Prefrontal cortical and striatal activity to happy and fear faces in bipolar disorder is associated with comorbid substance abuse and eating disorder

Background: The spectrum approach was used to examine contributions of comorbid symptom dimensions of substance abuse and eating disorder to abnormal prefrontal-cortical and subcortical-striatal activity to happy and fear faces previously demonstrated in bipolar disorder (BD). Method: Fourteen remitted BD-type I and sixteen healthy individuals viewed neutral, mild and intense happy and fear faces in two event-related fMRI experiments. All individuals completed Substance-Use and Eating-Disorder Spectrum measures. Region-of-Interest analyses for bilateral prefrontal and subcortical-striatal regions were performed. Results: BD individuals scored significantly higher on these spectrum measures than healthy individuals (p < 0.05), and were distinguished by activity in prefrontal and subcortical-striatal regions. BD relative to healthy individuals showed reduced dorsal prefrontal-cortical activity to all faces. Only BD individuals showed greater subcortical-striatal activity to happy and neutral faces. In BD individuals, negative correlations were shown between substance use severity and right PFC activity to intense happy faces (p < 0.04), and between substance use severity and right caudate nucleus activity to neutral faces (p < 0.03). Positive correlations were shown between eating disorder and right ventral putamen activity to intense happy (p < 0.02) and neutral faces (p < 0.03). Exploratory analyses revealed few significant relationships between illness variables and medication upon neural activity in BD individuals. Limitations: Small sample size of predominantly medicated BD individuals. Conclusion: This study is the first to report relationships between comorbid symptom dimensions of substance abuse and eating disorder and prefrontal-cortical and subcortical-striatal activity to facial expressions in BD. Our findings suggest that these comorbid features may contribute to observed patterns of functional abnormalities in neural systems underlying mood regulation in BD.

Phonology as Cause, Symptom and Treatment? Early Reading Development and Dyslexia, by Valerie Muter, London: Whurr, 2003, 232 pages + viii, ISBN 1 86156 327 2

Book review

Internal service quality and its impact on external service quality:a study of the role of internal customer types and the dimensions which are used to assess internal suppliers within an organisation and how this affects external service quality

This research explores the role of internal customers in the delivery of external service quality. It will consider any potentially different internal customer types that may exist within the organisation. Additionally, it will explore any potential differences in the dimensions that are used to measure service quality internally and externally. If there are different internal customer types then there may be different dimensions which are used to measure service quality between these types and this will be considered also. The approach adopted given the depth and breadth of understanding required, was an action research case based approach. The research objectives were:(i) To determine the dimensions of internal service quality between internal customer supplier cells. (ii) To determine what variation, if any, there is in the dimension sets between internal customer supplier cells. (iii) To determine any ranking in the dimensions that could exist by internal customer supplier cell type. (iv) To investigate the impact of internal service quality on external service quality over time. The research findings were: (i) The majority of the dimensions used in measuring external service quality were also used internally. There were additions of new dimensions however and some dimensions which were used externally, for internal use, had to be redefined. (ii) Variation in dimension sets were revealed during the research. Four different dimension sets were identified and these were matched with four different types of internal service interaction. (iii) Differences in the ranking of dimensions within each dimension set for each internal customer supplier cell type were confirmed. (iv) Internal service quality was seen to influence external service quality but at a cellular level rather than company level. At the company level, the average internal service quality at the start and finish of the research showed no improvement but external service quality had improved. Further investigation at the cellular level showed that improvements in internal service quality had occurred. Those improvements were found to be with the cells that were closest to the customer.The research implications were found to be: (i) some cells may not be necessary in the delivery of external service quality. (ii) The immediacy of the cell to the external customer and number of interactions into and out of that cell has the greatest effect on external customer satisfaction. (iii) Internal service quality may be driven by the customer affecting those cells at the front end of the business first. This then cascades back to those cells which are less immediate until ultimately the whole organisation shows improvements in internal service quality.

An optical study of human ocular dimensions

Many workers have studied the ocular components which occur in eyes exhibiting differing amounts of central refractive error but few have ever considered the additional information that could be derived from a study of peripheral refraction. Before now, peripheral refraction has either been measured in real eyes or has otherwise been modelled in schematic eyes of varying levels of sophistication. Several differences occur between measured and modelled results which, if accounted for, could give rise to more information regarding the nature of the optical and retinal surfaces and their asymmetries. Measurements of ocular components and peripheral refraction, however, have never been made in the same sample of eyes. In this study, ocular component and peripheral refractive measurements were made in a sample of young near-emmetropic, myopic and hyperopic eyes. The data for each refractive group was averaged. A computer program was written to construct spherical surfaced schematic eyes from this data. More sophisticated eye models were developed making use of linear algebraic ray tracing program. This method allowed rays to be traced through toroidal aspheric surfaces which were translated or rotated with respect to each other. For simplicity, the gradient index optical nature of the crystalline lens was neglected. Various alterations were made in these eye models to reproduce the measured peripheral refractive patterns. Excellent agreement was found between the modelled and measured peripheral refractive values over the central 70o of the visual field. This implied that the additional biometric features incorporated in each eye model were representative of those which were present in the measured eyes. As some of these features are not otherwise obtainable using in vivo techniques, it is proposed that the variation of refraction in the periphery offers a very useful optical method for studying human ocular component dimensions.

The effects of negative affectivity on self-reported activity limitations in stroke patients:testing the symptom perception, disability and psychosomatic hypotheses

This study investigated whether Negative Affectivity (NA) causes bias in self-report measures of activity limitations or whether NA has a real, non-artifactual association with activity limitations. The Symptom Perception Hypothesis (NA negatively biases self-reporting), Disability Hypothesis (activity limitations cause NA) and Psychosomatic Hypothesis (NA causes activity limitations) were examined longitudinally using both self-report and objective activity limitations measures. Participants were 101 stroke patients and their caregivers interviewed within two weeks of discharge, six weeks later and six months post-discharge. NA and self-report, proxy-report and observed performance activity (walking) limitations were assessed at each interview. NA was associated with activity limitations across measures. Both the Disability and Psychosomatic Hypotheses were supported: initial NA predicted objective activity limitations at six weeks but, additionally, activity limitations at six weeks predicted NA at six months. These results suggest that NA both affects and is affected by activity limitations and does not simply influence reporting.

Dimensions of perception and recognition of danger

Despite abundant literature on human behaviour in the face of danger, much remains to be discovered. Some descriptive models of behaviour in the face of danger are reviewed in order to identify areas where documentation is lacking. It is argued that little is known about recognition and assessment of danger and yet, these are important aspects of cognitive processes. Speculative arguments about hazard assessment are reviewed and tested against the results of previous studies. Once hypotheses are formulated, the reason for retaining the reportory grid as the main research instrument are outlined, and the choice of data analysis techniques is described. Whilst all samples used repertory grids, the rating scales were different between samples; therefore, an analysis is performed of the way in which rating scales were used in the various samples and of some reasons why the scales were used differently. Then, individual grids are looked into and compared between respondents within each sample; consensus grids are also discussed. the major results from all samples are then contrasted and compared. It was hypothesized that hazard assessment would encompass three main dimensions, i.e. 'controllability', 'severity of consequences' and 'likelihood of occurrence', which would emerge in that order. the results suggest that these dimensions are but facets of two broader dimensions labelled 'scope of human intervention' and 'dangerousness'. It seems that these two dimensions encompass a number of more specific dimensions some of which can be further fragmented. Thus, hazard assessment appears to be a more complex process about which much remains to be discovered. Some of the ways in which further discovery might proceed are discussed.

Dimensions of satisfaction in retail settings:a research note

Taking issue with the prevalent practice of measuring customer satisfaction with a single global measurement item, this article stresses the importance of measuring customer satisfaction through its underlying dimensions, especially in retail settings. Empirical results of a survey of 351 consumers demonstrate that (a) consumer satisfaction with retail stores has 6 key dimensions, (b) the suggested dimensions of retail satisfaction predict overall satisfaction, and (c) the dimensions of retail satisfaction have a greater effect on overall satisfaction than SERVQUAL dimensions. However, the predictive power of the dimensions of retail satisfaction is still fairly low. Implications for retail management as well as academic research are outlined.

Exploring the dimensions and transactional outcomes of incomplete business contracts

With an increased emphasis on outsourcing and shortening business cycles, contracts between firms have become more important. Carefully written contracts contribute to the efficiency and longevity of inter-firm relationships as they may constrain opportunism and are often a less costly governance mechanism than maintaining complex social relationships (Larson 1992). This exploratory examination adds to our understanding of how incomplete contracts affect interorganizational exchange. First, we consider the multiple dimensions of contract constraints (safeguards). We also investigate the extent that constraints affect decisions to enforce the relationship by delaying payments, and whether the decision is efficient. Finally, we examine the extent the constraints are effective (and ineffective) at reducing transaction problems associated with enforcement. Based on 971 observations of transactions using explicit, written terms and other secondary data in the context of IT transaction in The Netherlands we test our research propositions.

Paradoxical psychometric functions ("swan functions") are explained by dilution masking in four stimulus dimensions

The visual system dissects the retinal image into millions of local analyses along numerous visual dimensions. However, our perceptions of the world are not fragmentary, so further processes must be involved in stitching it all back together. Simply summing up the responses would not work because this would convey an increase in image contrast with an increase in the number of mechanisms stimulated. Here, we consider a generic model of signal combination and counter-suppression designed to address this problem. The model is derived and tested for simple stimulus pairings (e.g. A + B), but is readily extended over multiple analysers. The model can account for nonlinear contrast transduction, dilution masking, and signal combination at threshold and above. It also predicts nonmonotonic psychometric functions where sensitivity to signal A in the presence of pedestal B first declines with increasing signal strength (paradoxically dropping below 50% correct in two-interval forced choice), but then rises back up again, producing a contour that follows the wings and neck of a swan. We looked for and found these "swan" functions in four different stimulus dimensions (ocularity, space, orientation, and time), providing some support for our proposal.

Nonlinear speech analysis algorithms mapped to a standard metric achieve clinically useful quantification of average Parkinson's disease symptom severity

The standard reference clinical score quantifying average Parkinson's disease (PD) symptom severity is the Unified Parkinson's Disease Rating Scale (UPDRS). At present, UPDRS is determined by the subjective clinical evaluation of the patient's ability to adequately cope with a range of tasks. In this study, we extend recent findings that UPDRS can be objectively assessed to clinically useful accuracy using simple, self-administered speech tests, without requiring the patient's physical presence in the clinic. We apply a wide range of known speech signal processing algorithms to a large database (approx. 6000 recordings from 42 PD patients, recruited to a six-month, multi-centre trial) and propose a number of novel, nonlinear signal processing algorithms which reveal pathological characteristics in PD more accurately than existing approaches. Robust feature selection algorithms select the optimal subset of these algorithms, which is fed into non-parametric regression and classification algorithms, mapping the signal processing algorithm outputs to UPDRS. We demonstrate rapid, accurate replication of the UPDRS assessment with clinically useful accuracy (about 2 UPDRS points difference from the clinicians' estimates, p < 0.001). This study supports the viability of frequent, remote, cost-effective, objective, accurate UPDRS telemonitoring based on self-administered speech tests. This technology could facilitate large-scale clinical trials into novel PD treatments.

Quantifying short-term dynamics of Parkinson's disease using self-reported symptom data from an internet social network

Background: Parkinson’s disease (PD) is an incurable neurological disease with approximately 0.3% prevalence. The hallmark symptom is gradual movement deterioration. Current scientific consensus about disease progression holds that symptoms will worsen smoothly over time unless treated. Accurate information about symptom dynamics is of critical importance to patients, caregivers, and the scientific community for the design of new treatments, clinical decision making, and individual disease management. Long-term studies characterize the typical time course of the disease as an early linear progression gradually reaching a plateau in later stages. However, symptom dynamics over durations of days to weeks remains unquantified. Currently, there is a scarcity of objective clinical information about symptom dynamics at intervals shorter than 3 months stretching over several years, but Internet-based patient self-report platforms may change this. Objective: To assess the clinical value of online self-reported PD symptom data recorded by users of the health-focused Internet social research platform PatientsLikeMe (PLM), in which patients quantify their symptoms on a regular basis on a subset of the Unified Parkinson’s Disease Ratings Scale (UPDRS). By analyzing this data, we aim for a scientific window on the nature of symptom dynamics for assessment intervals shorter than 3 months over durations of several years. Methods: Online self-reported data was validated against the gold standard Parkinson’s Disease Data and Organizing Center (PD-DOC) database, containing clinical symptom data at intervals greater than 3 months. The data were compared visually using quantile-quantile plots, and numerically using the Kolmogorov-Smirnov test. By using a simple piecewise linear trend estimation algorithm, the PLM data was smoothed to separate random fluctuations from continuous symptom dynamics. Subtracting the trends from the original data revealed random fluctuations in symptom severity. The average magnitude of fluctuations versus time since diagnosis was modeled by using a gamma generalized linear model. Results: Distributions of ages at diagnosis and UPDRS in the PLM and PD-DOC databases were broadly consistent. The PLM patients were systematically younger than the PD-DOC patients and showed increased symptom severity in the PD off state. The average fluctuation in symptoms (UPDRS Parts I and II) was 2.6 points at the time of diagnosis, rising to 5.9 points 16 years after diagnosis. This fluctuation exceeds the estimated minimal and moderate clinically important differences, respectively. Not all patients conformed to the current clinical picture of gradual, smooth changes: many patients had regimes where symptom severity varied in an unpredictable manner, or underwent large rapid changes in an otherwise more stable progression. Conclusions: This information about short-term PD symptom dynamics contributes new scientific understanding about the disease progression, currently very costly to obtain without self-administered Internet-based reporting. This understanding should have implications for the optimization of clinical trials into new treatments and for the choice of treatment decision timescales.

Internet banking service quality:an investigation of interrelationships between construct dimensions

Service quality measurement in Internet banking services is an area of growing interest to researchers and managers. This research investigates the interrelationships between the dimensions comprising the Internet banking service quality construct through structural equation modelling. Five Internet service quality dimensions are identified: access, web interface, trust, attention and credibility. Credibility is modelled as an outcome of the causal variables of access, web interface, trust and attention. Trust and attention emerges as key dimensions in explaining the credibility dimension. Access is found to be a common antecedent of trust, attention and Web interface dimensions. Implications from the findings are offered.