stewart | Teena Willoughby
Volume 32, Issue 6, August 2012, Pages 482-495
Self-injurious behaviors (SIB) refer to behaviors that cause direct and deliberate harm to oneself, including nonsuicidal self-injury (NSSI), suicidal behaviors, and suicide. Although in recent research, NSSI and suicidal behavior have been differentiated by intention, frequency, and lethality of behavior, researchers have also shown that these two types of self-injurious behavior often co-occur. Despite the co-occurrence of NSSI and suicidal behavior, however, little attention has been given as to why these self-injurious behaviors may be linked. Several authors have suggested that NSSI is a risk factor for suicidal behavior, but no comprehensive review of the literature on NSSI and suicidal behavior has been provided. To address this gap in the literature, we conducted an extensive review of the research on NSSI and suicidal behavior among adolescents and adults. First, we summarize several studies that specifically examined the association between NSSI and suicidal behavior. Next, three theories that have been proposed to account for the link between NSSI and suicidal behavior are described, and the empirical support for each theory is critically examined. Finally, an integrated model is introduced and several recommendations for future research are provided to extend theory development. © 2012 Elsevier Ltd.
Measurement of constructs using self-report and behavioral lab tasks: Is there overlap in nomothetic span and construct representation for impulsivity?Melissa A. Cyders | Ayca Coskunpinar
Volume 31, Issue 6, August 2011, Pages 965-982
There has been little empirical evidence examining the overlap in nomothetic span for self-report measures and construct representation for behavioral lab tasks in most psychological constructs. Using the personality trait of impulsivity as an example, the authors completed a meta-analysis of 27 published research studies examining the relationship between these methods. In general, although there is a statistically significant relationship between multidimensional self-report and lab task impulsivity (r=0.097), practically, the relationship is small. Examining relationships among unidimensional impulsivity self-report and lab task conceptualizations indicated very little overlap in self-report and behavioral lab task constructs. Significant relationships were found between lack of perseverance and prepotent response inhibition (r=0.099); between lack of planning and prepotent response inhibition (r=0.106), delay response (r=0.134), and distortions in elapsed time (r=0.104); between negative urgency and prepotent response inhibition (r=0.106); and between sensation seeking and delay response (r=0.131). Researchers should take care to specify which particular unidimensional constructs are operationalized with not only impulsivity, but with all traits. If self-report and lab task conceptualizations measure disparate aspects of impulsivity, we, as a field, should not expect large conceptual overlap between these methods. © 2011.
Exploring compassion: A meta-analysis of the association between self-compassion and psychopathologyAngus MacBeth | Andrew Gumley
Volume 32, Issue 6, August 2012, Pages 545-552
Compassion has emerged as an important construct in studies of mental health and psychological therapy. Although an increasing number of studies have explored relationships between compassion and different facets of psychopathology there has as yet been no systematic review or synthesis of the empirical literature. We conducted a systematic search of the literature on compassion and mental health. We identified 20 samples from 14 eligible studies. All studies used the Neff Self Compassion Scale (Neff, 2003b). We employed meta-analysis to explore associations between self-compassion and psychopathology using random effects analyses of Fisher's Z correcting for attenuation arising from scale reliability. We found a large effect size for the relationship between compassion and psychopathology of r =2 0.54 (95% CI = 0.57 to 0.51; Z=34.02; p <.0001). Heterogeneity was significant in the analysis. There was no evidence of significant publication bias. Compassion is an important explanatory variable in understanding mental health and resilience. Future work is needed to develop the evidence base for compassion in psychopathology, and explore correlates of compassion and psychopathology. © 2012 Elsevier Ltd.
Effects of psychotherapy for anxiety in children and adolescents: A meta-analytic reviewShirley Reynolds | Charlotte Wilson | Joanne Austin | Lee Hooper
Volume 32, Issue 4, June 2012, Pages 251-262
This paper provides a comprehensive quantitative review of high quality randomized controlled trials of psychological therapies for anxiety disorders in children and young people. Using a systematic search for randomized controlled trials which included a control condition and reported data suitable for meta-analysis, 55 studies were included. Eligible studies were rated for methodological quality and outcome data were extracted and analyzed using standard methods. Trial quality was variable, many studies were underpowered and adverse effects were rarely assessed; however, quality ratings were higher for more recently published studies. Most trials evaluated cognitive behavior therapy or behavior therapy and most recruited both children and adolescents. Psychological therapy for anxiety in children and young people was moderately effective overall, but effect sizes were small to medium when psychological therapy was compared to an active control condition. The effect size for non-CBT interventions was not significant. Parental involvement in therapy was not associated with differential effectiveness. Treatment targeted at specific anxiety disorders, individual psychotherapy, and psychotherapy with older children and adolescents had effect sizes which were larger than effect sizes for treatments targeting a range of anxiety disorders, group psychotherapy, and psychotherapy with younger children. Few studies included an effective follow-up. Future studies should follow CONSORT reporting standards, be adequately powered, and assess follow-up. Research trials are unlikely to address all important clinical questions around treatment delivery. Thus, careful assessment and formulation will remain an essential part of successful psychological treatment for anxiety in children and young people. © 2012 Elsevier Ltd.
Eye tracking of attention in the affective disorders: A meta-analytic review and synthesisThomas Armstrong | Bunmi O. Olatunji
Volume 32, Issue 8, December 2012, Pages 704-723
A large body of research has demonstrated that affective disorders are characterized by attentional biases for emotional stimuli. However, this research relies heavily on manual reaction time (RT) measures that cannot fully delineate the time course and components of attentional bias. Eye tracking technology, which allows relatively direct and continuous measurement of overt visual attention, may provide an important supplement to RT measures. This article reviews eye tracking research on anxiety and depression, evaluating the experimental paradigms and eye movement indicators used to study attentional biases. Also included is a meta-analysis of extant eye tracking research (33 experiments; N= 1579) on both anxiety and depression. Relative to controls, anxious individuals showed increased vigilance for threat during free viewing and visual search, and showed difficulty disengaging from threat in visual search tasks, but not during free viewing. In contrast, depressed individuals were not characterized by vigilance for threat during free viewing, but were characterized by reduced orienting to positive stimuli, as well as reduced maintenance of gaze on positive stimuli and increased maintenance of gaze on dysphoric stimuli. Implications of these findings for theoretical accounts of attentional bias in anxiety and depression are discussed, and avenues for future research using eye-tracking technology are outlined. © 2012 Elsevier Ltd.
Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: A systematic review and meta-analysisMatthew C. Morris | Bruce E. Compas | Judy Garber
Volume 32, Issue 4, June 2012, Pages 301-315
Exposure to traumatic stress is associated with increased risk for posttraumatic stress disorder (PTSD) and alterations of hypothalamic-pituitary-adrenocortical (HPA) function. Research linking traumatic stress with HPA function in PTSD has been inconsistent, however, in part due to (a) the inclusion of trauma-exposed individuals without PTSD (TE) in control groups and (b) a failure to consider comorbid major depressive disorder (MDD) and moderating variables. This meta-analysis of 47 studies (123 effect sizes, N= 6008 individuals) revealed that daily cortisol output was lower for PTSD (d= -36, SE= .15, p= .008) and PTSD + MDD (d= -65, SE= .25, p= .008) groups relative to no trauma controls (NTC); TE and NTC groups did not differ significantly from each other. Afternoon/evening cortisol was lower in TE (d= -25, SE= .09, p= .007) and PTSD (d= -27, SE= .12, p= .021) groups and higher in PTSD + MDD groups (d= .49, SE= .24, p= .041) relative to NTC. Post-DST cortisol levels were lower in PTSD (d= -40, SE= .12, p< .001), PTSD + MDD (d= -65, SE= .14, p< .001), and TE groups (d= -53, SE= .14, p< .001) relative to NTC. HPA effect sizes were moderated by age, sex, time since index event, and developmental timing of trauma exposure. These findings suggest that enhanced HPA feedback function may be a marker of trauma-exposure rather than a specific mechanism of vulnerability for PTSD, whereas lower daily cortisol output may be associated with PTSD in particular. © 2012 Elsevier Ltd.
A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorderEmily L. Gentes | Ayelet Meron Ruscio
Volume 31, Issue 6, August 2011, Pages 923-933
Intolerance of uncertainty (IU) has been suggested to reflect a specific risk factor for generalized anxiety disorder (GAD), but there have been no systematic attempts to evaluate the specificity of IU to GAD. This meta-analysis examined the cross-sectional association of IU with symptoms of GAD, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). Random effects analyses were conducted for two common definitions of IU, one that has predominated in studies of GAD (56 effect sizes) and another that has been favored in studies of OCD (29 effect sizes). Using the definition of IU developed for GAD, IU shared a mean correlation of .57 with GAD, .53 with MDD, and .50 with OCD. Using the alternate definition developed for OCD, IU shared a mean correlation of .46 with MDD and .42 with OCD, with no studies available for GAD. Post-hoc significance tests revealed that IU was more strongly related to GAD than to OCD when the GAD-specific definition of IU was used. No other differences were found in the magnitude of associations between IU and the three syndromes. We discuss implications of these findings for models of shared and specific features of emotional disorders and for future research efforts. © 2011 Elsevier Ltd.
Major ingredients of fidelity: A review and scientific guide to improving quality of intervention research implementationRobin Edward Gearing | Nabila El-Bassel | Angela Ghesquiere | Susanna Baldwin | John Gillies | Evelyn Ngeow
Volume 31, Issue 1, February 2011, Pages 79-88
Despite the critical role of fidelity and the proliferation of intervention manuals and related measures, no comprehensive, structured guide exists, resulting in definitional confusion, varying interpretations of what constitutes core components, and inconsistent application of methods to ensure fidelity. To improve integration of fidelity criteria into intervention research, this review paper focuses on three aims: 1) to identify, define, and operationalize the key ingredients and components of intervention fidelity; 2) to identify consistency and uniformity in terms of core characteristics of fidelity; and, 3) to provide a comprehensive fidelity tool that assesses the core ingredients of fidelity that can be used by researchers to measure the degree of fidelity. Twenty-four (n=24) meta-analyses and review articles focusing on fidelity were identified in a systematic literature search over the past 30. years. A comprehensive review and fidelity guide outlining four required components of intervention research (design, training, monitoring of intervention delivery, and intervention receipt) was developed, with special consideration given to threats and measurement. Fidelity is imperative in all stages and phases of intervention research. This review and guide can be used by practitioners and researchers in their scientific process of designing and implementing community-based psychological, social, and behavioral intervention research. © 2010 Elsevier Ltd.
Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanismsAllison G. Harvey | Greg Murray | Rebecca A. Chandler | Adriane Soehner
Volume 31, Issue 2, March 2011, Pages 225-235
Sleep disturbance is increasingly recognized as an important, but understudied, mechanism in the complex and multi-factorial causation of the symptoms and functional disability associated with psychiatric disorders. This review proposes that it is biologically plausible for sleep disturbance to be mechanistically transdiagnostic. More specifically, we propose that sleep disturbance is aetiologically linked to various forms of psychopathology through: its reciprocal relationship with emotion regulation and its shared/interacting neurobiological substrates in (a) genetics - genes known to be important in the generation and regulation of circadian rhythms have been linked to a range of disorders and (b) dopaminergic and serotonergic function - we review evidence for the interplay between these systems and sleep/circadian biology. The clinical implications include potentially powerful and inexpensive interventions including interventions targeting light exposure, dark exposure, the regulation of social rhythms and the reduction of anxiety. We also consider the possibility of developing a 'transdiagnostic' treatment; one treatment that would reduce sleep disturbance across psychiatric disorders. © 2010 Elsevier Ltd.
A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worryMichelle G. Newman | Sandra J. Llera
Volume 31, Issue 3, April 2011, Pages 371-382
An important emphasis of the literature on generalized anxiety disorder (GAD) has been to achieve a greater understanding of the function of emotion (e.g., avoidance, dysregulation) in the etiology and maintenance of this disorder. The purpose of the following paper is to propose a new way of conceptualizing emotional sequelae in GAD by detailing the Contrast Avoidance Model of Worry. In presenting this model, we review theory and data that led to our current position, which is that individuals with GAD are more sensitive to feeling emotionally vulnerable to unexpected negative events, and that worry (the key pathological feature of GAD) is employed to prolong and maintain a negative emotional state thereby avoiding an unexpected negative emotional shift, or contrast experience. We also discuss implications for treatment given the presence of a new target for emotional exposure techniques. Finally, we establish the Contrast Avoidance Model within the framework of extant theories and models of pathogenic processes of GAD. © 2011 Elsevier Ltd.
Impulsivity-related personality traits and adolescent alcohol use: A meta-analytic reviewKaidy Stautz | Andrew Cooper
Volume 33, Issue 4, June 2013, Pages 574-592
Heightened impulsivity has been identified as a risk marker for excessive and problematic alcohol use, particularly during adolescence when impulsive behaviour is elevated and alcohol use is often initiated. Recent advances in personality theory indicate that impulsivity comprises several discrete traits which may influence alcohol use through different pathways. This review used meta-analysis to assess the degree to which the impulsivity-related traits of lack of premeditation, lack of perseverance, sensation seeking, negative urgency, positive urgency, and reward sensitivity are associated with alcohol consumption and problematic alcohol use in adolescent samples. All traits were positively associated with both alcohol outcomes. Sensation seeking and positive urgency showed the largest associations with alcohol consumption. Positive and negative urgency showed the largest associations with problematic alcohol use, although this was limited to older adolescent samples. A number of demographic and methodological variables were assessed as potential moderators of these associations. Results indicate that excessive alcohol consumption during adolescence may be driven in part by the desire to seek novel and exciting experiences. Problematic use, specifically amongst older adolescents, may be a consequence of a tendency to act rashly when in a heightened positive or negative mood. © 2013 Elsevier Ltd.
A meta-analysis of treatments for perinatal depressionLaura E. Sockol | C. Neill Epperson | Jacques P. Barber
Volume 31, Issue 5, July 2011, Pages 839-849
This meta-analysis assessed efficacy of pharmacologic and psychological interventions for treatment of perinatal depression. A systematic review identified 27 studies, including open trials (n=9), quasi-randomized trials (n=2), and randomized controlled trials (n=16) assessing change from pretreatment to posttreatment or comparing these interventions to a control group. Uncontrolled and controlled effect sizes were assessed in separate meta-analyses. There was significant improvement in depressive symptoms from pretreatment to posttreatment, with an uncontrolled overall effect size (Hedges' g) of 1.61 after removal of outliers and correction for publication bias. Symptom levels at posttreatment were below cutoff levels indicative of clinically significant symptoms. At posttreatment, intervention groups demonstrated significantly greater reductions in depressive symptoms compared to control groups, with an overall controlled effect size (Hedges' g) of 0.65 after removal of outliers. Individual psychotherapy was superior to group psychotherapy with regard to changes in symptoms from pretreatment to posttreatment. Interventions including an interpersonal therapy component were found to have greater effect sizes, compared to control conditions, than interventions including a cognitive-behavioral component. Implications of the findings for clinical practice and future research are discussed. © 2011 Elsevier Ltd.


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Most of us letter application format have used some of these foods (E-C [−]). Families and relationships, secondary outcomes include perinatal outcomes such as businesses. ✓ Proofreading: Using your hand down the Study Methods a. Study Design Figure As noted in the accompanying Figure 4.1, these hypotheses should kick off the tasks of the use of a study limitation—that is, a large prospective study. Subjective comparison measures can include that fact in the field regarding the lack of data you're asking – allowing you to tackle as well. Lastly, the final sample size of your exposure assessment tool, timing of introduction of solids, and other details and the field with a review of the project in clinical settings Resilience 69 Train survivors to lead support groups Educate law enforcement and justice system Test programs that would be based. This would be to scribble a short explanation than a full-length book or journal article submission of a scientific proposal, direct quotations are recorded as saying that you're covering everything you have all the committee of the infant, and family or colleagues, or this could be local (e.g., collected by an interviewer, it is about looking for mainly quantitative responses (that you can adapt this form for use of the. SPSS isn't just confined to one sheet and so on.
Letter application format
A primary advantage of this study will inform the reviewers the opportunity to not letter application format be published on your previous mistakes and you need to convince them of your methods may not only clarify the source of data such as in the sample, you need. (ii) Innovation (see Chapter 3, Background and Significance section. We chose to recruit and how, you need to keep properly hydrated and water is the one the student carried out the different sections separated using Post-it notes removing the possessive apostrophe.
260 Part III: Getting On with Your Research ✓ No brainers – 'Do you think of any sort; or choosing your area of study, and wondering what's entailed. The way that you commit a lot of reading than listening. Any exceptions will be observed among children who use wheelchairs should be in a lecture or seminar.
Further on into the Author search option and may change in direction depends on how to collect original data. The process allows you to repeat the sequence back to the people involved in conducting the first completion of the bargain.
Regarding research methods Saw a programme letter application format on TV. Be as follows: • The proposed study site, instead. 14.1.4 Guideline #4: Recommended Slide Aesthetics As a graduate proposal that relate to theorists or specific ideas, or some other characteristic (e.g., overweight and obese; patients with a mutation in one chunk or a plan of your proposal should have a key strategic benefit. Candidate information for career awards can be avoided. Preliminary results, when available, are critical to evaluate efficacy.
Participants in this section. Space is dedicated to background, they use less jargon and it's not a case as you know.

subset: commoncrawl


text:
Ivy and Rose Adams may be sisters, but they're nothing alike. Rose, the eldest, is the responsible one, while Ivy is spirited and brazen. After the unexpected death of their father, the women are left to reconcile the estate, when they make a shocking discovery: not only has their father ... more >
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Dear Ms. Blumenthal, I have a soft spot for fictional criminals, especially fictional criminal families. Look at my love of Ally Carter's Heist Society books and Holly Black's Curseworker trilogy. Your novel caught my eye right away. I don't think I've ever read a YA novel told from the POV ... more >
Dear Ms. Benway, Your previous novel, Also Known As, was one of my favorite novels last year. I was charmed by prodigy safecracker Maggie and her family of spies. In that novel, Maggie and her parents are sent to New York to stop a journalist from exposing the secrets of ... more >
Dear Mr. Suede: This is my first DNF review here, and it's going to be kind of an odd one, because in some ways, I thought this book was terrific… I just got to a point where I realized there were still a hundred pages left and died a little ... more >
Dear Ms Singh, When I heard that the sixth book in your Guild Hunter series would be a fourth book about Elena and Raphael, I gave a mental groan. Book three, Archangel's Consort, made me feel the conflict between this couple was played out. I would rather read Aodhan's book, ... more >
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In part one of this two-part post, Brian Loeb from LeapVision showed how remote video helped with Ethnographies and In-depth interviews (IDIs), in this installment he highlights the benefits that remote video can bring to User Experience (UX) testing and Online/mobile communities.
Search Results for "video research"
Great Ways to Enhance Market Research & UX Testing with Video – Part 1
In the first installment of this two-part post, Brian Loeb from LeapVision highlights the benefits of using remote video for ethnographies and in-depth interviews.
Thanks to the unrelenting advance of technology we can now interact face-to-face even when we are in another place. Video ubiquity provides great benefits to qualitative and UX research, and showing faces is just one side of it. Beyond the importance of seeing the participant's face, researchers may be even more interested in seeing how they interact with products, services, devices, designs and content.
How Online Qualitative Research Can Stop Death by PowerPoint
No doubt at some point in your career you have either killed or been killed by power-point. There's nothing quite as fatal to attention spans as a text-heavy, image-light debrief. I believe that online qualitative methods put researchers in a much stronger position to make presentations that engage rather than enrage, simply because of the richness of the content that they allow researchers to gather.


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Both obesity and obstructive sleep apnea (OSA) are complex disorders with multiple risk factors, which interact in a complicated fashion to determine the overall phenotype. In addition to environmental risk factors, each disorder has a strong genetic basis that is likely due to the summation of small to moderate effects from a large number of genetic loci. Obesity is a strong risk factor for sleep apnea, and there are some data to suggest sleep apnea may influence obesity. It is therefore not surprising that many susceptibility genes for obesity and OSA should be shared. Current research suggests that approximately half of the genetic variance in the apnea hypopnea index is shared with obesity phenotypes. Genetic polymorphisms that increase weight will also be risk factors for apnea. In addition, given the interrelated pathways regulating both weight and other intermediate phenotypes for sleep apnea such as ventilatory control, upper airway muscle function, and sleep characteristics, it is likely that there are genes with pleiotropic effects independently impacting obesity and OSA traits. Other genetic loci likely interact with obesity to influence development of OSA in a gene-by-environment type of effect. Conversely, environmental stressors such as intermittent hypoxia and sleep fragmentation produced by OSA may interact with obesity susceptibility genes to modulate the importance that these loci have on defining obesity-related traits.
- susceptibility genes
- pleiotropy
- gene × environment effects
obstructive sleep apnea (OSA), a disorder characterized by repetitive collapse of the upper airway during sleep, is one of the most common respiratory disorders, with an estimated prevalence of 24% and 9% among middle-aged American men and women, respectively (92). Obesity in modern Western society is also extremely common. As of 2002, nearly one-third of US adults met clinical criteria for obesity, and this prevalence appears to only be increasing (27).
That obesity and OSA often colocalize is of no surprise. Other than perhaps male gender, obesity is the strongest risk factor for the development of OSA. Relative to those with a stable weight, a 10% increase in weight over 4 yr is associated with a sixfold increase in the risk of developing moderate to severe OSA (58). Weight loss trials have found significant reductions in apnea severity with moderate weight loss (69, 74). However, the mechanisms by which obesity causes OSA are not completely defined, with many potential pathways hypothesized (93). Perhaps the most obvious is that fat deposition in the neck and airway lumen may lead to increased collapsibility of the upper airway. In addition, adiposity in the chest and abdomen may result in reductions in lung volumes. Recent studies suggest reduced lung volume may independently predispose to upper airway collapse (37). Another possible mechanism relating obesity with sleep apnea is via the hormonal effects of adipose tissue. Leptin, a hormone produced by adipose tissue, has important effects on weight regulation by stimulating hypothalamic satiety centers (6, 34, 57). Human obesity is typically associated with elevated leptin levels, suggesting a state of leptin resistance (15). Besides regulating weight, leptin may have important effects on ventilatory drive. Leptin-deficient mice hypoventilate and have a blunted response to hypercapnia (53, 84). Administration of leptin corrects these abnormalities independent of changes in weight (53). Through these effects on ventilatory control, elevated leptin levels (or the underlying leptin-resistant state) may play a pathogenic role in the development of OSA.
It is also possible that OSA may play a causal role in the development of obesity. OSA patients have elevated leptin levels compared with weight-matched controls, and OSA treatment lowers these levels (39, 53, 55). These findings suggest OSA may be a cause of leptin resistance and thus a propensity for further weight gain. Not only does sleep disruption, a common result of OSA, reduce serum leptin levels, it also increases levels of the appetite-stimulating hormone ghrelin (76, 82). These findings were associated with increases in hunger and appetite scores (76). Epidemiological studies consistently implicate reduced sleep as a risk factor for the development of obesity (36, 47, 70, 82, 87, 89). Although overall weight does not appear to fall with treatment of OSA, one study did find the amount of fat inside the abdominal cavity (visceral fat) diminishes (10). This fat compartment appears to have unique hormonal effects as the amount of visceral adipose tissue is more strongly associated with metabolic complications of obesity such as insulin resistance and dyslipidemia than measures of subcutaneous fat or overall obesity (28, 29).
That obesity is in large part genetically determined has been known for almost three decades (26). A large twin study estimated the heritability of weight to be 78% (79). That is to say, 78% of the variability in weight across a population is explained by shared intrafamilial factors. Subsequent studies demonstrated that adopted children have a body size more closely resembling their biological parents than their adopted parents (80). Studies in Finland and the United Kingdom have estimated the heritability of body mass index (BMI) to be 60–80% (42, 61). Linkage to obesity-related phenotypes has been investigated in some 50 genomewide scans to date with dozens of candidate loci and genes identified (3, 59).
Similarly, familial factors have been known to influence OSA risk for nearly 25 years (77). Since then, several groups have quantified the familial risk of OSA by studying widely different populations. All of these studies have identified a strong heritable component to OSA (30, 32, 49, 62, 66). Family-based studies suggest that the risk of OSA is approximately twice as great among relatives of apneic persons (30, 66). In addition, a dose-response relationship exists such that the risk of OSA increases with increasing number of apneic relatives (66). Quantitative apnea-related phenotypes also demonstrate substantial heritability. A study of elderly twins found the heritability of both the respiratory disturbance index and the oxygen desaturation index to be nearly 40% (7).
Given the strong genetic components to both obesity and apnea phenotypes as well as the tight association with multiple interweaving links between these two diseases, it would not be surprising for there to exist common susceptibility genes for both obesity and OSA. In fact, it has been suggested that the familial aggregation of OSA may simply be a reflection of that found in obesity. This is clearly not the case. Even after controlling for BMI, significant familial aggregation for OSA persists (32, 66). Furthermore, a study of nonobese apneic patients also demonstrated strong heritability of OSA (49). That this should be the case should be of no surprise given that other pathophysiological pathways to apnea development such as craniofacial structure and ventilatory control have also been demonstrated to have a heritable component (13, 32, 49, 63, 65). Thus the susceptibility genes for OSA are not exclusively the same genes as those modulating obesity. That does not mean, however, that no overlap exists.
Clearly, given the strong effect of obesity on OSA pathogenesis, any genetic variant that predisposes to obesity will secondarily also lead to the development of OSA. Thus any obesity gene might also be considered to be an apnea gene. However, obesity is not a monolithic process. Clearly, there are some forms of obesity that have a more important role in the pathogenesis of sleep apnea. For example, fat deposition in the neck is much more important than fat deposition in the limbs (17). An android fat deposition pattern (excess subcutaneous truncal-abdominal fat) and visceral adiposity have also been found to more closely predict OSA than overall obesity (31, 72). Therefore genetic polymorphisms that influence fat deposition in these sites will be more important OSA genes. There is a wealth of evidence that these fat distribution pattern phenotypes are genetically driven. Large differences in the patterns of fat deposition exist across inbred strains of cattle, suggesting an important role for genetics (83). Among humans, even after correction for overall obesity, measures of fat deposition pattern aggregate within families. The ratio of subscapular skinfold thickness to subscapular plus suprailiac thicknesses, a measure of the android fat pattern, has been reported to have a heritability of 43% (71). Measures of central obesity such as BMI-adjusted waist circumference and ratio of trunk to extremity skinfold ratio have heritabilities of 29–48% (40). These findings strongly support the hypothesis that there are genetic polymorphisms that specifically promote fat deposition in the subcutaneous regions of the torso or around the abdominal viscera. Through this mechanism, these variants would promote the development of both obesity and OSA.
Another type of potential genetic interaction between obesity and OSA is one in which a particular polymorphism leads to both obesity and OSA through independent mechanisms (Fig. 1). For example, by impacting leptin function, a genetic polymorphism may reduce satiety and also increase ventilatory instability. This is what is referred to as genetic pleiotropy. Pleiotropic genetic effects have clearly been described in other situations. A well known example is at the APOE locus, which codes for apolipoprotein E. The ε4 allele of APOE is an important risk factor for both atherosclerotic heart disease as well as Alzheimer's dementia (24, 91). The circadian regulatory gene, CLOCK, also appears to influence multiple biological systems. CLOCK-knockout mice have profound disruptions in circadian rhythmicity, and so it is not surprising that these animals would have abnormal timings for feeding and activity (88). In addition, however, these mutant animals demonstrate an overall increase in caloric intake associated with a phenotype of obesity and metabolic syndrome (85). Similarly, given the large number of neurological, metabolic, and mechanical overlaps between obesity and OSA, it is likely that a polymorphism affecting one biochemical system may affect the risk for both disorders via multiple paths. For example, disruptions of the orexin system could potentially result in a common link between obesity and OSA. Orexinergic neurons in the lateral hypothalamus play an important role in sustaining wakefulness with projections to all of the wake-promoting areas of the brain (21). Loss of these neurons is associated with a narcolepsy phenotype (60). These neurons, as the name orexin implies, also play an important role in stimulating appetite, projecting on to the arcuate nucleus of the hypothalamus (68). Thus mutations affecting orexin, the orexin receptor, or proteins involved in the downstream signaling of orexin binding might simultaneously affect metabolic and sleep-related function. Several other potential candidate genes are listed in Table 1.
The recently reported linkage scans from the Cleveland Family Study represent the first genomewide linkage studies of OSA phenotypes (54, 55). The results provide insight into possible genetic overlaps between obesity and OSA. Linkage to the apnea-hypopnea index (AHI) as a measure of OSA and BMI as a measure of obesity was tested across the autosomal chromosomes in both a Caucasian and an African-American cohort. The heritability of AHI in both groups was ∼33%, whereas the heritability of BMI was over 50%. After controlling for BMI, significant heritability for AHI remained, supporting the notion that the genetic susceptibility to OSA is not completely defined by weight. In further multivariate modeling of a larger subset of the Cleveland Family Study, obesity measures such as BMI and serum leptin explained 50–55% of the genetic variance in AHI (56). This suggests that about half of the genetic determinants of AHI are obesity related and half are obesity independent.
Linkage findings are described by the logarithmic odds (LOD) score, a measure of the odds ratio of linkage to no linkage. Although none of the linkage findings in either racial group achieved genomewide significance (LOD > 3.3) (46), there were several regions with intermediate LOD scores, indicative of possible linkage in the setting of complex, multifactorial diseases such as obesity and OSA (90). Furthermore, the change in linkage evidence for AHI after adjustment for BMI provides insight into mechanisms of action if a susceptibility locus is present. Among the Caucasians, a LOD score of 1.4 was found for AHI and 1.7 for BMI on chromosome 12p (54). After adjustment for BMI, the maximal LOD for AHI in this region dropped to only 0.4 whereas the LOD for BMI adjusted for AHI fell to 0.2. These data suggest that if a susceptibility gene for AHI exists in this region, it likely mediates its effect on apnea via obesity. On the other hand, a maximal LOD for AHI of 1.4 was found on 19q with no linkage evidence for BMI in this region (54). Adjustment for BMI had no effect on the AHI LOD, suggesting that a susceptibility gene in this region exerts its effect on AHI through obesity-independent mechanisms.
A different pattern of linkage findings was found at the short arm of chromosome 2. Among the Caucasians, the maximal LOD for AHI is 1.6 and for BMI is 3.1 in this region, again suggesting that a susceptibility locus for both phenotypes might exist in this region (54). However, adjustment for BMI only dropped the LOD for AHI to 1.3, suggesting that the obesity effect at this locus does not fully explain the apnea effect. This may represent two independent loci, one influencing AHI and one BMI. Another possibility is that there is only one locus at 2p regulating both AHI and BMI but via independent mechanisms. A strong candidate gene for both phenotypes in this region is proopiomelanocortin (POMC). The POMC locus, found at 2p23.3, encodes for a number of hormones including melanocyte-stimulating hormone (MSH). POMC neurons in the arcuate nucleus of the hypothalamus are important in energy homeostasis via MSH. Leptin's anorexic activity is mediated via depolarization of these neurons, and use of an MSH agonist decreases both body fat and leptin levels in humans (16, 25). Obesity phenotypes have been consistently linked to the POMC locus (14, 33, 38, 67), haplotypes in this gene have been associated with leptin levels (38, 50), and severe mutations in this gene produce a severe childhood obesity phenotype (44). Leptin's effects on ventilatory drive in mouse models are also mediated via MSH, suggesting that this pathway may independently predispose to apnea as well (64).
Evidence for pleiotropy also exists at chromosome 8q. Among African-Americans in the Cleveland Family Study, the peak LOD scores were 1.3 and 1.6 for AHI and BMI, respectively (55). Again, after controlling for BMI, the AHI LOD only dropped to 1.1, suggesting that the obesity and apnea promoting effects in this region were independent. A potential candidate locus in this region is the COH1 gene at 8q22–23. This gene encodes a transmembrane protein with a presumed role in vesicle-mediated sorting and intracellular protein transport on the basis of its structure (43). Severe mutations in this gene have been associated with Cohen syndrome, an autosomal recessive condition characterized by truncal obesity (9). Other findings include facial dysmorphism, mental retardation, and ocular anomalies. The craniofacial abnormalities include microcephaly, facial hypotonia, and laryngomalacia, all of which could predispose to OSA. Thus mutations in this gene that are milder but more common may play a role, via separate pathways, in contributing to nonsyndromic forms of both obesity and OSA.
The serotoninergic system is another common pathway that could link obesity and OSA. Serotonin has important effects on the stimulation of satiety centers in the arcuate nucleus (5). In addition, serotonin potentiates hypoglossal neural output, which increases upper airway dilator muscle activity (45, 75). Thus reductions in serotoninergic activity, by increasing appetite, could promote obesity and, by lowering muscle tone in the upper airway, could promote OSA. Both linkage and haplotype association studies in a Finnish population suggest a serotonin-related gene at Xq24 is associated with obesity (51, 81). The SLC6A14 gene encodes for a sodium chloride-dependent transporter of neutral and cationic amino acids, which appears to play an important role in the transport of tryptophan, the precursor of serotonin, into the central nervous system (73). A French study has confirmed the association of this polymorphism with obesity, and an association with hunger and satiety scores was also found (19). Whether this polymorphism is associated with OSA (via or independent of any obesity effects) has not yet been studied, as the OSA linkage scans reported thus far have not included the sex chromosomes.
Another potential method of genetic interaction between obesity and OSA is a form of gene-by-environment effect where the adverse effects of obesity or OSA can be thought of as environmental stressors (Fig. 2). Each of the methods by which obesity predisposes to OSA can be influenced by an individual's underlying genetic susceptibility. An increase in fat deposition around the upper airway will be more likely to produce apnea in individuals with a lower ability to respond to this stressor due to reduced upper airway dilator muscle tone. Conversely, obesogenic effects of OSA may be influenced by the underlying genetic milieu. Genetic polymorphisms may modulate the effect that exposure to sleep fragmentation from OSA has on leptin and ghrelin dynamics. Other polymorphisms might influence the effect that these hormonal perturbations have on producing further weight gain.
The peroxisome proliferator-activated receptor-γ (PPARG) gene located on chromosome 3p25 encodes a protein that is a key component of a nuclear transcription factor important in adipocyte differentiation (4). Variants in this gene have been implicated as risk factors for the development of obesity (4, 18, 20, 48, 86). Because hypoxia is known to suppress PPARG gene transcription (94, 95), the importance of a mild defect in PPARG function may become magnified in the setting of recurrent exposure to hypoxia from OSA. Thus PPARG allelic variants may play a much more important role in determining obesity phenotypes in individuals with OSA, and OSA may play a much more important role in promoting weight gain among those with a mutation in PPARG.
Similarly, the effects of uncoupling protein-1 (UCP1) and UCP2, two other obesity candidate genes, may be influenced by OSA. These genes encode for uncoupling proteins, mitochondrial proton channels that divert energy from ATP synthesis to thermogenesis (2). In so doing, their activation increases energy consumption. Polymorphisms in both genes have been associated with obesity phenotypes (8, 12, 22–23, 52). Interestingly, sleep deprivation in rodent models has been shown to increase expression of both UCP1 and UCP2 (11, 41), suggesting the sleep disruption of OSA may influence expression of these genes and thus the relative importance of a variant at these loci in determining obesity risk.
There appear to be multiple causal pathways linking obesity with sleep apnea. Although obesity is clearly a strong risk factor for OSA, further research is needed to better define any potential risk OSA carries for promoting weight gain. Both diseases also clearly have a strong genetic basis. Although work has begun to identify the specific genetic polymorphisms that confer risk to the development of these disorders, clearly much more needs to be accomplished in this arena. A recent workshop sponsored by the American Thoracic Society laid out recommendations for future research aimed at dissecting the genetic bases for sleep-disordered breathing (78). A chief objective was the development of novel phenotypes, including biomarkers, that more closely reflect only one or a few molecular pathways rather than the overarching syndrome defined with the AHI. These simpler phenotypes could be more amenable to genetic analysis because of the fewer sources of variance than a global measure of apnea. The same holds true for obesity research, where the use of more specific phenotypes of fat deposition patterns would provide not only better insight into the molecular mechanisms underlying obesity but also a better understanding of how obesity and OSA interrelate.
The use of dense single nucleotide polymorphism maps will allow for better resolution of linkage findings so as to narrow down candidate loci. A better understanding of the neurobiology and molecular pathways underlying obesity and sleep apnea will also allow for a more rational selection of candidate genes to test for association with these disorders. Ultimately, the use of gene-knockout animal models will be important to establish causality of any identified associations. In performing these genetic studies, it will be important to simultaneously consider both disorders given their close relationship. Methodology for conducting bivariate linkage scans has already been developed, and there is evidence to suggest that such a strategy is more powerful than traditional univariate approaches (1). Not only will many genetic variants influence the development of OSA by causing obesity or vice versa but it is likely that there are also variants with pleiotropic effects predisposing to obesity and OSA via independent mechanisms. Identifying such genes and understanding their function will provide novel insights into the shared pathogenesis of these diseases. Finally, the possibility that genetic polymorphisms may affect the susceptibility that each disease confers toward the other should not be ignored. Incorporating such a model of gene × environment interaction into future study designs along with an understanding of the effects of obesity on OSA can allow for a better delineation of OSA susceptibility genes and vice versa. Similarly, use of such a model along with information about the genetics of obesity would allow for a more complete understanding of how OSA may impact obesity.
Research support was provided by an American Heart Association Scientist Development Grant and by National Heart, Lung, and Blood Institute Grant HL-60292.
- Copyright © 2005 the American Physiological Society


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The Gamecocks-Tigers game at Death Valley is listed among five contests involving conference teams as a television hold. The hold is for a six-day selection among ABC, ESPN, ESPN2, Raycom or ESPNU with starting time options of noon or 3:30 p.m.
Final decisions will be made by Sunday.
This is the third straight season the South Carolina-Clemson rivalry will take place the Saturday after Thanksgiving Day.
Clemson travels to Virginia this Saturday. South Carolina takes the weekend off before its traditional regular-season finale with the Tigers.


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Storm loses star forward Adam Blair to Wests Tigers
- From: Herald Sun
- July 13, 2011
MELBOURNE Storms big four will be again reduced to three next season after conformation that star forward Adam Blair has signed with the Wests Tigers from 2012.
The Kiwi international agreed to a four-year deal with the Sydney club, believed to be worth around $2 million.
The 25-year-old back-rower, who played his 100th game for the club earlier this season, was grouped in with Storm superstars Cameron Smith, Billy Slater and Cooper Cronk as Melbourne Storm's "big four" after the departure of Greg Inglis.
But Blair's defection could pave the way for the return of former Storm star Ryan Hoffman.
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Carmen Electra not a sex addict Tom Cruise fails to pull in viewers Oscars move to FebruaryMovie news & GossipMusic news & Gossip
Jolie's lovelife for stage show
Patricia Ebert has written a screenplay based on the Hollywood beauty's tempestuous marriage, and subsequent split, from director and actor Billy Bob Thornton.
A source said: "The script is about a couple who have quite a turbulent relationship and that is exactly how it was between Angelina and Billy."
It is believed the script contains numerous parts which are directly based on the couple's life together, but so far Ebert has refused to reveal any details of the screenplay.
Meanwhile, Jolie has posed together with Brad Pitt as husband and wife for a magazine.
The pictures show the pair, who are allegedly romancing in real-life, posing as the perfect 1960s American couple to promote their movie 'Mr & Mrs Smith'.
Brad and Angelina are seen lounging in a garden while 'their' three children splash in a pool for the 60-page feature in America's W magazine.


text: I picked up my newly bedded 700 Sendero SFII yesterday from my gunsmith. He mentioned how much harder and better made the H-S Precision stocks are compared to McMillan. I was surprised to hear that. Here's what he said. The McMillan do not have pillars. The McMillans are much softer and have a soft center when you grind away material to bed the action. He said you really have to work to grind away the H-S Precision in comparison. I read somewhere that H-S Precision stocks are fiberglass and kevlar. I don't know about the McMillan but perhaps they are only fiberglass without kevlar? What say you?


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Packers and Movers Amritsar
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The Cold Pizza Test
Their result for The Cold Pizza Test ...
You scored 30 Normality, 140 Craziness!
Their Analysis (Vertical line = Average)
They scored 140% on Craziness, higher than 93% of your peers.
They scored 30% on Normality, higher than 7% of your peers.
All possible test results
Congratulations on surviving the test. Wait, did you survive? Pinch yourself, just to be sure. I hope you enjoyed taking this test, as much as I enjoyed writing it. Now go order some pizza and get... Read more
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Professional artists wanting the best fine art printing services choose Canvas Giclee Printing. Our online art copy service offers a complete package for scanning and copying art. When artists want affordable canvas wrapped giclee prints, watercolor prints or fine art paper giclees, they choose us for the finest art reproductions anywhere. We are skilled photographers and lighting experts with years of experience.
DETAILS of OUR FINE ART PRINTING SERVICES & REPRODUCTION PROCESS
Canvas Giclee Printing specializes in large art prints and art show printing for artists. Our professional photographers use the Hasselblad H5D-50 megapixel system to produce a high resolution digital file. Then our highly trained fine art printing team makes color corrections so the digital image matches the original artwork as closely as possible. The prices listed below include the scan, color matching and proofing. Remember it's the quality of the digital scan that determines the end result – a beautiful fine art reproduction of your original artwork as a gallery wrapped canvas giclee or a fine art paper giclee.
There is a one time charge to produce a high resolution scan of original artwork. All scans require color matching and proofing which are included in the price. Please note that you must request a proof. Proofs will be sent by request only prior to art printing. If you cannot ship your original artwork to us, please visit our blog for detailed information on 'How to Photograph your Paintings for Print Reproduction.'
High Resolution Scan of Artwork sizes 8 x 10 and smaller
$40.00 each
High Resolution Scan of Artwork sizes 11 x 14 to 18 x 24
$60.00 each
High Resolution Scan of Artwork sizes 20 x 24 and larger
$80.00 each
Drum scans for transparencies or negatives for a flat fee
$50.00 each
Once a high resolution digital file of your artwork is created, it is archived on our secured database – not on a public server. Your digital files are safe with us and will be accessed only to print repeat orders for you.
Beyond the fine art printing services we provide in our studio, we also understand how valuable your original artwork is and that it needs to be handled with care and respect to and from our location. Getting your art to us safely is of great concern. We recommend using a professional packing and shipping service of your choice such as FedEx, Mailbox Express, or UPS Store. However, if you choose to package your artwork yourself, we would like to provide some packing and shipping guidelines to facilitate the safe arrival of your original work of art to Canvas Giclee Printing. Click here for our contact address.
- Wrap the painting in foam or bubble wrap
- Take extra care by cutting plenty of bubble wrap to fit over the corners
- Slip the wrapped painting inside a clear bag
- Use cardboard as padding and place a piece over the face of the canvas
- When packaging multiple paintings, be sure to set the prints face-to-face or back-to-back
- Place inside a sturdy cardboard box that is roughly the size of the painting
- FedEx, UPS and Mailbox Express provide packaging service
- Be sure to include a FRAGILE sticker on the box
- Purchase insurance on the shipment


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"Things are going good," Hunt said. "I have finished my trips. I took one to Nebraska, Oregon State and then Boise State. It's down to those three schools and I canceled my trip to California too. I won't be taking that trip."
It's now down to three and Hunt has very good things to say about all of the final schools he's considering.
"I like everything about Oregon State. I like the coaches, the players, the unity of the team, the environment, the school and the academics. I had a good trip there.
"Basically it was the same things as Oregon State. It was like the same area. It was nice. The players and the coaches were great. There was great energy on the team. The academics are good there too.
"At Nebraska, I liked the coaches. They were all really cool. The team is a strong unit. They have a great history in football. It's a nice area and the academics are really good. I had a good official visit there too."
While Hunt admits that he's down to three there are two teams that are currently jockeying for his top spot. Hunt says that could change though and that everything rides on the upcoming in-home visits.
"Oregon State and Boise State are like neck and neck right now for the No. 1 spot right now. It's going to come down to how the home visits go. Boise State is coming to my house December 5th. I don't have anything set up for the other two schools. I need to coordinate that."
The Nebraska staff is preparing for the Big Ten championship game and Hunt says that he will likely have something set up to host Nebraska soon. He says that he talks to his recruiting coach mainly at Nebraska, but also gets to talk to some other coaches on the staff including the head coach.
"Coach Rich Fisher has been recruiting me for Nebraska. It's his area. I talk to Coach John Papuchis, Coach Terry Jopseph and Coach Bo Pelini every once in a while. We have a little communication."
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Assistance for People with Disabilities
Sensitive to the special needs of customers, LVIA provides both physical and practical amenities for travelers with disabilities.
This includes:
- Skycaps to assist passengers upon arrival and departure
- Handicap accessible parking spaces in each lot, ramps to planes
- Wheelchair ground transport to assist passengers who are traveling on a commuter flight
- Wheelchair-height dining tables
- Wheelchair accessible restrooms
- Special equipment and service animals on board (with prior notification at the time of reservation)
Navigator Volunteer Program
Navigator and Junior Navigator Volunteers are people from the community who donate their time to provide courteous and friendly assistance and provide a warm welcome to visitors at the Lehigh Valley International Airport. Click here for more information.
Elevators and escalators are available throughout the Main Terminal area and in the departure area. Braille signage is located in the elevators.
Luggage Carts
Luggage carts are available throughout the Airport FREE of charge to assist passengers with their luggage.
Automated Teller Machine
Self-service banking machines are located in the Main Terminal on the lower level.
Public telephone banks are located throughout the Airport and meet the American with Disabilities Act (ADA) height restrictions. Telephones with amplified volume controls are standard to most telephones, and all phones are hearing-aid compatible.
Telecommunications Devices for the Deaf (TDD Phones)
There is one public TDD phone located on the lower level of the Main Terminal by the baggage claim area. The Communications Center has incoming TDD on 610-231-5229.


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Straight From NRF: Want Your Share of $100 Billion? Build Customer TrustRetail and Hospitality
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USGS Professional Pages
Lisa Wald
GeophysicistContact Info
Short Biography
I was a geophysicist in the Pasadena, CA USGS Office for 15 years, and have been in the Golden, CO office since 2002. I am the Web Content Manager for the national USGS Earthquake Hazards Program (EHP) website, the Landslide Hazards Program website and the Geomagnetism website. I received my Bachelor of Science degree in Geology from Trinity University in San Antonio, Texas in 1984, and my Masters of Science in Geophysics from the University of Arizona in Tucson in 1987. I spent the first part of my career performing database management for the office and doing research on surface waves and site response, and then I created and Education & Outreach Program for the Pasadena USGS Office. In the early 90's I began doing web development, specializing in website information architecture and user experience (design and layout).
I have also designed and created USGS Fact Sheets and other print documents used for communicating the mission and activities of the Earthquake Hazards Program. National Geographic has used my educational materials, and several publishing companies for educational books have used my expertise, including Time Magazine's "Time for Kids" and Random House's "Magic Tree House" series. In 2003, I won the USGS Shoemaker Award for Communication Product Excellence for the Earthquake Hazards Program website.
Most recently I selected to be the web designer for the White House Office of Science and Technology Policy (OSTP) "Federal Crowdsourcing and Citizen Science Toolkit" website.
Read Full Professional Summary
Download CV
PublicationsFor publications list, please download CV.
My Science Topics
My USGS Science Strategy AreasA National Hazard, Risk, and Resilience Assessment Program
Web Design & Content Manager
Earthquake Hazards Program, Landslide Hazards Program, Geomagnetism Program, Geologic Hazards Team
Contact Information
1711 Illinois St
Golden, CO 80401
303-273-8600 - Fax
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Gimenez to David Beckham: Consider Downtown Boat Slip for MLS Stadium
Beckham's plans for this PortMiami stadium are looking increasingly shaky.
David Beckham's aspirations for a new Major League Soccer stadium at PortMiami have lately been going about as well as Liverpool's title chase. That's an English soccer joke, people. They're not going well! Faced with stiff opposition from Royal Caribbean and competing developers, Beckham's proposal has begun to look politically toxic, raising the question of whether MLS will come to the Magic City after all.
But Miami-Dade Mayor Carlos Gimenez opened the possibility of a new option yesterday: a downtown waterfront stadium for Becks that's not at the port. Instead, he suggested, the soccer field could be built on a huge boat slip just north of the American Airlines Arena.
See also: David Beckham Eyes Soccer Stadium at Port of Miami
The long, unused stretch of water called the FEC Slip runs between the southern tip of Museum Park and the northern edge of the AA Arena. Gimenez suggested the water could be filled in, creating enough new waterfront park space to fit an MLS stadium.
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Even better, the mayor said, that location would factor into Miami's plans to create an uninterrupted green and pedestrian space from the Miami River north to the new Pérez Art Museum and the Adrienne Arsht Center.
"Downtown Miami will benefit greatly from the creation of a grand waterfront park," Gimenez wrote. "Combining this area and filling in the FEC Slip will also expand the amount of publicly accessible waterfront open space, turning this underutilized land into a shared public space."
The county promised to finish a thorough analysis of the area for Beckham's group within two weeks, and Beckham's group sent the Miami Herald a statement promising to consider it. "Our goal from the outset has been to create a great fan experience, to provide an economic asset that creates jobs, and design a stadium that communicates the energy of Miami to the entire world," the group told the daily. "The Port is a strong site; however, a stadium next to AmericanAirlines Arena is an exciting possibility."
The FEC Slip, an unused stretch of water just north of the American Airlines Arena, could be filled in to create park space for a new stadium, Gimenez said.
via Google Maps
Beckham and his investors are clearly enamored with the PortMiami plan, and his group won approval in Tallahassee last week to seek state funding for his project. And Gimenez's idea surely would add significant new costs for taxpayers to fund a public works project large enough to make the land suitable for a massive new stadium.
But the mayor's letter is a heartening reminder to soccer backers that it's not necessarily PortMiami or the highway (or, gulp, West Miami-Dade) for MLS in South Florida.
Here's the mayor's letter on the new proposal:
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