Executive impairment determines ADHD medication response: implications for academic achievement

Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to indirect informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed.     

A Rare Case of Short-Chain Acyl-COA Dehydrogenase Deficiency: The Apparent Rarity of the Disorder Results in Under Diagnosis

Short-chain acyl-CoA dehydrogenase (ACAD) deficiency is an extremely rare inherited mitochondrial disorder of fat metabolism. This belongs to a group of diseases known as fatty acid oxidation disorders. Screening programmes have provided evidence that all the fatty acid oxidation disorders combined are among the most common inborn errors of metabolism. Mitochondrial beta oxidation of fatty acids is an essential energy producing pathway. It is a particularly important pathway during prolonged periods of starvation and during periods of reduced caloric intake due to gastrointestinal illness or increased energy expenditure during febrile illness. The most common presentation is an acute episode of life threatening coma and hypoglycemia induced by a period of fasting due to defective hepatic ketogenesis. Here, the case of a 4 month old female patient who had seizures since the third day of her birth and persistent hypoglycemia is described. She was born to parents of second degree consanguinity after 10 years of infertility treatment. There was history of delayed cry after birth. Metabolic screening for TSH, galactosemia, 17-OHP, G6PD, cystic fibrosis, biotinidase were normal. Tandem mass spectrometric (TMS) screening for blood amino acids, organic acids, fatty acids showed elevated butyryl carnitine (C4) as 3.40 μmol/L (normal <2.00 μmol/L), hexanoyl carnitine (C6) as 0.92 μmol/L (normal <0.72 μmol/L), C4/C3 as 2.93 μmol/L (normal <1.18 μmol/L). The child was started immediately on carnitor syrup (carnitine) 1/2 ml twice daily. Limitation of fasting stress and dietary fat was advised. Baby responded well by gaining weight and seizures were controlled. Until now, less than 25 patients have been reported worldwide. The limited number of patients diagnosed until now is due to the rarity of the disorder resulting in under diagnosis.     

Partial Empty Sella Syndrome: A Case Report and Review

Empty sella syndrome is a damaged pituitary gland. Either the gland has shrunk or has been crushed and flattened making it look like an empty sella on MRI scan. The reported prevalence of primary empty sella in general population is 8–35 %. The incidence is more in females, the ratio being 5:1. It is generally found in middle aged women who are obese and hypertensive.     

Necessary,But Not Sufficient: Critiquing the Role of Information and Communication Technology in Putting Knowledge into Use

Abstract

Purpose: This article reviews the experience of ICT applications as a tool for putting research derived knowledge into use for innovation in South Asia.

Design/methodology/approach: The article uses the contemporary understanding of communication and innovation in reviewing the experience of ICTs in putting new knowledge into use in South Asia.

Findings: The findings from this study suggest that ICTs in general have not contributed effectively to the challenge of putting new knowledge into use as they are mostly used to support traditional communication tasks — such as information dissemination and training. The article argues that this under-utilisation of the potential of ICTs could be due to: a lack of appreciation of the new communication-intermediation tasks required for innovation, underestimation of the roles of intermediaries and their capacities for innovation and lack of networks needed for communities to make use of the information provided through ICTs.

Practical implications: Although the understanding of communication, innovation and extension has changed substantially in the past two decades, there is still a big gap between theory and practice. This article contends that this gap needs to be bridged if ICTs are to effectively contribute to putting new knowledge into use.

Originality/value: The article manifests the necessity for ICT based initiatives to be embedded into the renewed understanding of communication and innovation and it moves ICT related debates from merely a success story to a pragmatic world of communication and innovation process.     

Om： One tool for many （Indian） languages

INTRODUCTION India is a nation with pluralistic culture, a large number of cultures, ethnicities, languages and relig- ions coexisting with each other. While the culture and faith unify the country under one umbrella either by similarity or by tolerance, the language is what separates them. In the 1951 census, the first census after India attained independence, 845 languages (dialects) were identified, of which 60 were spoken by at least 100000 people each. The Indian constitu- tion iden…     

Evaluating risk for targeted violence in schools: Comparing risk assessment,threat assessment,and other approaches

In the wake of recent school shootings, fear over violence in schools has prompted increased requests for psychologists, educators, and law enforcement professionals to assist in preventing future school violence incidents. We attempt to lay a foundation for developing effective assessment and prevention approaches by first distinguishing planned school‐based attacks from other forms of school and youth violence. We then review the three assessment approaches that have been advocated and used in some jurisdictions (profiling, guided professional judgment, automated decision‐making) and demonstrate why they are inappropriate—and potentially harmful—in preventing planned school‐based attacks. We then describe the contours of the threat assessment approach, developed by the U.S. Secret Service to prevent assassinations, and examine its utility for responding to communications or behaviors of concern that students may present in school settings. © 2001 John Wiley & Sons, Inc.     

Serum alpha-2-macroglobulin, antitrypsin and antichymotrypsin activities in patients receiving treatment with cyclosporine

Cyclosporine has been reported to function as an inhibitor of the chymotrypsin like activity of proteasome. We hypothesized that the administration of an exogenous proteinase inhibitor may affect the activities of the naturally occurring serum anti proteinases. The aim of this study was to observe the pattern of alteration of serum alpha 2 macroglobulin (AMG), alpha 1- antitrypsin (AT) and alpha 1-antichymotrypsin (ACT) activities in renal transplant patients receiving the immunosuppressive drug, cyclosporine. Patients (97) who had received a single renal allograft were inducted into the study. Subjects were on a twice-daily dosage of cyclosporine capsules. Trough (Co) and two-hour post dose (C 2) cyclosporine levels were regularly estimated and all patients had stable creatinine levels. In 5 newly transplanted patients, antiproteinase activities were estimated weekly over a 4-week period as their cyclosporine doses were gradually tapered. Average serum activities of ACT and AMG in the transplant group were significantly less than in the control group (p<0.002 and p<0.003 respectively). AT and ACT activities fell gradually over 4 weeks. AMG activities showed a biphasic pattern, initially falling by almost 50% in the second week, increasing marginally in the third week and decreasing to less than 50% of the activities observed in the first week. Serum antiproteinase activities of serum alpha 2 macroglobulin (AMG), alpha 1-antitrypsin (AT) and alpha 1-antichymotrypsin (ACT) were found to be altered in renal transplant patients receiving cyclosporine.     

Targeting phonological representations can help in the early stages of reading in a non‐dominant language

It is not known whether children who are struggling with reading in a non‐dominant language will respond better to a phonological intervention or to one that addresses oral proficiency. Multilingual seven‐to nine‐year‐olds showing reading difficulty in a non‐dominant language, English, were given a three‐week intervention in phonological skills or in language proficiency and were compared with two control groups (one with reading difficulties and one with no reading difficulties) who received a non‐language based intervention. The group receiving the explicit phonological instructions showed significantly better gain in reading and spelling measures than the language proficiency and reading difficulties control group, but did not reach the levels of the noreading‐difficulty group. The phonological intervention was particularly effective for children with the lowest single‐word reading scores. We suggest that the intervention helped to catalyse the fine‐tuning of the phonological domain, making phonological representations optimally available for decoding, phonological manipulations and literacy development.