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Background: Fetal alcohol spectrum disorder (FASD) describes a combination of developmental, cognitive, and behavioral disabilities in children with prenatal exposure to alcohol. The literature suggests that there are higher rates of sleep disturbances in these children. Few studies have investigated sleep disturbances in relation to common comorbidities of FASD. We examined the prevalence of disturbed sleep and the relationship between parent‐reported sleep problems in different FASD subgroups and comorbidities like epilepsy or attention‐deficit hyperactivity disorder (ADHD) and impact on clinical functioning. Methods: In this prospective cross‐sectional survey, caregivers of 53 children with FASD completed the Sleep Disturbance Scale for Children (SDSC). Information about comorbidities was collected, and EEG and assessment of IQ, daily‐life executive and adaptive functioning were performed. Group comparisons and ANCOVA interaction models were used to test the associations between different sleep disturbances and clinical factors that could interfere with sleep. Results: An abnormal sleep score on the SDSC was very common, affecting 79% of children (n = 42) with equal prevalence in all FASD subgroups. Difficulty falling asleep was the most common sleep problem, followed by difficulty staying asleep and waking early. The incidence of epilepsy was 9.4%, with an abnormal EEG seen in 24.5%, and a diagnosis of ADHD in 47.2% of children. The distribution of these conditions was equal in all FASD subgroups. Children with signs of sleep disturbance had poorer working memory, executive function, and adaptive functioning. Children with ADHD had a greater prevalence of sleep disturbance than those without ADHD (OR 1.36; 95% CI 1.03 to 1.79). Conclusion: Problems with sleep are very common in FASD children and seem independent of FASD subgroup and the presence of epilepsy or a pathological EEG finding, while those with ADHD had more sleep problems. The study underscores the importance of screening for sleep disturbances in all children with FASD as these problems may be treatable. [ABSTRACT FROM AUTHOR]

Background: Children born preterm with very low birthweight (VLBW) face long-lasting neurodevelopmental challenges, where multidisciplinary assessments are warranted. The International Classification of Functioning, Disability and Health (ICF) provides a framework for understanding and conceptualising these outcomes.Objectives: We aimed to review clinical and neuroimaging findings from birth to adulthood in a Norwegian cohort of individuals born preterm with VLBW (gestational age <37 weeks, birthweight ≤1500 g) within the framework of ICF.Data Sources: We searched PubMed and Embase for articles reporting results of the Norwegian University of Science and Technology (NTNU) Low Birth Weight in a Lifetime Perspective study.Study Selection and Data Extraction: We included original articles reporting proportions of adverse outcomes, mean group differences, risk factors or associations between outcomes. Data were extracted according to ICF's two-level classification. Body functions and structures comprised outcomes of brain structures, cognition, mental health, vision, pain and physical health. Activities and participation comprised motor skills, general and social functioning, education, employment, and health-related quality of life.Synthesis: We performed a qualitative synthesis of included articles. Where mean (SD) was reported, we calculated group differences in SD units.Results: Fifty-eight publications were included. Within body functions and structures, increased prevalence of brain structure pathology, lower cognitive performance, mental health problems, visual and physical health impairments through childhood, adolescence and young adulthood were reported among preterm VLBW participants compared with controls. Within activities and participation, motor problems, lower general and social functioning, and lower academic attainment were found. Perinatal factors were associated with several outcomes, and longitudinal findings suggested persistent consequences of being born preterm with VLBW.Conclusions: Being born preterm with VLBW has long-term influences on body functions and structures, activities and participation. The ICF is appropriate for assessing general domains of functioning and guiding the management of individuals born preterm with VLBW. [ABSTRACT FROM AUTHOR]

Background: Adaptive computerized working memory (WM) training has shown favorable effects on cerebral cortical thickness as compared to non-adaptive training in healthy individuals. However, knowledge of WM training-related morphological changes in mild cognitive impairment (MCI) is limited. Objective: The primary objective of this double-blind randomized study was to investigate differences in longitudinal cortical thickness trajectories after adaptive and non-adaptive WM training in patients with MCI. We also investigated the genotype effects on cortical thickness trajectories after WM training combining these two training groups using longitudinal structural magnetic resonance imaging (MRI) analysis in Freesurfer. Method: Magnetic resonance imaging acquisition at 1.5 T were performed at baseline, and after four- and 16-weeks post training. A total of 81 individuals with MCI accepted invitations to undergo 25 training sessions over 5 weeks. Longitudinal Linear Mixed effect models investigated the effect of adaptive vs. non-adaptive WM training. The LME model was fitted for each location (vertex). On all statistical analyzes, a threshold was applied to yield an expected false discovery rate (FDR) of 5%. A secondary LME model investigated the effects of LMX 1A and APOE- ε4 on cortical thickness trajectories after WM training. Results: A total of 62 participants/patients completed the 25 training sessions. Structural MRI showed no group difference between the two training regimes in our MCI patients, contrary to previous reports in cognitively healthy adults. No significant structural cortical changes were found after training, regardless of training type, across all participants. However, LMX 1A-AA carriers displayed increased cortical thickness trajectories or lack of decrease in two regions post-training compared to those with LMX 1A-GG/GA. No training or training type effects were found in relation to the APOE -ε4 gene variants. Conclusion: The MCI patients in our study, did not have improved cortical thickness after WM training with either adaptive or non-adaptive training. These results were derived from a heterogeneous population of MCI participants. The lack of changes in the cortical thickness trajectory after WM training may also suggest the lack of atrophy during this follow-up period. Our promising results of increased cortical thickness trajectory, suggesting greater neuroplasticity, in those with LMX 1A-AA genotype need to be validated in future trials. [ABSTRACT FROM AUTHOR]

Objective: To assess and evaluate the change in functional skills among children with cerebral palsy (CP) who participated in an intensified habilitation program. Methods: In this prospective longitudinal study, a cohort of 39 preschool children (2–5 years) with cerebral palsy (Gross Motor Function Classification System levels I–V) together with their parents participated in an intensified multidimensional habilitation program for 1 year. Activities strengthening functional skills were among the main interventions. The children were evaluated with the Pediatric Evaluation of Disability Inventory before and after the program period. Results: Only children at GMFCS levels I–II showed improvements in mobility and social function on norm-referenced scales. After the intervention period, these children scored similar to the mean for typically developing children of the same age on the social function domain. Conclusions: Functional skills among preschool children with CP, GMFCS levels I–II, seems strengthened after participation in an intensified habilitation program. [ABSTRACT FROM AUTHOR]

Intellectual abilities are supported by a large-scale fronto-parietal brain network distributed across both cerebral hemispheres. This bihemispheric network suggests a functional relevance of inter-hemispheric coordination, a notion which is supported by a series of recent structural magnetic resonance imaging (MRI) studies demonstrating correlations between intelligence scores (IQ) and corpus-callosum anatomy. However, these studies also reveal an age-related dissociation: mostly positive associations are reported in adult samples, while negative associations are found in developing samples. In the present study, we re-examine the association between corpus callosum and intelligence measures in a large (734 datasets from 495 participants) developmental mixed cross-sectional and longitudinal sample (6.4-21.9 years) using raw test scores rather than deviation IQ measures to account for the ongoing cognitive development in this age period. Analyzing mid-sagittal measures of regional callosal thickness, a positive association in the splenium of the corpus callosum was found for both verbal and performance raw test scores. This association was not present when the participants' age was considered in the analysis. Thus, we did not reveal any association that cannot be explained by a temporal co-occurrence of overall developmental trends in intellectual abilities and corpus callosum maturation in the present developing sample. [ABSTRACT FROM AUTHOR]

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Background: Being born preterm with very low birthweight (VLBW ≤ 1500 g) poses a risk for cortical and subcortical gray matter (GM) abnormalities, as well as for having more psychiatric problems during childhood and adolescence than term-born individuals. The aim of this study was to investigate the relationship between cortical and subcortical GM volumes and the course of psychiatric disorders during adolescence in VLBW individuals.Methods: We followed VLBW individuals and term-born controls (birth weight ≥10th percentile) from 15 (VLBW;controls n = 40;56) to 19 (n = 44;60) years of age. Of these, 30;37 individuals were examined longitudinally. Cortical and subcortical GM volumes were extracted from MRPRAGE images obtained with the same 1.5 T MRI scanner at both time points and analyzed at each time point with the longitudinal stream of the FreeSurfer software package 5.3.0. All participants underwent clinical interviews and were assessed for psychiatric symptoms and diagnosis (Schedule for Affective Disorders and Schizophrenia for School-age Children, Children's Global Assessment Scale, Attention-Deficit/Hyperactivity Disorder Rating Scale-IV). VLBW adolescents were divided into two groups according to diagnostic status from 15 to 19 years of age: persisting/developing psychiatric diagnosis or healthy/becoming healthy.Results: Reduction in subcortical GM volume at 15 and 19 years, not including the thalamus, was limited to VLBW adolescents with persisting/developing diagnosis during adolescence, whereas VLBW adolescents in the healthy/becoming healthy group had similar subcortical GM volumes to controls. Moreover, across the entire VLBW group, poorer psychosocial functioning was predicted by smaller subcortical GM volumes at both time points and with reduced GM volume in the thalamus and the parietal and occipital cortex at 15 years. Inattention problems were predicted by smaller GM volumes in the parietal and occipital cortex.Conclusions: GM volume reductions in the parietal and occipital cortex as well as smaller thalamic and subcortical GM volumes were associated with the higher rates of psychiatric symptoms found across the entire VLBW group. Significantly smaller subcortical GM volumes in VLBW individuals compared with term-born peers might pose a risk for developing and maintaining psychiatric diagnoses during adolescence. Future research should explore the possible role of reduced cortical and subcortical GM volumes in the pathogenesis of psychiatric illness in VLBW adolescents. [ABSTRACT FROM AUTHOR]

Importance: Methamphetamine is a common illicit drug used worldwide. Methamphetamine and/or tobacco use by pregnant women remains prevalent. However, little is known about the effect of comorbid methamphetamine and tobacco use on human fetal brain development.Objective: To investigate whether microstructural brain abnormalities reported in children with prenatal methamphetamine and/or tobacco exposure are present at birth before childhood environmental influences.Design, Setting, and Participants: A prospective, longitudinal study was conducted between September 17, 2008, and February 28, 2015, at an ambulatory academic medical center. A total of 752 infant-mother dyads were screened and 139 of 195 qualified neonates were evaluated (36 methamphetamine/tobacco exposed, 32 tobacco exposed, and 71 unexposed controls). They were recruited consecutively from the community.Exposures: Prenatal methamphetamine and/or tobacco exposure.Main Outcomes and Measures: Quantitative neurologic examination and diffusion tensor imaging performed 1 to 3 times through age 4 months; diffusivities and fractional anisotropy (FA) assessed in 7 white matter tracts and 4 subcortical brain regions using an automated atlas-based method.Results: Of the 139 infants evaluated, 72 were female (51.8%); the mean (SE) postmenstrual age at baseline was 41.5 (0.27) weeks. Methamphetamine/tobacco-exposed infants showed delayed developmental trajectories on active muscle tone (group × age, P < .001) and total neurologic scores (group × age, P = .01) that normalized by ages 3 to 4 months. Only methamphetamine/tobacco-exposed boys had lower FA (group × age, P = .02) and higher diffusivities in superior (SCR) and posterior corona radiatae (PCR) (group × age × sex, P = .002; group × age × sex, P = .01) at baseline that normalized by age 3 months. Only methamphetamine/tobacco- and tobacco-exposed girls showed persistently lower FA in anterior corona radiata (ACR) (group, P = .04; group × age × sex, P = .01). Tobacco-exposed infants showed persistently lower axial diffusion in the thalamus and internal capsule across groups (P = .02).Conclusions and Relevance: Prenatal methamphetamine/tobacco exposure may lead to delays in motor development, with less coherent fibers and less myelination in SCR and PCR only in male infants, but these abnormalities may normalize by ages 3 to 4 months after cessation of stimulant exposure. In contrast, persistently less coherent ACR fibers were observed in methamphetamine/tobacco- and tobacco-exposed girls, possibly from increased dendritic branching or spine density due to epigenetic influences. Persistently lower diffusivity in the thalamus and internal capsule of all tobacco-exposed infants suggests aberrant axonal development. Collectively, prenatal methamphetamine and/or tobacco exposure may lead to delayed motor development and white matter maturation in sex- and regional-specific manners. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between concentrations of endogenous erythropoietin (EPO) in blood the first 2 weeks of life and neonatal disorders in extremely low gestational age newborns (ELGANs).Design: Prospective cohort study.Setting: Neonatal care units at 14 participating hospitals in the USA.Patients: 867 children born before the 28th week of gestation from the ELGAN study cohort.Main Outcome Measures: EPO blood concentrations were measured on postnatal days 1, 7 and 14. The following neonatal characteristics and disorders were registered: blood gases, early and late respiratory dysfunction, pulmonary deterioration, retinopathy of prematurity (ROP), necrotising enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). We calculated the gestational age-adjusted ORs for having each disorder associated with an EPO blood concentration in the highest or lowest quartile, compared with infants whose EPO concentration was in the middle two quartiles on the corresponding day.Results: Newborns whose day-1 EPO was in the highest quartile were at increased risk for early and persistent respiratory dysfunction during the first 2 weeks of life, and NEC requiring surgery. The lowest EPO quartile on day 1 was associated with a decreased risk of moderate BPD. The association between low EPO and decreased risk of respiratory complications persisted on day 7. On day 14, being in the highest EPO quartile was associated with increased risk of ROP, and BPD not requiring ventilation assistance.Conclusions: EPO blood concentrations in extremely preterm newborns during the first 2 weeks of life convey information about increased risks of bowel, lung and retinal diseases. [ABSTRACT FROM AUTHOR]

Background: Being born with very low birth weight (VLBW: ≤ 1,500 g) is related to long-term disability and neurodevelopmental problems, possibly affecting mental health and health-related quality of life (HRQoL). However, studies in young adulthood yield mixed findings. The aim of this study was to examine mental health and HRQoL at 23 years, including changes from 20 to 23 years and associations with motor skills in VLBW young adults compared with controls.Methods: In a geographically based follow-up study, 35 VLBW and 37 term-born young adults were assessed at 23 years by using Achenbach Adult Self-Report (ASR), Short Form 36 Health Survey (SF-36), Beck Depression Inventory (BDI) and various motor tests. The ASR and SF-36 were also used at 20 years. Longitudinal changes in ASR and SF-36 from 20 to 23 years were analysed by linear mixed models and associations with motor skills at 23 years by linear regression.Results: At 23 years, total ASR score was 38.6 (SD: 21.7) in the VLBW group compared with 29.0 (SD: 18.6) in the control group (p = 0.048). VLBW participants had higher scores for attention problems, internalizing problems and critical items, and they reported to drink less alcohol than controls. BDI total score did not differ between groups. On SF-36, VLBW participants reported significantly poorer physical and social functioning, more role-limitations due to physical and emotional problems, more bodily pain and lower physical and mental component summaries than controls. In the VLBW group, total ASR score increased by 9.0 (95 % CI: 3.3 to 14.7) points from 20 to 23 years (p = 0.009 vs controls), physical and mental component summaries of SF-36 decreased by 2.9 (95 % CI: -4.8 to -1.1) and 4.4 (95 % CI: -7.1 to -1.7) points, respectively (p = 0.012 and p = 0.022 vs controls). Among VLBW participants, more mental health problems and lower physical and mental HRQoL were associated with poorer motor skills at 23 years.Conclusions: VLBW young adults reported poorer and declining mental health and HRQoL in the transitional phase into adulthood. They seemed to have a cautious lifestyle with more internalizing problems and less alcohol use. The associations of mental health problems and HRQoL with motor skills are likely to reflect a shared aetiology. [ABSTRACT FROM AUTHOR]

Objective: To assess the level of executive functioning among preschool children with cerebral palsy (CP) and evaluate effects of the Program Intensified habilitation (PIH). Methods: In this non-randomized, prospective study, 15 preschool children with CP, and their parents attended the PIH for a 1-year period. Executive functions were evaluated using the Behavior Rating Inventory of Executive functions – Preschool version (BRIEF-P), filled out by parents and preschool teachers. Results: Before PIH, scores of executive function difficulties were close to the general population mean. After PIH, fathers and preschool teachers reported reduced levels of executive difficulties on, respectively, the Emergent Metacognition Index and the Flexibility Index on the BRIEF-P. Mothers reported no changes. Conclusion: The children in our sample showed age-appropriate levels of executive functions before attending PIH. Some aspects of executive skills difficulties were reduced after PIH. Using BRIEF-P contributed to the differentiation of cognitive strengths and weaknesses among the children. [ABSTRACT FROM AUTHOR]

Aim: Working memory deficits are frequently found in children born preterm and have been linked to learning disabilities, and cognitive and behavioural problems. Our aim was to evaluate if a computerized working memory training program has long-term positive effects on memory, learning, and behaviour in very-low-birthweight (VLBW) children at age 5 to 6 years.Method: This prospective, intervention study included 20 VLBW preschool children in the intervention group and 17 age-matched, non-training VLBW children in the comparison group. The intervention group trained with the Cogmed JM working memory training program daily for 5 weeks (25 training sessions). Extensive neuropsychological assessment and parental questionnaires were performed 4 weeks after intervention and at follow-up 7 months later. For most of the statistical analyses, general linear models were applied.Results: At follow-up, higher scores and increased or equal performance gain were found in the intervention group than the comparison group on memory for faces (p=0.012), narrative memory (p=0.002), and spatial span (p=0.003). No group differences in performance gain were found for attention and behaviour.Interpretation: Computerized working memory training seems to have positive and persisting effects on working memory, and visual and verbal learning, at 7-month follow-up in VLBW preschool children. We speculate that such training is beneficial by improving the ability to learn from the teaching at school and for further cognitive development. [ABSTRACT FROM AUTHOR]

Aim: The Internet is the main source of child health information among parents of young children. The aim of this study was to evaluate how regular use of a specific child health website would influence the perceived parental self-efficacy and knowledge of Norwegian mothers with young children. We also wanted the mothers to evaluate the usefulness and user-friendliness of the study website. In addition, usage of the web site in the general population was recorded in the same period. Subjects and methods: In this prospective survey, 99 Norwegian mothers were recruited as users of a Norwegian website () developed and managed by Norwegian physicians. Standardized questionnaires were used to assess background information and self-perceived parental competence before and after using the website. Forty-six mothers reported using the site regularly for 9-12 months, and after usage a questionnaire was filled out to evaluate the site's usefulness. General usage of site was examined with Google Statistics. Results: After usage, the mothers rated themselves with less anxiety when their child was ill ( t = 2.49, p = 0.017, paired sample t-test) and with increased knowledge about childhood disease ( t = −2.95, p = 0.004). More mothers claimed to know how to recognize serious disease in their child ( t = −3.16, p = 0.003). More than 80 % of mothers appreciated the structure, content and usefulness of the study website. Search characteristics of the mothers were similar to those of the general population. Conclusion: Regular usage of a child health website developed by physicians increased the self-efficacy and knowledge and reduced anxiety among Norwegian mothers of young children. [ABSTRACT FROM AUTHOR]

Aim: The Internet has become the leading source of child health information for parents. Perceived parental competence, self-efficacy, education and satisfaction with traditional health services may influence Internet use. The aim of study was to investigate the interplay between these factors. Subject and methods: A survey that included 99 Norwegian mothers to young children was conducted to assess the relationship between Internet use concerning child health, perceived parental competence, self-efficacy and demographic factors in the context of having a sick child. Results: Nearly all Norwegian parents have Internet access at home and use the net regularly, including when their child is sick. The Internet was the main source of information about child health in general, while most parents used the traditional health services when their child became sick. Internet usage was negatively correlated to mother's education, but not to mother's age, number of children or degree of satisfaction with traditional health services. A third of mothers reported that they became very anxious and nearly half reported lack of knowledge when their child was sick. Parental perceived competence and self-efficacy were not correlated with maternal age, education or number of children, and it did not influence the extent of Internet searching for child health information. Conclusion: The Internet is the main source of child health information for Norwegian mothers of young children, and usage seems mainly independent of maternal age, education, perceived competence and self-efficacy, and the degree of satisfaction with traditional health services. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine psychiatric symptoms in adults born preterm with very low birthweight or born at term small for gestational age compared with normal birthweight peers, and examine associations with perinatal factors and childhood motor and cognitive function. Methods: In this longitudinal cohort study, one preterm born group with very low birthweight (VLBW: birthweight ≤1500 g), one term-born Small for Gestational Age (SGA: birthweight <10th percentile) group and one term-born non-SGA control group, were assessed at 26 years of age. Primary outcomes were scores on self-reported questionnaires: Achenbach System of Empirically Based Assessment - Adult Self-Report, The Autism-Spectrum Quotient and Peters et al. Delusions Inventory. Exposure variables were perinatal data, while childhood motor and cognitive function were examined as possible early markers. Results: Both the preterm VLBW and the term SGA group reported higher levels of attention, internalizing and externalizing problems compared to the control group. In addition, the VLBW participants reported more critical items and a higher proportion had intermediate level autistic traits, while the SGA participants reported more intrusive behavior. Increasing length of respiratory support and hospital stay in the neonatal period, and motor problems in early adolescence, were associated with adult psychiatric symptoms in the VLBW group. Conclusions: Psychiatric symptoms were frequent in the preterm VLBW group and also in the term-born SGA group. Those who were sickest as babies were most at risk. Motor problems can possibly serve as an early marker of adult psychiatric symptoms in low birthweight individuals. [ABSTRACT FROM AUTHOR]

Background:Neonatal intermittent hyperoxia-hypoxia (IHH) is involved in the pathogenesis of retinopathy of prematurity. Whether similar oxygen fluctuations will create pathological changes in the grey and white matter of the brain is unknown. Methods:From birth until postnatal day 14 (P14), two litters (total n = 22) were reared in IHH: hyperoxia (50% O2) interrupted by three consecutive two-minute episodes of hypoxia (12% O2) every sixth hour. Controls (n = 8) were reared in room-air (20.9% O2). Longitudinal MRI (Diffusion Tensor Imaging and T2-mapping) was performed on P14 and P28 and retinal and brain tissue were examined for histopathological changes. Long-term neurodevelopment was assessed on P20 and P27. Results:Mean, radial and axial diffusivity were higher in white matter of IHH versus controls at P14 (p < 0.04), while fractional anisotropy (FA) was lower in the hippocampal fimbria and tended to be lower in corpus callosum (p = 0.08) and external capsule (p = 0.05). White matter diffusivity in IHH was similar to controls at P28. Higher cortical vessel density (p = 0.005) was observed at P14. Cortical and thalamic T2-relaxation time and mean diffusivity were higher in the IHH group at P14 (p ≤ 0.03), and albumin leakage was present at P28. Rats in the IHH group ran for a longer time on a Rotarod than the control group (p ≤ 0.005). Pups with lower bodyweight had more severe MRI alterations and albumin leakage. Conclusion:IHH led to subtle reversible changes in brain white matter diffusivity, grey matter water content and vascular density. However, alterations in blood-brain barrier permeability may point to long-term effects. The changes seen after IHH exposure were more severe in animals with lower bodyweight and future studies should aim at exploring possible interactions between IHH and growth restriction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine psychiatric morbidity and overall functioning in adults born with low birth weight compared with normal birth weight controls at age 26 years and to study longitudinal trajectories of psychiatric morbidity from early adolescence to adulthood. METHODS: Prospective cohort study wherein 44 preterm very low birth weight (≤1500 g), 64 term small for gestational age (SGA; <10th percentile), and 81 control adults were examined using the MINI-International Neuropsychiatric Interview: M.I.N.I. Plus, Norwegian version, the Global Assessment of Functioning, and questions on daily occupation and level of education. Prevalence of psychiatric disorders from previous follow-ups at age 14 and 19 years were included for longitudinal analysis. RESULTS: From adolescence to adulthood, the term SGA group had a marked increase in the estimated probability of psychiatric disorders from 9% (95% confidence interval, 4-19) to 39% (95% confidence interval, 28-51). At 26 years, psychiatric diagnoses were significantly more prevalent in the preterm very low birth weight group (n = 16, 36%; P = .003) and the term SGA group (n = 24, 38%; P = .019) compared with the control group (n = 11,14%). Both low birth weight groups had lower educational level and functioning scores than controls and a higher frequency of unemployment and disability benefit. CONCLUSIONS: Low birth weight was a substantial risk factor for adult psychiatric morbidity and lowered overall functioning. The results underscore the need for long-term follow-up of low birth weight survivors through adolescence and adulthood, focusing on mental health. The longitudinal increase in psychiatric morbidity in the term SGA group calls for additional investigation. [ABSTRACT FROM AUTHOR]