Cognitive status and development in the oldest old: a longitudinal analysis from the Heidelberg Centenarian Study

In the present study, we investigated cognitive status, cognitive development and the effect of mortality on cognitive changes in very old age. Analyzing data from the population-based Heidelberg Centenarian Study, results revealed that centenarians differed quite strongly in their cognitive capacities. While about half of the population showed moderate to severe cognitive impairment, one quarter was found to be cognitively intact. Moreover, analyzing cognitive change over a period of 1.5 years, centenarians' cognitive performance was revealed to be rather stable. Finally, only a small effect of mortality on cognitive status and changes was detected, supporting a recent hypothesis that the terminal decline or drop in cognitive functioning decreases in very old age.     

Extreme dietary selectivity following liver transplantation in a 5-year-old girl; management via behavior therapy

In a 5.1-year-old girl who had been treated by surgical correction of biliary atresia and total orthotopic liver transplantation, extreme dietary selectivity was noted; this was treated by behaviour therapy. On entry in the rehabilitation centre, she manifested malnutrition along with a variety of gastro-enterologic complaints. The treatment consisted of a set of behavioural procedures such as stepwise expansion of the diet, verbal prompting, intermittent contingent attention and a list of agreements with a system of rewards; this led to the elimination of the dietary selectivity and to the consumption of a varied diet in a normal tempo.     

Bayesian applications of belief networks and multilayer perceptrons for ovarian tumor classification with rejection

Incorporating prior knowledge into black-box classifiers is still much of an open problem. We propose a hybrid Bayesian methodology that consists in encoding prior knowledge in the form of a (Bayesian) belief network and then using this knowledge to estimate an informative prior for a black-box model (e.g. a multilayer perceptron). Two technical approaches are proposed for the transformation of the belief network into an informative prior. The first one consists in generating samples according to the most probable parameterization of the Bayesian belief network and using them as virtual data together with the real data in the Bayesian learning of a multilayer perceptron. The second approach consists in transforming probability distributions over belief network parameters into distributions over multilayer perceptron parameters. The essential attribute of the hybrid methodology is that it combines prior knowledge and statistical data efficiently when prior knowledge is available and the sample is of small or medium size. Additionally, we describe how the Bayesian approach can provide uncertainty information about the predictions (e.g. for classification with rejection). We demonstrate these techniques on the medical task of predicting the malignancy of ovarian masses and summarize the practical advantages of the Bayesian approach. We compare the learning curves for the hybrid methodology with those of several belief networks and multilayer perceptrons. Furthermore, we report the performance of Bayesian belief networks when they are allowed to exclude hard cases based on various measures of prediction uncertainty.     

Parents' reasons for enrolment of their motor-disabled child in a Dutch therapeutic toddler class

This article describes and categorizes the reasons why parents enrol their motor-disabled children in the therapeutic toddler class, a special centre-based service in early intervention. The results among a representative Dutch sample of 84 mothers showed that child-related reasons were considered more important than family- and parent-related reasons. Family- and parent-related reasons were influenced by the presence and severity of the child's behaviour problems. The results of this study are discussed within the context of parental expectations in early intervention, and the concept of family centredness.     

Periapical lesions accidentally filled with calcium hydroxide

AIM: To evaluate the effect of accidental and voluminous calcium hydroxide overextensions into periradicular lesions and tissues on the prognosis of periapical healing. SUMMARY: Eleven cases with periapical lesions and voluminous calcium hydroxide overextension are presented. Despite literature reports on the deleterious effects of calcium hydroxide extension in the periapical area, none of the endodontic treatments failed and surgical intervention was not indicated. KEY LEARNING POINTS: Extensive extrusion of calcium hydroxide into the periapical tissues does not appear to comprise periapical healing. Despite this finding, the deliberate extrusion of dental materials into the apical tissues is not advocated.     

Treatment of advanced head and neck cancer by means of radiation therapy plus chemotherapy — a randomised trial

Fifty-eight patients with advanced head and neck cancer were entered into a randomised trial comparing radical radiation therapy to the primary tumour and associated lymph node areas with a combination of radiation therapy plus chemotherapy. The distribution of tumour types and stages was similar in the two treatment groups. The response rates to radiation therapy alone (50% complete plus partial response) and to radiation therapy plus chemotherapy (60% complete plus partial response) were not significantly different. However, a significant difference in survival was found between the two groups. The median duration of survival for the patients treated by means of radiation therapy alone was 18 weeks; that for the combined therapy was 36 weeks. The combination of radical radiation therapy plus intermittent high-dose chemotherapy was well tolerated and appears to be an approach that warrants further trial.     

Neurofeedback improves executive functioning in children with autism spectrum disorders

Seven autistic children diagnosed with autism spectrum disorders (ASD) received a neurofeedback treatment that aimed to improve their level of executive control. Neurofeedback successfully reduced children's heightened theta/beta ratio by inhibiting theta activation and enhancing beta activation over sessions. Following treatment, children's executive capacities were found to have improved greatly relative to pre-treatment assessment on a range of executive function tasks. Additional improvements were found in children's social, communicative and typical behavior, relative to a waiting list control group. These findings suggest a basic executive function impairment in ASD that can be alleviated through specific neurofeedback treatment. Possible neural mechanisms that may underlie neurofeedback mediated improvement in executive functioning in autistic children are discussed.     

Sleepiness, on-task behavior and attention in children with epilepsy who visited a school for special education: A comparative study

Children with epilepsy are at risk for problems in daytime functioning. We assessed daytime sleepiness, on-task behavior and attention in 17 children (aged between 7 and 11 years) with epilepsy who visited a school for special education and compared these to 17 children from a control group who visited a regular school. Within the group of children with epilepsy, we explored whether behavioral and cognitive functioning varied across days of the week and times of the day. Data were collected during four consecutive school days. Children with epilepsy had more daytime sleepiness, less on-task behavior and less attention than controls. Furthermore, sleepiness and on-task behavior varied cross days of the week and times of the day, an effect that was not found in controls. Implications for educational practice are discussed.