Background: Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRIs) are the first pharmacological choice for this condition due to mild adverse effect profile.Objective: This systematic review was performed to evaluate the efficacy of SSRI for OCD in adolescents and children.Methods: Search terms were entered into PubMed, PsycINFO, Scopus, CINAHL, and Google Scholar. The included studies were randomized, placebo-controlled trials of SSRIs conducted in populations of children and adolescents younger than 18 years. Change from baseline Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), end-treatment CY-BOCS with respective SD, and response and remission rates were collected for continuous and dichotomous outcome assessment, respectively. Cochrane Rev Man software was used for meta-analyses, providing Forest plots where applicable.Results: SSRIs were superior to placebo with a small effect size. There was no additional benefit of combination treatment over cognitive behavioral therapy (CBT) alone, but CBT added substantial benefit to SSRI monotherapy. Fluoxetine and sertraline appear to be superior to fluvoxamine.Conclusion: The results of current systematic review and meta-analysis support the existing National Institute for Health and Care Excellence (NICE) guidelines for choosing CBT as first line of treatment and substituting it with SSRI, depending on patient preference. Adding CBT to current SSRI treatment is effective for non-responders and partial responders, but adding SSRI to ongoing CBT does not prove beneficial. The SSRIs have different effectiveness, and their relative efficacy remains to be investigated. Obsessive-compulsive disorder (OCD) is a chronic debilitating condition that is associated with recurrent and persistent thoughts and the compulsions to suppress them with certain excessive and repetitive behaviors. For about half of the diagnosed cases, the onset of OCD takes place in childhood or adolescence . CompareDiagnostic and Statistical Manual of Mental Disorders in its fifth edition (DSM 5) in the United States and, less frequently, ICD 10 criteria elsewhere. In addition to diagnosing, the severity of the condition is assessed and documented using validated scales, such as Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) for children and adolescents, which is a modification of the original Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) used for adults.Currently, the diagnosis is based on internationally accepted classification systems, namely Medications and psychotherapy or a combination of both are commonly used to treat patients with OCD. The only currently available treatment options for OCD are either medication or psychotherapy or the combination thereof , 5, the Treatment with clomipramine, a tricyclic antidepressant (TCA) that inhibits reuptake of serotonin, was the first option demonstrated to be effective at reducing OCD symptoms , and thiApproved by the FDA at the end of 1978, fluoxetine (Prozac) was the first agent marketed as an SSRI, and its use has once and for all established the role of serotonin (5-HT) in the pathogenesis of psychiatric disorders. SSRIs were in many aspects’ superior to the pre-existing classes of anti-depressants, i.e., TCAs and monoamine oxidase inhibitors (MAOIs). Being selective in nature of their action, SSRIs had a much more favorable side-effect profile , easier dose titration, remarkable margin of safety when considering overdoses, and thus overall were better tolerated and adhered to by the populations with psychiatric and mood disorders .A meta-analysis suggested clomipramine to be more effective compared with SSRI for the treatment of OCD in children . That saThe commonly held opinion is that cognitive behavioral therapy (CBT) should be the first line of treatment for OCD in children and adolescents. This approach has also been endorsed by the existing clinical guidelines , 17 and Thus, the current role of SSRIs in managing OCD in adolescents and children remains at least under-investigated. We have undertaken this review to address some of the gaps concerning SSRI treatment, as described more thoroughly below.To be familiar with the ground of research on OCD treatment, the reader is humbly referred to the previously conducted systematic reviews and meta-analyses concerning the above-mentioned issues , 19–23.The current systematic review was undertaken for the following reasons. There have been a number of both remote and recent systematic reviews and meta-analyses on various treatment options for OCD in adolescents and children (see above), including CBT, SRI, and the combination thereof, but none has specifically addressed the role of SSRIs, and comparisons between different SSRIs are lacking as well. Thus, we have decided to review the existing literature regarding treatments that utilize only SSRIs as the medication of intervention for treatment of OCD in adolescents and children.The purpose of the current systematic review and meta-analysis was to investigate the efficacy of SSRIs in forms of monotherapy or in combination treatment with CBT for the management of OCD in adolescents and children and compare the effectiveness of different SSRIs.The authors (AK and VK) searched the PubMed, PsycINFO, Scopus, CINAHL, and Google Scholar databases using the following keywords:  AND  AND (“children” OR “adolescents”), for citations from first available index date to January 1, 2018. The authors also manually searched the references from relevant systematic reviews and meta-analyses for additional citations that could have been missed through the initial search.Two authors (AK and SD) then independently screened the titles and abstracts for the exclusion of irrelevant studies. The full papers were then obtained to verify for inclusion eligibility. At each step, the results were compared between the researchers and any discrepancies were handled with means of discussion. Any disagreements were resolved by involving the third independent author (RA).The studies were included if they successfully fulfilled any of the following criteria:Participants were 18 years or youngerParticipants had a primary diagnosis of OCDSSRIs, such as escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vilazodone, and citalopram, were usedvia appropriate psychometric scale, i.e., CY-BOCSOCD symptom severity was reported RCTsStudies published in Englishvia random effects model, and standard mean differences (SMDs) were presented for continuous and in odds ratios (ORs) for dichotomous outcomes, respectively. Forest plots and corresponding mean differences were presented in the figures and tables, where appropriate. A subgroup comparison was attempted for different SSRIs using the I2 statistic in generic inverse variance analysis.Change from baseline CY-BOCS, end-treatment CY-BOCS, and remission and response rates was compared for different interventions arms. Cochrane’s Review Manager software was used to perform effect size calculations The search of databases produced 3,429 results. Following the exclusion of duplicates, another 2,241 studies were excluded during the title and abstract screening. This resulted in 136 articles, the full paper texts of which were retrieved and reviewed. The search through citations did not reveal any additional relevant sources. Twelve articles, which met the inclusion criteria, were eventually included Figure 1We have included 12 RCTs (published from 1992 to 2015) in our systematic review with a total number of 958 patients. Patients’ age ranged from 6 to 18 years with reported means ranging from 11 ± 3 to 15 ± 2.4 years. Two studies  implemenAll included studies reported primary outcome measures using CY-BOCS or calculations based on it. Ten studies reported rates of response to treatment, the definition of which varied across studies: 4, 2, and 1 studies defined response as 25%, 30%, and 40% decrease from baseline CY-BOCS, respectively, one study used end-treatment CY-BOCS ≤16 as a definition, and in only one report  the authAltogether 39.5% of patients involved in the 12 RCTs responded to all forms of treatment (intervention and placebo) as defined by the variety of numerical cutoffs , and 6.4% were considered to have achieved remission (as defined by CY-BOCS ≤11). The characteristics of included studies and their participants are presented in further detail in via Orwin’s fail-safe N formula  wouand Ref. ].fs only with data from that analysis. The other analyses in this review used end-treatment scores for comparison, which by far is not the most appropriate manner of demonstrating effect size and is not recommended by Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0).Because the only meta-analysis performed in this review that utilizes change from baseline for comparison was that for SSRI vs. placebo, the decision was made to calculate N0 = 7, d0 = −0.43, dc = 0.2 , and dfs = 0.However, the following values were inserted into the formula above: Nfs = 8 studies with reported CY-BOCS standardized mean difference of 0.2  were required to bring the current SMD from −0.43 to 0.The calculation followed that Nt, p, baseline, end-treatment scores), and the change and SD were calculated in the following manner: the available values were entered into Rev Man Software’s built-in calculator, which returned the desirable measures. The mean differences and their pooled analysis are shown in small effect size of −0.43 , which was significant , I2 = 0%).There were seven RCTs comparing SSRIs with placebo treatment included in our review. One of them  was condcant see Figure 2Five studies also reported response rates, and one study reported remission rates based on various definitions  and a small effect size of –0.25 , which was not significant  compared with placebo . The paper also provided data regarding remission rates as defined by achieved CY-BOCS ≤11 with odds ratio of 31.1  and 50% risk difference, which were statistically significant (P < 0.05).The combination treatment and placebo arms yielded scores of 11.2 (SD = 8.6) and 21.5 (SD = 5.4), respectively, and the mean difference (MD) of these scores Only two studies , 24 presdemonstrating no significant difference  was observed between the regular and CBT + placebo arms with an effect size of −0.02, 95% CI: −0.74, 0.69 . The titfference .favoring the combination treatment.Two studies , 26 compno significant difference between the two interventions   see Figure 4which was of small size, albeit significant . Data from SSRI vs. Placebo comparison were added to the previous generic inverse variance analysis. The SSRI + CBT vs. Placebo arm of POTS study was not included in the analysis, as having a large effect size  would clearly deviate the results. The pooled analysis demonstrated a mean difference of −2.3, 95% CI, −3.6 to −1.1, cant see Figure 5t values from the t tables and to calculate the standard errors with Rev Man calculator . This was facilitated by unchecking all the other subgroups not to be compared. The two largest subgroups, namely, the sertraline and fluoxetine, encompassing four studies each, appeared to achieve similar results . The largest grossly visualized difference was detected between subgroups of fluoxetine and fluvoxamine , mandating an evaluation of heterogeneity between them. Once the other subgroups were unchecked from Rev Man, the test for subgroup differences displayed as: Chi2 = 8.64, df = 1 (P = 0.003), I2 = 88.4%, where the I2 statistic notifies of considerable heterogeneity, suggesting a possibility of fluoxetine’s superiority. Similar findings were noted when attempting to compare sertraline and fluvoxamine in the same manner, again suggesting Sertraline’s superiority . The I2 statistic displayed 0 for all other possible subgroup comparisons carried out in the same fashion.The pooled results of studies that used the same SSRI were compared visually, and any gross differences (exceeding 2 points on CY-BOCS) were evaluated Further studies with longer trial durations are required to assess the long-term effects and benefits of SSRI monotherapy.SSRIs are clearly effective compared to placebo for treating OCD in adolescents and children, but the effect size is small (SMD = −0.43), which converts to 3.5-point reduction in the CY-BOCS score. The clinical implication of this finding is hard to evaluate, as even though the change is statistically significant, some 3.5 points reduced from the initial CY-BOCS of 25 is merely little symptom reduction to a score of 21.5, which by no means can be designated as response . Since the RCTs were conducted in a mean time period of 8 weeks, the observed effect represents only the short-term finding. Using the method put forward by Chinn , the pooThe reported findings across studies are overall reliable, as judged from risk of bias, albeit heterogeneous. The interpretations regarding the effectiveness of SSRI versus Placebo presented above are mainly consistent with those previously stated , 22, 39.Future studies with the mentioned design are less probable, the reason being twofold. First, being superior over placebo does not yet advocate for the intervention’s clinical implications, especially when an even more effective treatment option clearly exists. Such an option, exemplified herein by CBT, has been fairly validated, and its efficacy in children and adolescents has been confirmed multiple times by various studies , 40–42. The only study comparing the combination of SSRI and CBT with placebo  found thThere were two studies comparing the combination to SSRI monotherapy , 26 and The limitation regarding trial duration is as well relevant here, and the question “which treatment option would hold the benefit for the longest period” is of important clinical implication.The findings summarized above are mainly consistent with observations from adult studies . We concTo evaluate the overall effect of SSRIs across various treatment regimens, the effect sizes of all comparisons made between arms that involved an SSRI and those without an SSRI were entered into a generic inverse variance analysis. At first, placebos were not considered, and the overall benefit of SSRIs across four studies [6 comparisons, 2 intervention arms in each of Storch et al. ; and POTIt suffices to say that the method implemented here was bizarre and nowhere near a head-to-head comparison or a network meta-analysis, but it was worth entertaining the idea that one SSRI could be superior over another , thus setting soil for future investigations and direct comparisons. Overall the findings suggested the similar efficacy of fluoxetine and sertraline and favored these two over fluvoxamine, based on considerable effect size heterogeneity. As already mentioned, this does not replace direct comparisons, which are expected to take place in the future in part by RCTs probably receiving funding by pharmaceutical companies.The most important limitation is the paucity of studies incorporated into meta-analyses, which clearly prevents the use of more sophisticated research tools and publication bias reporting with funnel plots and trims and fill technique. The limitation of excluding non-English studies is also recognized.The authors conclude that the results of current systematic review and meta-analysis support the existing NICE guidelines for choosing CBT as the first line of treatment or substituting it with an SSRI for patient preference matters, as both options seem to be equally effective and the choice rather depends on patient compliance with either option. Adding CBT to current SSRI treatment is an effective option for non-responders and partial responders but adding SSRI to ongoing CBT does not hold a significant benefit. The SSRIs have different effectiveness, and their relative efficacy remains to be investigated.Head-to-head studies are required to evaluate the relative efficacy of different SSRIs, and a number of new direct studies are needed to compare SSRIs and CBT. Considering the interesting outcomes of group CBT, further studies should evaluate this intervention. The reported outcomes are expected to include pre- and post-treatment CY-BOCS scores, change from baseline and respective standard deviations, response and remission rates, with more homogenous definitions. A research guide from authorities for investigating treatment in children and adolescents with OCD would be appropriate and of great help to settle such reporting discrepancies. Regulations regarding study duration would also contribute to the future research to evaluate the long-term effects of different treatment regimens, which by all means remains uninvestigated in children and adolescents with OCD.VK, AK, GB, and RA participated in the study conception. RB, MA, AZ, and SD participated in the study design. VK, AK, RB, RA, and MA participated in the data acquisition. RA, RB, MA, and GB participated in the data analysis and interpretation. VK, AK, SD, and AZ participated in writing the paper draft and critical revision of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest


RA, spirituality and the family environment, i.e., family communication, perceived emotional support, and parental monitoring, were measured. Higher adolescent RA was associated with lower self-reported easiness of communication with mother (odds ratio (OR) = 0.68; 99% confidence interval (99% CI) = 0.47–0.99; p < 0.01). In contrast, spiritual respondents were more likely to report both easier communication with their father (OR per standard deviation (SD) change = 1.12, 99% CI 1.02–1.23; p < 0.01) and mother (OR per SD change = 1.38 (1.23–1.55); p < 0.001) and higher perceived emotional support (OR per SD change = 1.73 (1.55–1.92); p < 0.001). Parents of respondents who attended religious services at least once a week, as well as parents of spiritual respondents, were generally more likely to monitor adolescent behaviour. Thus, this study provides information for parents, mental health workers, and pastoral carers. Further research should assess the association of a lower easiness of family communication with dissonances in adolescent–parent religiosity/spirituality and with higher parental monitoring.The family environment is associated with religiosity and spirituality as well as many aspects of adolescent lives, including their health behaviour. Therefore, the aim of this study was to assess family environment associations with adolescent religious attendance (RA), i.e., weekly participation in religious services, and spirituality in a highly secular country. A nationally representative sample ( Religion and spirituality (R/S) are generally suggested to be associated with the higher well-being of individuals . ReligioBefore proceeding to the overview of family communication patterns and parenting styles, the difference between religiosity and spirituality should first be briefly outlined. Religiosity is defined in terms of behaviour, such as church attendance , whereasAs mentioned above, religiosity and spirituality in the family environment may have positive impact on adolescent health behaviour. For a better understanding of how religious attitudes and behaviours are shared and communicated within a family, the Family Communication Patterns Theory (FCPT)  providesDespite the lack of research in the area, the communication of spiritual and religious attitudes may be expected to be influenced by the family atmosphere, conformity, or pluralism within family environment. Furthermore, parenting styles may also have a crucial impact on communication and the sharing of religious attitudes and behaviours within the family. Following Maccoby and Martin’s initial typology , differeParental communication and the sharing of attitudes, including spiritual and religious ones, cannot be separated from family emotional support and monitoring. Parenting is closely connected with emotional support and control , and parThe present study is focused on adolescence, which is a very sensitive period otherwise highly vulnerable for engaging in various risky behaviours. A lack of adolescent adjustment was found to be related with poor socialization outcomes in adulthood . AdolescSeveral previous studies have explored the links between family communication and parents’ spirituality and religiosity. The study of Brelsford  investigInterestingly, the Czech Republic ranks among those European countries with a high percentage of adolescents perceiving difficulties in communication with parents. In their comparison of 12 European countries, Tabak et al.  state thTo the best of our knowledge, there are only a few studies on this topic in the Czech Republic or in other highly secular countries. Therefore, the aim of this study was to assess the association between some family characteristics  and adolescent religious attendance and spirituality in a highly secular country.We obtained data on a nationally representative sample of Czech boys and girls from the 2014 Health Behaviour in School-aged Children (HBSC) study. This cross-sectional World Health Organization collaborative study focused on health and health-related behaviour and their socioeconomic determinants in 11-, 13- and 15-year-old children. More detailed information about the survey can be found in Roberts et al. . The HBSData from 14,539 pupils were obtained (response rate 89.2%). Most non-response was due to illness or other reasons, e.g., sports or academic competitions (10.6%), and 30 children refused to participate in the survey (0.002%). The HBSC survey consists of mandatory items, which are obligatory for each country, optional items which can be chosen by each country from a common package, and finally a limited number of national items that can be specifically added by each country. Our R/S items belonged to this last category; therefore, due to a limited space, two versions of a survey were created. R/S was included only in version B of the survey, and only adolescents from the 7th and the 9th grades responded to these questions; so, for the purpose of this paper the dataset comprised 4889 adolescents. Because of incomplete information on age, gender, spirituality, or religiosity, or an age distinctly differing from the rest , 707 questionnaires were excluded, leading to a final sample of 4182 respondents . Data was collected between April and June 2014. The questionnaires were distributed by trained administrators with no teachers present in the classroom in order to reduce information bias. Respondents had one class period (45 min) dedicated to completing the questionnaire. Participation in the survey was anonymous and voluntary.The study design was approved by the Ethics Committee of the Faculty of Physical Culture, Palacký University Olomouc (No. 17/2013).Religious attendance was assessed as an independent variable and was measured by the question “how often do you go to church or to religious sessions?” with possible answers of “several times a week, approximately once a week, approximately once a month, a few times a year, exceptionally, never”. This question was added into the survey as a national item. Sunday attendance is a matter of obligation in most of the churches/denominations in the Czech Republic; therefore, the participants who reported attending religious sessions at least once a week were dichotomized as attending.Spirituality was measured using the adjusted shortened version of the Spiritual Well-Being Scale (SWBS) . This scFamily environment was assessed using the following variables: Communication with parents and perceived emotional help from the family. All of these items were assessed as independent variables and represented mandatory items in the survey.Communication with parents was measured with the question: “How easy it is for you to talk to the persons listed below about things that really bother you?”, with the father and mother as separate options. Response options ranged from 1 (very easy) to 4 (very difficult), with a fifth option “I do not have or see this person”. According to the latest HBSC report , communiPerceived family support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS) family subscale , which iParental monitoring was assessed by using nine statements on different kinds of family rules, where participants reported how often their parents control specific behaviour  or allow specific behaviours  by using the response categories ranging from 1  to 4 (never). All of these items were assessed as independent variables and represented mandatory items in the survey. For each item, parents reported by participants as being either always or usually controlling certain behaviour, or on the contrary, never or seldom allowing it, were dichotomized as monitoring.Age, gender and socioeconomic status were considered as potential confounding variables. The socioeconomic status of the respondents’ families was used as a covariate and was assessed using the Family Affluence Scale (FAS) . The scaFirst, the exploratory data analysis was performed, and the differences in basic characteristics and in the observed categorical variables were assessed using the Chi-Square test, comparing the groups of attending versus non-attending as well as spiritual versus non-spiritual respondents. Then, differences in spirituality levels between attending and non-attending respondents were compared using the Mann–Whitney U test. Consequently, the mutual relationship between all variables of this study was assessed with the Pearson correlation, using binary variables, or where available, scale variables.z-test). All analyses were performed using the statistical software package IBM SPSS version 21 .In the next step, the associations between religious attendance, assessed as a dichotomized variable (Model 1), and spirituality, assessed as a continuous variable standardized to z-scores (Model 2), and family communication, perceived emotional support and nine types of family rules behaviour  were analysed using a binary logistic regression models. The logistic regression was chosen because of the categorical nature of the dependent variables and because of the non-normal distribution of the spirituality scale. The models were adjusted for gender, age and socioeconomic status, because these variables often represent potential confounders in adolescent research. Each of the independent variables was tested in a separate model. From the whole sample, 402 (9.6%) participants reported that they do not have or see their father, and 86 (2.1%) reported that they do not have or see their mother. These respondents were excluded from the corresponding analyses. Finally, the analyses were also repeated for religious attendance and spirituality mutually adjusted (Model 3) and in interaction (Model 4). In order to reduce the probability of an increased Type II error in multiple testing, the significance level was set to alpha = 0.01. For the sensitivity analysis using the dichotomized spirituality, the prevalence of the easiness of communication with parents and of perceived emotional support were compared with the proportion test (The background characteristics of the sample are presented in p < 0.001) from each other regarding the level of spirituality. For attending respondents, the mean SWBS score was 32.0 with SD = 8.16 , while for non-attending the mean SWBS score was 21.3 ± 6.99 .A comparison of the groups of attending and non-attending respondents did not reveal any significant differences regarding age, gender, or perceived emotional support. However, the groups differed significantly in their communication with both parents as well as in 5 of 9 kinds of parental monitoring behaviours. Moreover, the groups of attending and non-attending respondents differed significantly (p < 0.05) compared to girls, among 7th grade students compared to the 9th grade (p < 0.001), among respondents who reported a high perceived emotional support (p < 0.001), and among respondents who reported a higher parental monitoring .A comparison of the groups of spiritual and non-spiritual respondents showed a significantly higher prevalence of high spirituality  among boys , however, it showed only very weak (not exceeding 0.07) and mostly non-significant correlations with the dependent variables of the study. Spirituality showed similarly low values (below 0.16), with the exception of a significant correlation with perceived family support . Communication with mother was positively correlated with communication with father  and perceived emotional support . Communication with father was positively correlated with perceived emotional support . However, correlations of these three variables with the nine types of parental monitoring behaviour were either non-significant or weak, i.e., r did not exceed 0.15.The results of Pearson correlation coefficients are depicted in About 81% of respondents reported the finding their communication with mother easy, the figure being lower for communication with father (about 63%). Approximately three out of four of the participants also reported high perceived emotional support from their families. Parental monitoring ranged for different kinds of behaviour from 26.9% to 95.7%, with the control for smoking being the highest.p < 0.01), while the other associations were not significant. In contrast, compared to non-spiritual respondents, spiritual respondents were more likely to report both easier communication with parents (p < 0.001) and a higher perceived emotional support . However, as further analysis showed, easier communication with parents was associated only with adolescents’ existential well-being (p < 0.001), while no significant results were found for their religious well-being. Both subscales were associated with higher perceived emotional support (p < 0.001).p < 0.001), i.e., communication with father, communication with mother, and perceived emotional support, with the figures decreasing for religious attendance and increasing for spirituality. Nevertheless, the interaction of both variables (Model 4) was not significant in any of the observed variables. Sensitivity analysis using dichotomized spirituality , and their regular breakfast consumption (p < 0.001), whereas they were less likely to allow eating meals in front of the screen (p < 0.001) compared to the parents of non-attending respondents.p < 0.001), a regular breakfast consumption (p < 0.001), eating in front of the screen (p < 0.001), sweets and soft drinks consumption (p < 0.001). Regarding the associations with the subscales, the RWB was associated with five of the observed behaviour (p < 0.001), whereas the EWB with three of them (p < 0.05 to p < 0.001).Spirituality (Model 2) showed a similar pattern, with a significant increase of the likelihood of parental monitoring in the case of screen-based activities   revealed, in most cases, similar figures for both variables as previous analyses; however, in some cases it lost significance for religious attendance. The interaction of religious attendance and spirituality was not significant in any of the observed variables.We explored the association between some family characteristics  and adolescent religious attendance and spirituality in a highly secular country. We found that religious attendance was significantly associated with more difficult communication with mother. In contrast, spiritual respondents were more likely to report both easier communication with parents and good perceived emotional support. Regarding parental monitoring, adolescents reported that the parents of attending respondents were in four of the nine observed behaviours more likely to be in control. The same held for spirituality, where the results were significant in five behaviours. The RWB was associated with higher parental monitoring in five behaviours, the EWB in three.In our study, we did not find any significant differences in religious attendance between genders, and moreover, we found a higher prevalence of a high spirituality among boys. These findings are in contrast with the recent findings of studies on representative Czech samples which reported a higher prevalence of R/S among women ,36 in adOur results showed that attending respondents were less likely to perceive their communication with mother as easy, while no significant results were found for communication with father or perceived emotional support. However, a sensitivity analysis suggests that the group with more difficult family relationships could be represented by attending non-spiritual respondents. Previous research has usually reported a positive association between the religiosity of parents or adolescents and a higher family satisfaction in the relationship ,40, whicWe also found that although spirituality was generally associated with easy communication with parents, it was only the association with the EWB subscale that was statistically significant. It suggests that the existential aspect of spirituality (a sense of hope and meaning in life) was in the Czech conditions more important in connection with family communication than the explicit relationship with God. Given the recent trend in research that links the attachment theory and the image of God ,46, our Our findings regarding parental monitoring are in line with the general findings in this area, in which higher parental supervision of religious adolescents is reported , and couBased on the family communication patterns theory , Czech rThis study has several important strengths, the most important being the large and representative sample size of adolescents, the high response rate, and the use of the well-established HBSC methodology. Another strength is that this study extends the knowledge of the adolescents’ family conditions by assessing the role of religious attendance and spirituality. One limitation is that the design of the study did not allow us to measure the religious attendance or spirituality of the parents directly, and, also, the parental monitoring was reported by the adolescents only. Other limitations might be a potential information bias, as our data were based on self-reports of adolescents, which can be inaccurate or influenced by social desirability, and the cross-sectional design of the study, which does not allow us to make conclusions on causality. Moreover, it is also possible that problems in family communication might be influenced by other variables , which were not assessed in this study.Our research suggests that adolescent spirituality, especially some of its positive effects, like a perceived meaning of one’s life, might contribute to good adolescent communication with their parents and emotional support. Adolescents might therefore also be encouraged to develop this aspect of their lives. However, on the contrary, dissonance in this area, i.e., adolescent religious attendance without their own internal convictions, can possibly result in more difficult family communication. Religious parents should be better informed about these risks and the possible negative consequences of a mere maintaining of traditional values without their internal dimension.Further research should therefore focus on understanding the causes and consequences of discrepancies in adolescent–parent religious and spiritual values. It could also examine the role of the parental religiosity/spirituality in order to complete the present results and should take into account other possible confounding variables.We found that religious attendance was associated with lower self-reported easiness of communication with parents. In contrast, spirituality was associated with easier communication with parents and more perceived emotional support. Parents of attending as well as of spiritual respondents were in general more likely to control adolescent behaviour. Further research should assess the association of the dissonance of adolescent–parent religiosity/spirituality and higher parental monitoring with the lower easiness of family communication.


Introduction: Infected “mycotic” Aneurysm (IA) of the extracranial carotid artery is a rare condition that can be fatal if mistaken for other pathology. An 83-year-old man presented with a mass on the neck initially suspected malignant. Weeks later it grew rapidly and was found to be an IA, thus requiring acute surgery. Via this case report, we discuss diagnostics and approach when diagnosing masses in relation to vessels of the neck not readily explained.Case Report: After diagnostic imaging and clinical assessment an unknown primary tumor of the neck was suspected. Fine needle aspiration was inconclusive. The patient did not present with any signs of infection or neurological symptoms—only discomfort and pain. Approximately two weeks later, the mass grew and the patient became dysphagic, febrile, and confused. Computed tomography angiography revealed an IA of the right common carotid artery. The patient underwent acute surgery consisting of ligation of the internal and external carotid arteries and resection of the internal jugular vein. The pathogen found was E. coli, supposedly from the bladder after surgical intervention due to polyposis.Conclusion: IA is a very rare entity and can have many etiologies. Since it can be fatal, it is necessary to keep IA in mind when diagnosing masses in relation to vessels of the neck. As shown in this case of a E. coli-induced IA, patients can present with atypical symptoms, on diagnostic imaging it can be mistaken for other pathology, and pathogenesis can be unclear. Masses of the neck can be caused by immensely diverse pathologies. Among these are: lymphadenopathy , congenital neck lesions , and persistent masses with high potential for malignancy either as a primary tumor or metastases from Unknown Primary Tumor (UPT) .At the beginning of 2008, a national fast-track program for head and neck cancer was introduced in Denmark. The goal was to improve survival by reducing the waiting time from initial suspicion of malignancy to the start of treatment -angiography as an Infected “mycotic” Aneurysm (IA)—an extremely rare condition especially in the Common Carotid Artery (CCA) .in situ of the bladder for which we had undergone a transurethral resection whereafter he developed postoperative sepsis, and one perioperative episode of arrhythmia with consequent cardiac arrest during hip surgery in 2017. The process had developed over ~3 weeks. The patient had experienced pain and discomfort with right-sided otalgia upon swallowing. He had no signs of dysphonia, was afebrile, had no erythema or calor in relation to the mass, and no neurological abnormalities. Thus, infection was not a provisional diagnosis. Ultrasound showed a hypoechoic, ill-defined tumor mass sheathing ~50 percent of the right CCA. No flow in the mass was detected with Color Doppler Ultrasound. Therefore, UPT was suspected.An 83-year-old man was referred from an ENT specialist practitioner to the ENT-department due to a painful process situated in level II-III on the right side of the neck. He had a history of arterial hypertension, low-malignant carcinoma Fine needle aspiration was inconclusive twice. Open biopsy and core biopsy was not an option due to the uncertainty of malignancy and potential spreading and bleeding. Therefore, diagnostic imaging was ordered.Magnetic Resonance Imaging (MRI) and Positron Emission Tomography/Computed Tomography (PET/CT) showed what was concluded to be a tumor suspected of malignancy sheathing the carotid artery, though a slight dilation of ~2.3 cm of the right CCA was detected Figure . FurtherSixteen days after being enrolled in the ENT fast-track program, having undergone a colonoscopy and initial examination at the department of pulmonary medicine, the patient was admitted due to pain and further growth of the process on the neck. The patient was not able to eat or drink sufficiently and was experiencing general fatigue. The patient's family found that the patient's mental condition had deteriorated.Upon admission, his vital signs were: A temperature of 38.4°C, 172/98 mm Hg blood pressure, a heart rate of 105 beats/min, and an unlabored respiratory rate of 16/min.9/L, and 24.1 × 109/L neutrophils. A urine sample was sent to the laboratory for cultivation and analysis of sensitivity.Biochemistry showed markedly high inflammatory indices with a c-reactive protein of 266 mg/L, white blood cell count of 26.9 × 10E. coli and relevant antibiotics were administered.Initially, the patient was prescribed Piperacillin and Tazobactam, treating symptoms as an infection with unknown primary focus. A diagnostic ultrasound was performed, which raised the suspicion of an aneurysm. CT-angiography showed an IA of about 5.4 × 3.9 cm Figure . The patThe only sequela was dysphonia due to paralysis of the right recurrent nerve.E. coli with the same resistance pattern as seen in the IA was found in the urine samples from the admission date. This suggested the bladder to be the primary focus of infection.After the resection of the IA, growth of First described by Sir William Osler in 1885, the term “mycotic” relates to the initial description of aneurysms with fungal appearance seen in several cases of bacterial endocarditis . This maSymptoms of an infected aneurysm of the ECA can vary depending on the size and position. These include the following symptoms: a growing, pulsatile cervical mass associated with pain, locally or radiating to the ear, tenderness, fever, dysphonia, dyspnea, and dysphagia , 8. FurtTreatment options include total resection, endovascular stenting, and autologous interposition vein graft which is the preferred contemporary method due to fewer complications , 13–15. Our case has several unique clinically interesting characteristics. The aneurysm was initially not pulsatile, there were no neurological symptoms, and the patient did not have any initial signs of infection; thus the primary diagnosis was UPT. PET/CT and MRI were performed as defined in the Danish fast-track program of head and neck cancers . ImagingE. Coli-induced IA in the ECA has been reported since 1966 (Fusobacterium and methicillin-resistant staphylococcus aureus (An IA is characterized by a positive culture result or evidence of other organisms on histological examination of the arterial wall . Only sence 1966 , 16, 17.nce 1966  and septnce 1966 . Furthers aureus .Staphylococcus aureus, Salmonella, and streptococcus species (E. coli-induced IA, in this case the strain was not beta-lactamase-producing, but it has been argued that further cases may be seen in the future due to drug-resistant E. coli urinary-tract infections (Nowadays, the most prevalent pathogens are  species , 22. Pre species . Thought species –26. In rfections .A history of sepsis, surgery, signs of pharyngitis/tonsillitis, trauma or procedures involving vascular puncturing of vessels of the neck support the diagnosis of IA . Even thIn conclusion, clinicians should think of IA as a possible etiology when diagnosing tumors of the neck in close proximity to the vessels. As discussed, both the presentation of IA and etiology can vary considerably, and should therefore always be considered. Consequently, a broad anamnesis of prior risk factors is very important for the detection. Early detection of the disease is imperative; though rare, an aneurysm of the carotid artery can have a fatal outcome. Furthermore, early detection can have relevance for surgical options and later complications.Written informed consent was obtained from the patient specifically for publication of this case report.PE: General script, gathering information, photoshop, and consent from patient; GH: Specialist consulting, re-writing, reference search, and revisions; PH: Re-writing and revisions, reference search, and help with submission.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Resilience is a psychological characteristic which enhances personal assets and protects individuals from potential negative effects of various stressors. While this topic has been considered in the separate context of sports injuries and anxiety states, these issues have rarely been considered together. The objective of this study is to analyse the association between motivation to overcome injuries in football and the state of anxiety caused by those injuries. One hundred and eighty-five footballers from Spain were analysed by way of the Connor-Davidson Resilience Scale, the State-Trait Anxiety Inventory questionnaires, and an injury self-registration sheet. Statistical analyses were performed using structural equations. Results showed a direct and positive relationship between the capacity to face up to injuries or potential injuries and to adapt successfully to them for injured footballers, especially when anxiety was considered as a transitory emotional state. In addition, this relationship was stronger in non-injured sportspersons because their resilience capacity was not being impaired by the experience of an injury. It is generally accepted that participation in professional sport carries an elevated risk of injury –2. ThereAnxiety is defined as a feeling of apprehension or threat that generates an increase in physiological activation . This tyResilience is a concept which has shown increasing importance in recent years within the scope of sports –16. AlthDifferent dimensions which shape resilience as a psychosocial factor have been established. These include the locus of control and commitment (LCC), which determines how events are perceived and the strength of behaviour to overcome them. Other dimensions include the defiance of conduct oriented to the action (DCOA), self-efficacy and resistance to malaise (ARM), which are linked to the individual's ability to withstand harmful events and the behaviours executed. Finally, optimism and adaptation to stressful events (OASE), and spirituality (ES) have been highlighted as dimensions which assist emotional regulation of the problematic situation , 17–20.Generally, resilience has been explored in various populations, including adolescents , older pAnxiety and resilience have been widely studied in the sport context in relation to success and sport performance. For instance, Nezhad et al.  demonstrTherefore, the general aim of this study was to analyse the association between the motivation of football players to overcome injury and the anxiety caused by that injury. The specific objectives were: (a) to identify the relationship between resilience and state-trait anxiety inventory scores (STAI-Trait) when a footballer is injured, and (b) to identify the relationship when the footballer is not injured.A descriptive and cross-sectional study was carried out with a single measure in a single group. A total of 185 male footballers, aged 15 to 34 , participated in the study. Sample selection was by convenience using as exclusion criteria to play in teams of Spanish first and second division for professionals, to play in third division for semi-professionally and to play in categories under third division for amateur. Of the total sample, a 30.8% (n = 57) was professionally, a 10.3% (n = 19) was semi-professionally and the remaining 58.9% (n = 109) was amateur footballers.The following variables were collected:Typology of Injury. Established via direct report of the injury status of the footballer at the time of data collection and labelled as ‘Injured’ or ‘Non Injured’, according to Fernández-García et al. .Anxiety State/Trait. The STAI Trait/State Questionnaire  was emplResilience. The Connor-Davidson Resilience Scale (CD-RISC) proposed by Connor & Davidson  was usedTeams across Granada and Jaen provided a convenient sample for the researchers of the present study. Teams were sent a letter which briefly explained the objective of the study and invited them to take part. The letter detailed the voluntary nature of the investigation and detailed the written informed consent procedure. For participants aged under 18 years old, consent had to be signed by a legal guardian. Informed consent were obtained from all participants and from the parents of all participants under age 18. Questionnaires were administered to players during training sessions in October which is a period of the season characterised by a low requirement for performance and therefore a low trait anxiety. Further, measurements were made following a standard training session to prevent disruption to the athlete’s normal routine. Participants were informed that their answers would remain anonymous. There were no issues to report during data collection, following which, all footballers returned to their training routines. A total of 17 footballers were eliminated owing to their refusal to complete the questionnaires or due to them changing teams during the data collection period. The study was approved by the ethics committee of the university Santo Tomás (Chile) (CE UST Nº80/2014).Structural equation models of relationships between the measured constructs were developed using AMOS 21 to investigate the relationships between the variables analysed, all other analyses  were computed using SPSS 22.0. All data were assessed for normality by examining each measure’s Shapiro -Wilks test statistic.p-value indicate good model fit [Several authors recommend evaluation of goodness of fit to take into account various indices –38. Chi-odel fit , 39.In accordance with the objectives, the theoretical constructs predicted to influence resilience are considered in conjunction with the hypothetical model shown . This mop and was significant  although we must take into account that this statistic, as an index, does not have an upper limit, for which reason it cannot be interpreted in a standardised manner. Thus, other standardised fit indexes that are less sensitive to the sample size are shown.A structural model was designed to estimate the relationships between the measured constructs. Model fit is evaluated to ascertain the compatibility between the model proposed and the empirical evidence obtained. The resultant Chi-square value was associated with The model demonstrated acceptable fit to the data using the goodness of fit index (GFI = 0.93), the comparative fit index (CFI = 0.93), the incremental fit index (IFI = 0.93), the adjusted goodness of fit index (AGFI = 0.88) and RMSEA, which produced a value of 0.06.Emanating from the analysis done on resilience and anxiety theoretical model, we observed the direct and indirect unidirectional and bidirectional relationships between these constructs through a multi-group analysis of the moderating effect among injured and non-injured footballers. In the theoretical model we can observe the structural analysis incorporating the correlation/covariance between the latent variables (Resilience and Anxiety), identified by way of bidirectional arrows, and the causality relationships among them and the observed variables or indicators which are marked with unidirectional arrows.The results presented in p < 0.001), as the correlation between these two. This states that for injured footballers there is a direct and positive relationship between the capacity to accept (i.e. face up to) injuries and to be able to adapt successfully (r = 0.38), which is shown via a transient emotional state using the STAI Trait/State Questionnaire (In ionnaire .p < 0.001). All relationships were direct and positive, and the greatest correlation strength was shown for LCC (r = 0.90), followed by OASE (r = 0.85) and ARM (r = 0.98). CCOA demonstrated the weakest relationship (r = 0.27). Furthermore, significant associations were shown for all categories of anxiety in injured footballers (p < 0.001). In this case, Stai-Positive and Trait-Positive were negatively related to anxiety  while Stai-Negative and Trait-Negative were positively related to anxiety .In addition, significant relationships were observed among all categories of resilience apart from spirituality and its global construct (p < 0.001), ARM (r = 0.87) and OASE (r = 0.84) were significant. In addition, there was a positive correlation among resilience and Stai-Trait (r = 0.61) which was significant at level of p < 0.001. This signifies that for non-injured footballers there was a direct and positive relationship between the capacity to face up to potential injuries and the ability to adapt successfully should an injury be sustained in the future (r = 0.61). This relationship was stronger for non-injured footballers than for injured footballers. Moreover, a significant relationship was shown for Stai-Negative and Stai-Trait in non-injured footballers (p < 0.001). In this case, this association was direct and positive (r = 0.88).In The findings of the present study reveal a relationship between the motivation of footballers to overcome injuries and the state of anxiety resulting from such injuries. A number of previous studies have examined aspects of football from various perspectives in the scientific field -sociological, technical, tactical and performance- , 4, 40. We have discussed two models in relation to injured footballers. Resilience was directly correlated with the values obtained from the anxiety questionnaire. This suggests that injured footballers experience a state of anxiety and concern as a direct result of sustaining an injury. This is supported by previous research conducted by Liberal et al.  and FernIt was observed that the capacity of resilience and anxiety in sport were positively related showing higher correlations in non-injured athletes. It is possible that the capacity for resilience of non-injured athletes is higher because it has not been diminished by the frustration experienced by injured athletes generated when they are not able to compete , 16. In It is also important to consider resilience during periods of injury as this psychological characteristic that can promote a much more positive adaptation to adverse processes or periods of adversity, such as suffering an injury –18. In tWith regards to footballers who are not injured and therefore, have no conscious preoccupation with an adverse and performance-restricting consequence, there was a stronger correlation between resilience and anxiety. This is consistent with the work of Olmedilla et al.  who founConsidering the potential impact of sports injuries on a sportsperson and the wider sport, it would be appropriate and advisable to put into action injury prevention programmes adapted to each individual . In thisFinally, it is important to highlight some of the limitations of the present study which could influence interpretation of the findings. Firstly, the sample size was relatively small and so a greater number of sportspersons need to be recruited to confirm these preliminary findings. The research should also be extended to a greater variety of sports including coactive sports to enable meaningful comparison of results. Another limitation is the timing of measurements which were taken during a period of low performance burden. It would be interesting to take measurements at various times of the season in order to observe fluctuations of state anxiety and its relationship with resilience. Finally, the present study included only males it would be interesting to carry out subsequent studies on females to enable further interesting comparisons.The model developed to observe the relationships between motivation to overcome injuries in footballers and the state of anxiety provoked by the sustained injury satisfactorily fits the empirical data. In injured footballers, there is a direct and positive relationship between the capacity to face up to injuries and to successfully adapt to them (i.e. resilience) and state anxiety . This relationship was stronger in uninjured sportspersons because their resilience capacity was not being impaired by the stresses of a period of injury. With regards to resilience, the defiance of behaviour was significant in injured players but was not significant for non-injured players. In addition, negative state anxiety was the only factor associated with global anxiety in non-injured players, while all categories of anxiety were related to the global dimensions in injured players.S1 FigNote 1: LCC, locus of control and commitment; DCOA, defiance of conduct oriented to the action; ARM, self-efficacy and resistance to malaise; OASE, optimism and adaptation to stressful situations; and ES, spirituality.(DOCX)Click here for additional data file.S2 FigNote 1: LCC, locus of control and commitment; DCOA, defiance of conduct oriented to the action; ARM, self-efficacy and resistance to malaise; OASE, optimism and adaptation to stressful situations; and ES, spirituality.(DOCX)Click here for additional data file.S3 FigNote 1: LCC, locus of control and commitment; DCOA, defiance of conduct oriented to the action; ARM, self-efficacy and resistance to malaise; OASE, optimism and adaptation to stressful situations; and ES, spirituality.(DOCX)Click here for additional data file.S1 TableNote 1: P.R., Regression Weights; P.E.R., Standardized Regression Weights; S.E., Estimation of error; C.R., Critical Ratio. Note 2: LCC, locus of control and commitment; DCOA, defiance of conduct oriented to the action; ARM, self-efficacy and resistance to malaise; OASE, optimism and adaptation to stressful situations; and ES, spirituality. Note 3: *** p < 0.001.(DOCX)Click here for additional data file.S2 TableNote 1: P.R., Regression Weights; P.E.R., Standardized Regression Weights; S.E., Estimation of error; C.R., Critical Ratio. Note 2: LCC, locus of control and commitment; DCOA, defiance of conduct oriented to the action; ARM, self-efficacy and resistance to malaise; OASE, optimism and adaptation to stressful situations; and ES, spirituality. Note 3: *** p < 0.001.(DOCX)Click here for additional data file.


Sense of agency refers to the feeling of control over one’s own actions. The strength of this sense varies inter-individually. This means that people differ in their perception concerning the intensity of their intentions and actions. The current study aims to determine the factors influencing this sense of agency on a personality level. Furthermore, it gives insight into the correlative relation between the strength of the sense of agency and substance use. The study involved 210 participants who were tested for the experiment . Significant determinants in personality were narcissism (vulnerable subtype) and substance use . Both personality types were associated with a weaker sense of agency compared to controls. For both results, alterations in the dopaminergic system need to be discussed. The present results confirm prior hypotheses that dopamine seems to play a crucial role in perception of agency. Possibly a higher accessibility of dopamine increases sense of agency (hyper-binding), whereas a lower accessibility of dopamine decreases sense of agency (hypo-binding). A second aim of the study was to see whether there is a connection between sense of agency and intentionality bias. The perception of intention in others differs widely; some people tend to see arbitrary or accidental actions as unintentional, and others quickly label actions as ‘intentional’ although the information is not distinct for a categorization. This cognitive error is called intentionality bias. Results could not confirm a relationship between the two constructs—one’s own intention and judging intention in others. This may be due to a lack of connection between the two constructs or to methodological aspects. Further directions and limitations are discussed. Sense of agency, examined in this study, is defined by naming the cause of action . It can To identify determinants of sense of agency, we chose to examine the relation to certain personality factors and particularly substance use.As to the relation of personality and sense of agency, the concepts of free will and narcissism have been investigated in previous studies. Free will and sense of agency both deliver information for the perception of action and events. They are similar constructs from different perspectives: free will as an explicit measure—the judgement of agency—and sense of agency as an implicit measure—the feeling of agency . NarcissOne study revealed that free-will beliefs are associated with conscious and unconscious processing of information involved in purposive behaviour and agency . People Regarding narcissism, a first study examining differences in personality and intentional binding was published in 2015 . People The manner of relationship between the dopaminergic system and intentional control has not yet been understood. Dopamine is involved in responses to attention-inducing stimuli and reward-related stimuli . It is pSeveral studies have found hints for an involvement of the dopaminergic system in sense of agency. For example, one study used ketamine as a model for psychosis . The aimFurthermore, psychosis-like experiences were seen to be correlated with an increased intentional binding; age was negatively related to intentional binding. Both results can be caused by alterations in the dopaminergic system . There aAnother relevant study in view of the dopaminergic system includes Parkinsonism and sense of agency . DopaminThe studies on L-Dopa medication in Parkinson’s and on ketamine indicate the relevance of the dopaminergic system to sense of agency. Dopamine increases the spectrum for the binding strength of two events. It is possible that the probability to include external stimuli is increased by a high dopamine concentration and decreased by low dopamine activity . This raAlready 20 years ago researchers suspected that chronic use of drugs could induce changes in the neurotransmitter systems, particularly the dopamine system . Hence, The substances in focus are cannabis, MDMA (e.g. ecstasy), cocaine, amphetamine (e.g. speed), and psychedelics . Therefore, we concentrate rather on long-term effects of substance use because none of the subjects will be tested for acute intoxication of drugs.Use of cannabis, contrary to use of other substances, is not associated with striatal dopamine alterations. However, observable alterations (lower dopamine release in the associative striatum) have been found in users who started early or reported a long duration of usage. Consequently, it is difficult to distinguish the effects of chronicity versus onset . EcstasyIt is likely that people consuming drugs have developed different mechanisms in the dopaminergic system, resulting in a weaker sense of agency  or a stronger sense of agency .In addition to the determinants of sense of agency in personality and substance use, we aim to investigate how the sense of agency relates to perception of intention in others. Until now, no research has combined perception of one’s own intention and evaluating the intention of others. Do we expect others to have the same level of control as we feel to have ourselves? Alternatively, do we measure their actions and intentions with different standards from our own actions?Concerning accidental or arbitrary actions of others, some people show a bias towards interpreting actions as intentional. If an action was performed unintentionally, but the information about the intention of action is missing, we still tend to label it as intentional. This construct is called intentionality bias .Rosset and Rottmann  developeUntil now, nothing has been known about the relationship of the two constructs. Is there a connection between the degree of feeling in control of one’s own actions (sense of agency) and the interpretation of intention (attribution of control) in other people’s actions ? And if so, do people with a higher sense of agency (higher feeling of control for their actions) suspect more actions as intentional by others as well?The first goal of this study is to find determinants for sense of agency in personality and substance use.In terms of personality factors, evidence exists for a stronger sense of agency in narcissists . We exteRecent experiences have manifested that dopaminergic drugs boost sense of agency under intoxication ,25. SubsThe second goal of the current study is to determine whether the perception of intention of one’s own action (sense of agency) and the evaluation of intention in the actions of others  are connected. Consequently, the third  research question is whether sense of agency and intentionality bias correlate with each other. If the two constructs are linked, it would be interesting to learn the following: Is the connection positive, meaning that the more we perceive our own action as voluntary, the more we presume intention in others? Or is the link negative, meaning that the more we act voluntarily, the less we expect others to act voluntarily?M = -157.40 (SD = 51.08) and low narcissism scores M = -100.20 (SD = 45.94) . PoM = 45 (SD = 69), ketamine administration M = 72 (SD = 70) [t-tests with α = .05, β = .95, and Cohen’s d = .388 calculated a necessary sample size of N = 145. Although the power analysis for narcissism calculated that only a small sample size is required, more participants were recruited with regard to effects for the different substances.An experiment using ketamine as a model for psychosis reported overall binding values of placebo SD = 70) . Power aM = 23.33, SD = 3.52, and sex; 84 (40.0%) participants were male, 126 (60.0%) female. IQ measured by the Trail Making Test was M = 118.35, SD = 15.97, ranging from 88 to 145, to ensure that both groups (drug users and controls) were demographically similar. Ten participants were not students; the other participants were students who studied psychology (30), sport sciences (99), arts and humanities (36), criminology (4), law (5), natural science (8), and other disciplines (18).We tested 210 participants for the experiment. Participants were informed about the purpose of the study and gave their written consent prior to participation. The experiment was conducted according to the ethical guidelines of the Helsinki Declaration. Data were analysed anonymously. Participants gave information about their age, ranging from 17 to 34 years, We did not seek approval from a research ethics board because it was not required for this study in accordance with conditions outlined in guidelines from the German Research Society : Research bearing no additional risk beyond daily activities does not require such approval. We communicated all considerations necessary to assess the ethical legitimacy of the study. We thus ensure that our research approach is in line with national and international human research ethics policies.To assess intentional binding (sense of agency), the method of Haggard et al.  was applBaseline action: The participants watched the analogue clock and pressed the key (space) whenever they wanted to in the second lap. Afterwards they reported the time of pressing the key .Baseline outcome: The participants watched the analogue clock and heard a tone at a random time. Afterwards they reported the time of hearing the tone .Agency action: The participants watched the analogue clock and pressed the key (space) whenever they wanted to in the second lap. A tone followed with a delay of 250ms. Afterwards the participants reported the time of pressing the key .Agency outcome: This condition was identical to agency action, but this time the participants reported the time of hearing the tone .In the three conditions when the participants had to press a key , they were asked to let the clock rotate once before pressing the key and not to press the key at a certain time . In addition, the instruction indicated that they should be as precise as possible . Each block contained 18 trials, according to Moore et al. .To guarantee that language  did not influence the task, a non-verbal task, developed by Moore and Pope , was useThe Trail Making Test  measureDemographics. Participants reported sex, age, studies, and profession.Narcissism Inventory. Narcissism is measured by the Short Version of the Narcissism Inventory (NI-20) of Daig et al. [N = 2262 and N = 2265 [g et al. . The basg et al. . The shoN = 2265 . ThreateFAD-Plus. The FAD-Plus covers four scales: free will, scientific determinism, fatalistic determinism, and unpredictability, with 27 items in total. It was normed by N = 257, N = 177, and N = 188 participants. Concerning quality criteria, the authors mention reliability . The four factorial structure was conformed in a confirmatory analysis [analysis .Substances. The items to gather information about the substance use of the participants were self-generated from the AUDIT [he AUDIT  questionThe study took part at the University of Regensburg, and the duration was roughly 50 minutes. Sessions started with the ZVT , followeTo calculate intentional binding in each trial, perceived time was subtracted from actual time to determine the perception error. First, action binding and outcome binding were calculated individually. Action binding is composed of baseline action minus agency action, and outcome binding of baseline outcome minus agency outcome (to generate the difference from baseline to the operant conditions). Outcome binding was then subtracted from action binding to calculate overall binding ,37. MediThe Pearson correlation coefficient was calculated to examine relationships between the two constructs , the link between sense of agency and personality factors, symptoms of disorder, and substance use. One-tailed t-tests were conducted for the highest versus lowest percentiles in narcissism types and different groups of substance users versus the control group.3. This means that the alpha error was 8.73% instead of 5%; therefore, the level of significance needed to be adjusted. The significance level was corrected according to Bonferroni, and the p-value was set to p = .017 to reach significance.The alpha error accumulation for the three questionnaires was calculated by using the formula 1 –(1–0.03)To understand the nomological network of the sense of agency and the examined variables, M = 84.70 (SD = 136.41). Negative values signify that the event is perceived later than it really was, and positive values indicate that the event is perceived earlier than it really occurred. The mean shift in the baseline action was M = -50.79 (SD = 95.62), mean shift in the agency action condition was M = -90.91 (SD = 117.55), mean shift in the baseline outcome condition was M = -59.40 (SD = 55.33), and mean shift in agency outcome was M = -14.18 (SD = 130.24). Action binding (baseline action minus agency action) was M = 41.52 (SD 77.77), and outcome binding (baseline outcome minus agency outcome) was M = -45.17 (SD = 122.01). No difference  could be observed for sex  = -.258 p = 797), age , or IQ. Due to technical errors, data were missing from eight participants in intentional binding .The mean intentional binding was r = -.078 p = .269) was found. Splitting the sample into the first and fourth percentiles of the subscales threatened self (vulnerable type) and classic narcissistic self (grandiose type), the following results were produced. The vulnerable type had a weaker shift in perception of the key press if the tone followed , and consequently a weaker sense of agency , than people with low scores of vulnerability (see t(2470) = -7.529 p < .001) from the means of threatened self in this study  compared to the means in the norms , and threatened self was significantly smaller in the current study in comparison to mean norms .Contrary to results previously reported in the literature, no correlation to general narcissism  = -1.737 p = .083).The grandiose type discriminated neither in binding nor in the sub-conditions, as presented in r = .09 p = .21).All explicit measures of beliefs measured by the FAD-Plus, in particular the subscale free will and sense of agency, as an implicit measure, were independent  = -5.931 p < .001), and IQ was lower in the group of drug users  = 2.712 p = .007). There were different gender ratios, the control group had more female members , the experimental group more male members . The differences in demographics are not expected to explain alterations in sense of agency .In regard to substance use (ever), there were several differences in binding see . Indepenr = -.101 p = .154).The analysis rejects any association between sense of agency and intentionality bias. Apparently there is no connection between how people perceive the control of their own actions and how they regard the control and intention in the actions of others . Both groups showed a decrease in intentional binding; they seemed to have a weaker link between action and consequence. A relation between the explicit (FAD-Plus) and implicit measure  of free will could not be found, nor was there a connection between intentionality bias and sense of agency .Previously, in narcissists, a stronger sense of agency has been found . In thisA recently published study differentiated also between the two subtypes of narcissism, grandiose type and vulnerable type. These subtypes are theoretically  based on the behavioural approach  and behavioural avoidance  systems of personality (Gray) . The stuBeing experienced with multiple drug use (consumption besides cannabis) in general, and particularly with the consumption of cannabis, ecstasy, or cocaine was significantly related to a weaker sense of agency in our experimental subjects. In the baseline conditions, the values of perception were similar, negating a prolonged perception in general for drug users. However, changes occur if actions and consequences are presented in the same trial. Usually people tend to compress the time between action and event. In drug users, in our study, the tone was perceived later, which extended the interval between action and consequence.The number of participants in this study limits the generalization of results to specific substances. In addition, the majority of the examined participants reported poly-drug use and variations in amount, frequency, and years of use, which limited the examination for single substances. At the same time, the study included participants who reported only a single drug consumption. The sample was heterogeneous; therefore, use of drugs seemed to produce a robust effect in the binding mechanism. Effects of single substances remain too difficult to interpret. However, their connecting feature is the possible alteration of the dopaminergic system.In the current data, no correlation could be found between the constructs sense of agency and intentionality bias. The experimental paradigm was conducted very simply to control potential influencing factors. Engbert et al.  conducte“Too often, we judge other groups by their worst examples—while judging ourselves by our best intentions” . We judge ourselves by our intentions; we judge others by their actions. This citation emphasizes that judging our own intentions may differ widely, but systematically, from understanding intention and actions in others. In contrast to the highly controlled laboratory experiment, in the outside world various potential aspects influence the judgement, for example situational factors, personality and mood factors, or the relationship of agents. Again, operationalization might be a highly contributing factor for the present results.In this study we investigated alterations in sense of agency in students, with an emphasis on illegal drug users. A sample of patients suffering from addictions, in a quasi-experimental design, could have delivered more distinct results. Alternatively, it would be interesting to examine people who consumed only a single substance, although recruiting such a homogenous sample might be an obstacle. Nevertheless, the results indicate an involvement of dopamine for sense of agency, even on a level that does not rise to a clinical one. Possibly the determination of the dopamine level could reveal whether higher accessibility of dopamine leads to hyper-binding and lower accessibility to hypo-binding. However, dopamine levels vary significantly, even intra-individually, so that many confounding factors would need to be controlled. Another possibility could be to determine gene types and genetic polymorphism involved in the dopaminergic metabolism (e.g. a transporter gene). For example, there are two variants of the COMT enzyme , that increase or decrease the dopamine level . It coulIn regard to narcissism, it would be interesting to take a closer look at the underlying motivational systems BIS and BAS. A clinical sample could produce stronger effects. In this study, the participants did not report high narcissistic traits. Subsequent studies could focus on a comparison between healthy individuals and the two subtypes of narcissism. Additionally, other mental diseases like attention deficit hyperactivity disorder  or eatinSelf-report questionnaires bear the risk of misreport and social desirability, especially in narcissism questionnaires. A second measure, more independent and objective than self-reports, could offer more elucidation. Sense of agency was measured with a validated paradigm . Since tS1 TableSignificance:p ≤ .017.(PDF)Click here for additional data file.S2 TableSignificance: p ≤ .017, Users only = consumption beyond cannabis N = 78.(PDF)Click here for additional data file.S3 Tablet-tests for intentional binding conditions, first  versus fourth  percentiles in the narcissism subscale threatened self. Significancep ≤ .017.One-tailed (PDF)Click here for additional data file.S4 Tablet-tests for intentional binding conditions, first  versus fourth  percentiles in the narcissism subscale scores for classic narcissistic self. Significancep ≤ .017.One-tailed (PDF)Click here for additional data file.S5 TableAbsolute number of users.(PDF)Click here for additional data file.S6 Tablet-tests for sense of agency in users versus controls for each substance. Significancep ≤ .017. Drug users = consumption beyond cannabis.One-tailed (PDF)Click here for additional data file.S1 Data file(SAV)Click here for additional data file.


Mycoplasma gallisepticum (MG), M. synoviae (MS), and IBV in several poultry farms in Myanmar.In Southeast Asian countries, including Myanmar, poultry farming is a major industry. In order to manage and maintain stable productivity, it is important to establish policies for biosecurity. Infectious respiratory diseases are a major threat to poultry farming. Avian influenza and Newcastle disease have been reported in Myanmar, but no scientific information is available for other respiratory pathogens, such as mycoplasmas and infectious bronchitis virus (IBV). Identifying the genotypes and serotypes of IBVs is especially important to inform vaccination programs. In this study, we detected Samples were collected from 20 farms in three major poultry farming areas in Myanmar, and MG, MS, and IBV were detected on two, four, and eight farms, respectively, by polymerase chain reaction. Phylogenetic analysis revealed that the observed MG and MS isolates were not identical to vaccine strains. Three different genotypes of IBV were detected, but none was an unknown variant.Mycoplasmas and IBV were detected on poultry farms in Myanmar. Periodic surveillance is required to establish the distribution of each pathogen, and to institute better vaccine protocols. Myanmar lies in the western region of mainland Southeast Asia. Agriculture is the backbone of the Myanmar economy, and poultry farming is one of the country’s major industries. In association with the recent economic development of Myanmar, the total number of raised chickens has increased over the last decade . In ordeMycoplasma gallisepticum (MG) and M. synoviae (MS) are the most impactful to the poultry industry. MG infections usually cause chronic respiratory disorders and are characterized by sneezing, coughing, and snicks as well as nasal and ocular discharges [Avian mycoplasmosis is caused by several pathogenic mycoplasmas. Among them, scharges , 6. MS ischarges . The co-scharges . Both MGscharges .Infectious bronchitis (IB) is a severe acute disease of poultry caused by IBV, which primarily infects the respiratory tracts, with respiratory disease being the most frequent sign. In addition, IBV can infect the kidneys and reproductive tracts and consequently cause kidney damage and decrease in egg production . GeneralIn this study, we performed molecular detection of MG, MS, and IBV in chickens from poultry farms at the outskirts of three large cities in Myanmar: Mandalay and Pyin Oo Lwin in February 2018 and Yangon in May 2018. In addition, by analyzing genetic characteristics, we detected at least three genotypes of IBV existing in Myanmar. To our knowledge, this is the first report using molecular analysis to detect MG, MS, and IBV in Myanmar.MG, MS and IBV were detected on two, four, and eight farms, respectively Table . Both MGThe phylogenetic tree for MG revealed that the two MG isolates detected in farm Ma-4 and Ya-1 were genetically identical; however, they were classified in a different cluster than those of vaccine strains Fig. . No unknRespiratory diseases cause significant economic losses in the poultry industry worldwide. Poultry farming is an important industry in Southeast Asian countries, including Myanmar. Nevertheless, surveillance of the distribution of such pathogens causing respiratory diseases is lacking in Myanmar. According to the observations by local veterinarians, respiratory signs that are indicative of IB or mycoplasmosis have been observed in poultry farms in Myanmar. We detected MG, MS, and IBV in poultry farms in Myanmar.vlhA genes of all the MS strains were closely related to those strains isolated in East Asian countries, such as South Korea and Japan, indicating that endemic strains from Asian countries may be prevalent in the poultry farms in Myanmar. Appropriate vaccination programs are necessary to prevent diseases caused by mycoplasmas, because both MG and MS can spread easily through vertical and horizontal transmission [In this study, MG was sporadically detected regardless of the area and season, whereas MS was detected only in the Yangon area in May. In addition, each bacteria strain detected in this study was genetically different from vaccine strains. Furthermore, the smission , 12.We found that IBV was widely distributed in the two districts around the center of Myanmar  in this study. In contrast, IBV was not detected at farms in the Yangon, the southern area of the country. Samples were collected in Yangon in May, which is the wet season in Myanmar, whereas sampling in Mandalay and Pyin Oo Lwin was conducted in February (the dry season). The climates in Myanmar are largely different in each season and in each area. Therefore, surveillance should be periodically performed throughout the country over the course of the year, especially considering the seasons.S1 gene of the IBVs detected at the Ma-1, Ma-3, Ma-5, and Py-1 farms were closely related to that of the C-78 IBV vaccine strain and that the IBV detected at farm Ma-2 was close to strain GN . Th-1 types ), and th-1 types ). All th-1 types , 14, andThis is the first report showing the presence of MG, MS and IBV in poultry farms in Myanmar. Several genotypes of IBV were detected in Myanmar, and some of them appear to be genetically different from the vaccine strains currently used in Myanmar. To improve vaccination programs and reduce the economic losses caused by these devastating pathogens, periodic surveillance including appropriate sample sizes should be performed. In addition, some agents threatening the poultry industry include enteropathogens, oncogenic viruses, and other respiratory pathogens. Further study is necessary to assess the prevalence of infectious agents and develop control strategies..Chicken oropharyngeal swabs were collected from five farms in Mandalay and five farms in Pyin Oo Lwin in February 2018, and 10 farms in Yangon in May 2018. Swab samples were collected from six, nine or twelve chickens in each farm  according to the manufacturer’s instructions, and the samples were stored at − 20 °C until use. For RNA extraction, a FastGene RNA Premium/Basic Kit  was used according to the manufacturer’s instructions. cDNA was synthesized using PrimeScript™ Reverse Transcriptase  as directed by the manufacturer.pMGA1.2 (hemagglutinin protein) gene, the MS2/12 DNA fragment of vlhA (variable lipoprotein hemagglutinin A gene), and the S1 (the spike glycoprotein) gene, respectively. The primer sequences used in each amplification and the PCR conditions are summarized in Table The DNA and cDNA samples were used as templates for PCR analysis. MG, MS, and IBV were detected by amplifying the gapA gene and the DNA fragment of vlhA gene were amplified using a PCR assay and sequenced. For sequencing, the amplicons were purified using a FastGene gel/PCR extraction kit (NIPPON Genetics Co. Ltd.), and the nucleotide sequences were determined using the GenomeLab™ GeXP Genetic Analysis System . The resulting sequences of the gapA, vlhA, and S1 genes were aligned using MEGA6 software [To analyze the genetic characteristics of MG and MS, the software , and thesoftware .


Daphnia pulex and included manipulations of food level and assessment of three genotypes. We investigated the interaction between essential (Cu) and non-essential (Cd) metals on ingestion rate, reproduction, maturation time, size at maturity and somatic growth rate of three D. pulex genotypes, over 21 days and under standard and high food conditions. We explored the potential interaction of the metals on ingestion and life history by implementing a response surface experimental design combining control and two levels of Cu and Cd and their combinations. Overall, both metals reduced ingestion rates, reduced reproduction, delayed maturation, reduced body size at maturity and lowered somatic growth rate. Our results further indicated pervasive interactions between the metals; numerous instances where the effects of each metal were non-linear; the effect of a metal varied by D. pulex food levels (ingestion rate and size at maturity), and the effect of a metal varied by genotypes (reproduction). Apart from the maturation time and somatic growth rate, our results suggest that life history traits are affected in non-additive ways by three factors that are often discussed and rarely estimated together: mixtures of metals, genotypes and resource levels. Our data that are derived from exposing daphnids to two metals highlight how metals interact with each other and the context of food resource and genetic variation. While interactions make it harder to generate predictions, and ultimately water quality regulations about the effects of metals, those detected in this study appear to be tractable.A key challenge of standard ecotoxicological risk assessment is to predict the sub-lethal risk of multiple contaminants on aquatic organisms. Our study assessed the sub-lethal mixture toxicity of copper (Cu) and cadmium (Cd) on  Metal toxicity is a worldwide concern arising from natural and anthropogenic discharges such as domestic effluents, agricultural and industrial activities  in metalloenzymes  between metals might arise, we still lack robust data on the outcomes of these cellular level effects, including how Cu and Cd combine to affect foraging and life history. Here, we focus on identifying whether the effects of Cu and Cd are additive or interactive on foraging and life history traits using three genotypes of Daphnia spp. are a model system for detecting the effects of metal pollution in aquatic environments. They have a significant role in the aquatic food chain linking between algae, higher invertebrates and fish. Given their susceptibility to various contaminants, short generation times, easy culturing and high fecundity rates, they are widely used in experiments .Our work here builds on a rich body of literature reporting on the toxicity of each of Cu or Cd . To assess this, we employ a response surface experiment and analysis, manipulating exposure to single and combined concentrations of each metal. We tested whether mixture concentrations of Cu and Cd affect ingestion rate, size at maturity, age at maturity, somatic growth rates and reproduction in an additive versus synergistic manner as revealed by patterns in a response surface, where the life history traits are measured along single and combined concentration gradients of Cu and Cd.A long history of statistical inference from response surface theory forms the basis by which we draw conclusions: additive effects are revealed by planar surfaces, while numerous forms of interactions are revealed by non-linearities in the surfaces. Our use of the response surface approach follows concepts in pharmacology called ‘isoboles’ . The algae cultures were grown in Ebert medium  were dissolved in distilled water and these stocks were used to prepare solutions for the experimental treatments. For chronic toxicity exposures (single and mixture), each treatment concentration  was prepared daily in 1-L volume ASTM hard water and subsequently delivered into experimental jars. Nominal Cu concentrations were 0, 5 and 10 μg/L and nominal Cd concentrations were 0, 0.5 and 1 μg/l. These sub-lethal concentrations were chosen based on an extensive literature review , and nine metal treatments defined by the three concentrations each of Cu and Cd and their combinations. This standard food level has been used for more than a decade with these genotypes . Animals were fed and media were replaced daily.n = 3 per metal concentration; assay 12 hours after media preparation; Cu: R2 = 0.99, F = 1913, p < 0.002; Cd: R2 = 0.98, F = 996, p < 0.002).Actual metal concentrations, estimated from solutions containing algae food resources, were calculated using a separate set of replicate jars using ICP-MS . We estimated realised concentration in media preparations that were prepared exactly as our daily preparations for experiment (see above). Realised concentrations did not deviate from nominal concentrations  with a Cannon EOS 350D DSLR camera. Size at maturity was measured from the top of the head to the base of the carapace spine using ImageJ   − initial measurement (0 time)) using spectrophotometry at wavelength 440 nm.  effects on the life history endpoints (Khuri and Cornell 2 + Cd + Cd2 + Cu * Cd) +Trait ~ (Cu + CuFood Level + Genotype +(Cu * Food level) + (Cd * Food level) +(Cu * Genotype) + (Cd * Genotype) +(Food Level * Genotype)The terms in the first line define the classic response surface model that allows for planar or non-linear shapes to be detected over the nine treatment combinations for each metal. The second line identifies the additional main effects of food level and genotype and the third–fifth line, the interactions between these terms and between them and the metals. This model allows us to answer the questions a) does the effect of Cu on trait vary by Cd?, b) is the effect of Cu or Cd non-linear?, c) does the effect of Cu or Cd vary by food level?, d) does the effect of Cu or Cd vary by genotype? and e) does the effect of food level vary by genotype?car package for R for significance testing.All data were analysed using the statistical software programme R . Furthermore, the effect of Cd, but not Cu, was non-linear, as indicated by the significant Cd2 term . This led to the lowest levels of ingestion occuring at the highest levels of Cu but not Cd.Overall, ingesting rate decreased with increasing Cu and Cd Fig. . The effp = 0.025, F-Cd:food level = 11.9, df = 1, p < 0.01). Ingestion declined more with increasing Cu and Cd at high food. In fact, ingestion under metal stress at high foods is reduced to control ingestion rates under low food.The effect of Cu and Cd also varied by food levels . However, the genotypes differ in their average rate of ingestion .In contrast to the above interactions, the effect of Cu and Cd on ingestion did not vary by genotype . Further, the effects of Cu and Cd were non-linear, defined by significant squared terms for each . Thus, the lowest levels of reproduction occur at the highest levels of Cd, but not Cu.Reproduction declined with increasing Cu and Cd. The effects of Cu and Cd on reproduction are defined by several interactions Fig. . The effp = 0.004; F-Cd:genotype = 4.6, p = 0.01). However, The effect of each metal on reproduction did not vary by food levels .The effect of Cu and Cd on reproduction varied by genotype . We detected only linear effects of Cu and Cd . Figure Cu and Cd delayed maturation. The effects of Cu and Cd on maturation time are defined by several interactions Fig. . The effp = 0.27, F-Cd:food level = 0.21, df = 1 , p < 0.64) or by genotypes . Maturation was earlier on high food . Genotypes did not differ in their maturation time with food levels .Cu and Cd effects did not vary by food levels . We detected only linear effects of Cu and Cd . The effect of Cu and Cd on size at maturity varied by food level . The effect on size at maturity of each metal did not vary by genotype . Average size at maturity did not vary by genotype .Size at maturity declined with increasing Cu and Cd concentrations. The effects of Cu and Cd on size at maturity are defined by several interactions Fig. . The effF = 214.85, df = 1, p < 0.01). We detected a non-linear effect of Cd concentration, but not Cu . The effect of Cu and Cd did not vary by food levels . Furthermore, the effect of Cu and Cd on somatic growth rate did not vary by genotype . Genotypes did not differ in their average growth rate .Growth rates were significantly lower with increasing Cu and Cd. The effects of Cu and Cd on somatic growth rate were defined by several interactions Fig. . The effEvaluation of the effect of metal mixtures at sub-lethal levels on life history traits of organisms in aquatic communities is of particular importance to the assessment of ecosystem services , to chemical risk assessment and subsequently, to water quality criteria. In the last few decades, metal pollution has drawn much attention due to their persistence and deleterious effects on aquatic food chains. Though there has been considerable exploration into the toxicity of Cu and Cd on aquatic organisms, particularly Cladocera, the majority of work has focused on single stressors and single genotypes under standardised conditions that are beneficial to a testing environment but not always reflective of natural communities , our data indicate Figs. , 4 and 5While, our findings showed a variation in the interaction between metals and food levels and metals and genotypes across traits, our data highlight the importance of context in assessment of life history endpoints in response to different stressors. With respect to Cu, which is known to interfere with digestion, we expected and found that the effect of Cu on ingestion rates varied by food. We also found this pattern of effect for Cd. Metals disrupt digestive physiology, which is linked to energy intake and hence resources acquired for growth and reproductive activities , zinc (Zn), Cu and Cd produced a more than additive effect on food consumption rate of Daphnia magna at low concentration of metals  is proven challenging. A recent meta-analysis evaluating Cu, Cd and Zn toxicity showed variable interactions for many endpoints measured under the same experimental conditions. The effects were strongly associated with the identity of the endpoint on which the metal combinations were tested . In contrast, Barata, et al. . This study supports the increasingly called for assessment of multiple performance measures (feeding and life history) under multiple stressors  and among naturally occurring genotypes from the wild.Our data indicate that the effect of Cu on ingestion rate and life history of