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A patient-adapting heartbeat classifier using ECG morphology and heartbeat interval features.

An adaptive system for the automatic processing of the electrocardiogram (ECG) for the classification of heartbeats into one of the five beat classes recommended by ANSI/AAMI EC57:1998 standard is presented. The heartbeat classification system processes an incoming recording with a global-classifier to produce the first set of beat annotations. An expert then validates and if necessary corrects a fraction of the beats of the recording. The system then adapts by first training a local-classifier using the newly annotated beats and combines this with the global-classifier to produce an adapted classification system. The adapted system is then used to update beat annotations. The results of this study show that the performance of a patient adaptable classifier increases with the amount of training of the system on the local record. Crucially, the performance of the system can be significantly boosted with a small amount of adaptation even when all beats used for adaptation are from a single class. This study illustrates the ability to provide highly beneficial automatic arrhythmia monitoring and is an improvement on previously reported results for automated heartbeat classification systems.

Algorithms↗

Adaptive CMAC-based supervisory control for uncertain nonlinear systems.

An adaptive cerebellar-model-articulation-controller (CMAC)-based supervisory control system is developed for uncertain nonlinear systems. This adaptive CMAC-based supervisory control system consists of an adaptive CMAC and a supervisory controller. In the adaptive CMAC, a CMAC is used to mimic an ideal control law and a compensated controller is designed to recover the residual of the approximation error. The supervisory controller is appended to the adaptive CMAC to force the system states within a predefined constraint set. In this design, if the adaptive CMAC can maintain the system states within the constraint set, the supervisory controller will be idle. Otherwise, the supervisory controller starts working to pull the states back to the constraint set. In addition, the adaptive laws of the control system are derived in the sense of Lyapunov function, so that the stability of the system can be guaranteed. Furthermore, to relax the requirement of approximation error bound, an estimation law is derived to estimate the error bound. Finally, the proposed control system is applied to control a robotic manipulator, a chaotic circuit and a linear piezoelectric ceramic motor (LPCM). Simulation and experimental results demonstrate the effectiveness of the proposed control scheme for uncertain nonlinear systems.

Journal Article↗

Adaptive critic autopilot design of bank-to-turn missiles using fuzzy basis function networks.

A new adaptive critic autopilot design for bank-to-turn missiles is presented. In this paper, the architecture of adaptive critic learning scheme contains a fuzzy-basis-function-network based associative search element (ASE), which is employed to approximate nonlinear and complex functions of bank-to-turn missiles, and an adaptive critic element (ACE) generating the reinforcement signal to tune the associative search element. In the design of the adaptive critic autopilot, the control law receives signals from a fixed gain controller, an ASE and an adaptive robust element, which can eliminate approximation errors and disturbances. Traditional adaptive critic reinforcement learning is the problem faced by an agent that must learn behavior through trial-and-error interactions with a dynamic environment, however, the proposed tuning algorithm can significantly shorten the learning time by online tuning all parameters of fuzzy basis functions and weights of ASE and ACE. Moreover, the weight updating law derived from the Lyapunov stability theory is capable of guaranteeing both tracking performance and stability. Computer simulation results confirm the effectiveness of the proposed adaptive critic autopilot.

Journal Article↗

Adaptation of eight modern dental amalgams to walls of Class I cavity preparations.

An in vitro study was conducted in which a range of amalgam alloys was condensed into Class I cavity preparations. The force of condensation and increment size were varied to determine the effect of these operator variables on the adaptation, of the alloys investigated, to the prepared cavity walls. Specimens were sectioned, metallographically polished and examined using light and scanning electron microscopes. For each specimen ten random points on the pulpal and both vertical walls were selected to measure the adaptation of the amalgam to the tooth structure. For the Class I cavity preparation the adaptation of all alloys to the vertical walls was better than the adaptation to the pulpal walls. The overall adaptability of the alloy did not appear to be determined by the particle size, shape or composition. Condensation force was the most important factor in influencing adaptation of amalgam to the cavity walls. Heavy condensation forces produced better adaptation for all alloys particularly when condensing small increments.

Dental Alloys↗

Adaptational modification and ligand occupancy have opposite effects on positioning of the transmembrane signalling helix of a chemoreceptor.

Sensory systems adapt to persistent stimulation. In the transmembrane receptors of bacterial chemotaxis, adaptation is mediated by methylation at specific glutamyl residues in the cytoplasmic domain. Methylation counteracts effects of ligand binding on functional activities of that domain. Both ligand binding and adaptational modification are thought to act through conformational changes. As characterized for Escherichia coli chemoreceptors, a mechanistically crucial feature of the ligand-induced conformational change is piston sliding towards the cytoplasm of a signalling helix in the periplasmic/transmembrane domain. Adaptational modification could counteract this signalling movement by blocking its influence on the cytoplasmic domain or by reversing it. To investigate, we characterized effects of adaptational modification on the position of the signalling helix in chemoreceptor Trg using rates of disulphide formation between introduced cysteines. We utilized an intact cell procedure in which receptors were in their native, functional state. In vivo rates of disulphide formation between diagnostic cysteine pairs spanning a signalling helix interface changed as a function of adaptational modification. Strikingly, those changes were opposite those caused by ligand occupancy for each diagnostic pair tested. This suggests that adaptational modification resets the receptor complex to its null state by reversal of the conformational change generated by ligand binding.

Cysteine↗

Visco-elastic properties of the rapidly adapting stretch receptor muscle of the crayfish.

The visco-elastic properties of the receptor muscle associated with the rapidly adapting stretch receptor organ of crayfish (Pacifastacus Leniusculus) were studied by recording the tension responses to various length changes. Steady-state length changes resulted in a non-linear tension development in the receptor muscle. The tension increased slowly for small extensions and more rapidly when extension increased. Muscle tension responses to ramp-and-hold extension were characterized by a transient peak followed by a gradual non-exponentional decline in tension. At the onset of the ramp the tension increased rapidly, similar to what has been observed in the muscle of the slowly adapting receptor (SM). The steeper rise in tension during the first part of the ramp indicating higher initial stiffness, resulted in a 'hump' when large extensions (> 15%) were applied. The results show that the rapidly adapting receptor muscle has a more pronounced dynamic component; the ratio between the amplitude of the peak and the steady state response was larger in the rapidly than in the slowly adapting receptor muscle. Accordingly, different values for the elements of a visco-elastic model of the muscle had to be set for the two types of receptors. The different properties of the rapidly and slowly adapting receptor muscles are in line with the differences in the overall adaptive behaviour of the organ and give further support to the idea that mechanical factors contribute to the adaptive properties.

Animals↗

Analysis of inositol phosphate metabolism in melanotrope cells of Xenopus laevis in relation to background adaptation.

The present study examined inositol phosphate metabolism in melanotrope cells of Xenopus laevis to determine if inositol phosphates are involved in regulating the biosynthetic or secretory activity of these cells. No correlation could be found between inositol phosphate metabolism and the secretory activity of the melanotrope cells. Therefore, we conclude that inositol phosphate production is not directly involved in the regulation of release of alpha-MSH from these cells. However, there were dramatic differences in the capacity of the melanotrope cells to produce inositol phosphates dependent on the state of background adaptation of the animals from which the melanotropes were derived; cells from white-adapted animals had a low capacity to produce inositol phosphates, whereas melanotropes from black-adapted animals had a high capacity in this regard. During adaptation of animals from a white to a black background, the capacity of the melanotrope cells to produce inositol phosphates was only very slowly acquired, reminiscent of the slow acquisition displayed by these cells to produce POMC during background adaptations. Likewise, during black to white background adaptation, the melanotrope cells very slowly lost the capacity to phosphorylate inositol, which correlates with the slow loss of the biosynthetic capacity of melanotrope cells during such adaptations. Altogether we conclude that inositol phospholipid metabolism is likely involved in the regulation of the biosynthetic processes of melanotrope cells of Xenopus laevis.

Acclimatization↗

Colour adaptation modifies the long-wave versus middle-wave cone weights and temporal phases in human luminance (but not red-green) mechanism.

1. The human luminance (LUM) mechanism detects rapid flicker and motion, responding to a linear sum of contrast signals, L' and M', from the long-wave (L) and middle-wave (M) cones. The red-green mechanism detects hue variations, responding to a linear difference of L' and M' contrast signals. 2. The two detection mechanisms were isolated to assess how chromatic adaptation affects summation of L' and M' signals in each mechanism. On coloured background (from blue to red), we measured, as a function of temporal frequency, both the relative temporal phase of the L' and M' signals producing optimal summation and the relative L' and M' contrast weights of the signals (at the optimal phase for summation). 3. Within the red-green mechanism at 6 Hz, the phase shift between the L' and M' signals was negligible on each coloured field, and the L' and M' contrast weights were equal and of opposite sign. 4. Relative phase shifts between the L' and M' signals in the LUM mechanism were markedly affected by adapting field colour. For stimuli of 1 cycle deg-1 and 9 Hz, the temporal phase shift was zero on a green-yellow field (approximately 570 nm). On an orange field, the L' signal lagged M' by as much as 70 deg phase while on a green field M' lagged L' by as much as 70 deg. The asymmetric phase shift about yellow adaptation reveals a spectrally opponent process which controls the phase shift. The phase shift occurs at an early site, for colour adaptation of the other eye had no effect, and the phase shift measured monocularly was identical for flicker and motion, thus occurring before the motion signal is extracted (this requires an extra delay). 5. The L' versus M' phase shift in the LUM mechanism was generally greatest at intermediate temporal frequencies (4-12 Hz) and was small at high frequencies (20-25 Hz). The phase shift was greatest at low spatial frequencies and strongly reduced at high spatial frequencies (5 cycle deg-1), indicating that the receptive field surround of neurones is important for the phase shift. 6. These temporal phase shifts were confirmed by measuring motion contrast thresholds for drifting L cone and M cone gratings summed in different spatial phases. Owing to the large phase shifts on green or orange fields, the L and M components were detected about equally well by the LUM mechanism (at 1 cycle deg-1 and 9 Hz) when summed spatially in phase or in antiphase. Antiphase summation is typically thought to produce an equiluminant red-green grating. 7. At low spatial frequency, the relative L' and M' contrast weights in the LUM mechanism (assessed at the optimal phase for summation) changed strongly with field colour and temporal frequency. 8. The phase shifts and changing contrast weights were modelled with phasic retinal ganglion cells, with chromatic adaptation strongly modifying the receptive field surround. The cells summate L' and M' in their centre, while the surround L' and M' signals are both antagonistic to the centre for approximately 570 nm yellow adaptation. Green or orange adaptation is assumed to modify the L and M surround inputs, causing them to be opponent with respect to each other, but with reversed polarity on the green versus orange field (to explain the chromatic reversal of the phase shift). Large changes in the relative L' and M' weights on green versus orange fields indicate the clear presence of the spectrally opponent surround even at 20 Hz. The spectrally opponent surround appears sluggish, with a long delay (approximately 20 ms) relative to the centre.

Adult↗

Selective adaptation effects in infant speech perception paradigms.

The present studies were conducted to explore the possible role of selective adaptation in infant speech perception. In the first study, in which the growth of adaptation was examined by presenting adult listeners with successive blocks of 20 repeating stimuli, reliable adaptation effects were observed after only 80 stimulus presentations. In addition, recovery following adaptation was relatively rapid and complete by the end of a postadaptation identification sequence. Experiment II constituted a more direct investigation of the possible role of adaptation in infant speech perception in which actual protocols from heart-rate (HR) and non-nutritive high-amplitude sucking (HAS) infant testing sessions were presented to adult listeners. Reliable adaptation effects were obtained within the HAS protocol, but not within the HR format. This pattern of results was consistent with that observed in experiment I. The implications of these adult adaptation results for the processes underlying the infant's responsiveness to these stimulis were discussed.

Adult↗

Loudness adaptation and excitation patterns: effects of frequency and level.

Simple loudness adaptation for pure tones was measured at frequencies from 0.125 to 16 kHz and at sensation levels from 5 to 60 dB. Sixteen young listeners with normal hearing participated in four experiments. Most of the loudness measurements were obtained by the method of successive magnitude estimation; some were also obtained by loudness matching. The two indices of loudness adaptation gave similar results. At all frequencies, loudness adaptation increased as sensation level decreased. After 6 min, average loudness declined at most frequencies by about 20% at 40-dB sensation level (SL) and by between 70% and almost 100% at 5-dB SL. Adaptation also increased with increasing frequency, and was especially marked at 16 kHz, where loudness declined more than 60% at a sensation level as high as 40 dB. Most of the adaptation occurred usually within the first 3 min of exposure, but loudness continued to diminish at a slower rate up to around 6 min. The dependence of loudness adaptation on frequency and level can be largely accounted for by the restricted-excitation-pattern hypothesis. Adaptation is assumed to take place when excitation is restricted to a narrow region of the cochlea. This hypothesis is supported by a quantitative analysis based on excitation patterns derived from measurements of masking.

Adolescent↗

Adaptation to and biodegradation of xenobiotic compounds by microbial communities from a pristine aquifer.

The ability of subsurface microbial communities to adapt to the biodegradation of xenobiotic compounds was examined in aquifer solids samples from a pristine aquifer. An increase in the rates of mineralization of radiolabeled substrates with exposure was used as an indication of adaptation. For some compounds, such as chlorobenzene and 1,2,4-trichlorobenzene, slight mineralization was observed but no adaptation was apparent during incubations of over 8 months. Other compounds demonstrated three patterns of response. For m-cresol, m-aminophenol, and aniline intermediate rates of biodegradation and a linear increase in the percent mineralized with time were observed. Phenol, p-chlorophenol, and ethylene dibromide were rapidly metabolized initially, with a nonlinear increase in the percent mineralized with time, indicating that the community was already adapted to the biodegradation of these compounds. Only p-nitrophenol demonstrated a typical adaptation response. In different samples of soil from the same layer in the aquifer, the adaptation period to p-nitrophenol varied from a few days to as long as 6 weeks. In most cases the concentration of xenobiotic added, over the range from a few nanograms to micrograms per gram, made no difference in the response. Most-probable-number counts demonstrated that adaptation is accompanied by an increase in specific degrader numbers. This study has shown that diverse patterns of response occur in the subsurface microbial community.

Aminophenols↗

PYRITHIAMINE ADAPTATION OF STAPHYLOCOCCUS AUREUS. II. TRICARBOXYLIC ACID CYCLE AND RELATED ENZYMES.

Das, S. K. (Calcutta University, Calcutta, India), and G. C. Chatterjee. Pyrithiamine adaptation of Staphylococcus aureus. II. Tricarboxylic acid cycle and related enzymes. J. Bacteriol. 86:1157-1164. 1963.-Evidence for the stimulated operation of the tricarboxylic acid cycle in Staphylococcus aureus after pyrithiamine adaptation is presented. In the cell-free extracts, isocitric, glutamic, malic, and succinic dehydrogenases and catalase were found to be stimulated after the adaptation of S. aureus to pyrithiamine. Besides such stimulation, the appearance of isocitratase and malate synthetase in the adapted strain supports the appearance of the glyoxalate bypass after such adaptation. There is little change in the activities of reduced nicotinamide adenine dinucleotide (NADH) and reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidases and diaphorase. Lactic dehydrogenase, NADH-cytochrome c reductase, and NADPH-cytochrome c reductase could not be demonstrated either in the normal or in the pyrithiamine-adapted S. aureus. These observations support the postulation that there is a stimulation in the tricarboxylic acid cycle and can account for the very marked stimulation in the utilization of acetate by the organism after adaptation.

Acclimatization↗

Long-term adaptation of renal cells to hypertonicity: role of MAP kinases and Na-K-ATPase.

Renal cells in culture have low viability when exposed to hypertonicity. We developed cell lines of inner medullary collecting duct cells adapted to live at 600 and 900 mosmol/kgH(2)O. We studied the three modules of the mitogen-activated protein (MAP) kinase family in the adapted cells. These cells had no increase in either extracellular signal-regulated kinase, c-Jun NH(2)-terminal kinase, or p38 MAP kinase protein or basal activity. When acutely challenged with further increments in tonicity, they had blunted activation of these kinases, which was not due to enhanced phosphatase activity. In contrast, the cells adapted to the hypertonicity displayed a marked increment in Na-K-ATPase expression (5-fold) and ouabain-sensitive Na-K-ATPase activity (10-fold). The changes were reversible on return to isotonic conditions. Replacement of 300 mosmol/kgH(2)O of NaCl by urea in cells adapted to 600 mosmol/kgH(2)O resulted in marked decrement in Na-K-ATPase and failure to maintain the cell line. Replacement of NaCl for urea in cells adapted to 900 mosmol/kgH(2)O did not alter either Na-K-ATPase expression, or the viability of the cells. The in vivo modulation of Na-K-ATPase was studied in the renal papilla of water-deprived mice (urinary osmolality 2,900 mosmol/kgH(2)O), compared with that of mice drinking dextrose in water (550 mosmol/kgH(2)O). Increased water intake was associated with a ~30% decrement in Na-K-ATPase expression (P < 0.02, n = 6), suggesting that this enzyme is osmoregulated in vivo. We conclude that whereas MAP kinases play a role in the response to acute changes in tonicity, they are not central to the chronic adaptive response. Rather, in this setting there is upregulation of other osmoprotective proteins, among which Na-K-ATPase appears to be an important component of the adaptive process.

Animals↗

The time course of direction-selective adaptation in simple and complex cells in cat striate cortex.

1. Responses of single cortical neurons in area 17 of anesthetized cats were recorded in response to prolonged stimulation with a patch of drifting square-wave grating. 2. During adaptation in the preferred direction, all neurons showed some reduction in response to motion in the stimulated direction and most showed some reduction in the opposite, nonstimulated direction. 3. For complex cells, the time course of response decrement in both the stimulated and nonstimulated directions was exponential, with an average time constant of 5 s. Response recovery was also exponential but significantly slower, with time constants of 8 and 13 s in the stimulated and nonstimulated directions, respectively. 4. For simple cells the dynamics of the adaptation effect depended on the direction of testing. In the nonstimulated direction the time course of the change in sensitivity was similar to that of complex cells. In the stimulated direction during both the adaptation and recovery periods, simple cells showed an initial rapid exponential change on the order of a few seconds that was followed by a more gradual exponential change. 5. During prolonged stimulation in the nonpreferred direction, there was less overall change in sensitivity. For some neurons the change in sensitivity during adaptation and recovery was exponential, with a short time constant for both simple and complex cells and for stimulated and nonstimulated directions. Other neurons showed no change in sensitivity in either direction and a few neurons showed facilitation during the adaptation period. 6. There appears to be a rapid general or nonspecific process, which may be related to contrast gain control, underlying motion adaptation in striate cortical neurons. An additional slow, direction-selective process is revealed when simple but not complex cells are stimulated in the preferred direction. We suggest that this latter type of adaptation is a key feature underlying the perceptual motion aftereffect.

Animals↗

Calcium coding and adaptive temporal computation in cortical pyramidal neurons.

In this work, we present a quantitative theory of temporal spike-frequency adaptation in cortical pyramidal cells. Our model pyramidal neuron has two-compartments (a "soma" and a "dendrite") with a voltage-gated Ca2+ conductance (gCa) and a Ca2+-dependent K+ conductance (gAHP) located at the dendrite or at both compartments. Its frequency-current relations are comparable with data from cortical pyramidal cells, and the properties of spike-evoked intracellular [Ca2+] transients are matched with recent dendritic [Ca2+] imaging measurements. Spike-frequency adaptation in response to a current pulse is characterized by an adaptation time constant tauadap and percentage adaptation of spike frequency Fadap [% (peak - steady state)/peak]. We show how tauadap and Fadap can be derived in terms of the biophysical parameters of the neural membrane and [Ca2+] dynamics. Two simple, experimentally testable, relations between tauadap and Fadap are predicted. The dependence of tauadap and Fadap on current pulse intensity, electrotonic coupling between the two compartments, gAHP as well the [Ca2+] decay time constant tauCa, is assessed quantitatively. In addition, we demonstrate that the intracellular [Ca2+] signal can encode the instantaneous neuronal firing rate and that the conductance-based model can be reduced to a simple calcium-model of neuronal activity that faithfully predicts the neuronal firing output even when the input varies relatively rapidly in time (tens to hundreds of milliseconds). Extensive simulations have been carried out for the model neuron with random excitatory synaptic inputs mimicked by a Poisson process. Our findings include 1) the instantaneous firing frequency (averaged over trials) shows strong adaptation similar to the case with current pulses; 2) when the gAHP is blocked, the dendritic gCa could produce a hysteresis phenomenon where the neuron is driven to switch randomly between a quiescent state and a repetitive firing state. The firing pattern is very irregular with a large coefficient of variation of the interspike intervals (ISI CV > 1). The ISI distribution shows a long tail but is not bimodal. 3) By contrast, in an intrinsically bursting regime (with different parameter values), the model neuron displays a random temporal mixture of single action potentials and brief bursts of spikes. Its ISI distribution is often bimodal and its power spectrum has a peak. 4) The spike-adapting current IAHP, as delayed inhibition through intracellular Ca2+ accumulation, generates a "forward masking" effect, where a masking input dramatically reduces or completely suppresses the neuronal response to a subsequent test input. When two inputs are presented repetitively in time, this mechanism greatly enhances the ratio of the responses to the stronger and weaker inputs, fulfilling a cellular form of lateral inhibition in time. 5) The [Ca2+]-dependent IAHP provides a mechanism by which the neuron unceasingly adapts to the stochastic synaptic inputs, even in the stationary state following the input onset. This creates strong negative correlations between output ISIs in a frequency-dependent manner, while the Poisson input is totally uncorrelated in time. Possible functional implications of these results are discussed.

Animals↗

Self-adaptive genetic algorithms with simulated binary crossover.

Self-adaptation is an essential feature of natural evolution. However, in the context of function optimization, self-adaptation features of evolutionary search algorithms have been explored mainly with evolution strategy (ES) and evolutionary programming (EP). In this paper, we demonstrate the self-adaptive feature of real-parameter genetic algorithms (GAs) using a simulated binary crossover (SBX) operator and without any mutation operator. The connection between the working of self-adaptive ESs and real-parameter GAs with the SBX operator is also discussed. Thereafter, the self-adaptive behavior of real-parameter GAs is demonstrated on a number of test problems commonly used in the ES literature. The remarkable similarity in the working principle of real-parameter GAs and self-adaptive ESs shown in this study suggests the need for emphasizing further studies on self-adaptive GAs.

Algorithms↗

Noise adaptation in integrate-and fire neurons.

The statistical spiking response of an ensemble of identically prepared stochastic integrate-and-fire neurons to a rectangular input current plus gaussian white noise is analyzed. It is shown that, on average, integrate-and-fire neurons adapt to the root-mean-square noise level of their input. This phenomenon is referred to as noise adaptation. Noise adaptation is characterized by a decrease in the average neural firing rate and an accompanying decrease in the average value of the generator potential, both of which can be attributed to noise-induced resets of the generator potential mediated by the integrate-and-fire mechanism. A quantitative theory of noise adaptation in stochastic integrate-and-fire neurons is developed. It is shown that integrate-and-fire neurons, on average, produce transient spiking activity whenever there is an increase in the level of their input noise. This transient noise response is either reduced or eliminated over time, depending on the parameters of the model neuron. Analytical methods are used to prove that nonleaky integrate-and-fire neurons totally adapt to any constant input noise level, in the sense that their asymptotic spiking rates are independent of the magnitude of their input noise. For leaky integrate-and-fire neurons, the long-run noise adaptation is not total, but the response to noise is partially eliminated. Expressions for the probability density function of the generator potential and the first two moments of the potential distribution are derived for the particular case of a nonleaky neuron driven by gaussian white noise of mean zero and constant variance. The functional significance of noise adaptation for the performance of networks comprising integrate-and-fire neurons is discussed.

Acclimatization↗

Randomized controlled trial of the use of compensatory strategies to enhance adaptive functioning in outpatients with schizophrenia.

OBJECTIVE: Cognitive adaptation training is a novel psychosocial treatment approach designed to improve adaptive functioning by using compensatory strategies in the home or work environment to bypass the cognitive deficits associated with schizophrenia. The authors tested the effect of cognitive adaptation training on level of adaptive functioning in outpatients with schizophrenia. METHOD: Forty-five patients with DSM-IV schizophrenia or schizoaffective disorder were randomly assigned for 9 months to one of three treatment conditions: 1) standard medication follow-up, 2) standard medication follow-up plus cognitive adaptation training, and 3) standard medication follow-up plus a condition designed to control for therapist time and provide environmental changes unrelated to cognitive deficits. Comprehensive assessments were conducted every 3 months by raters who were blind to treatment condition. RESULTS: Significant differences were found between the three treatment groups in levels of psychotic symptoms, motivation, and global functioning at the end of the 9-month study period. Patients in the cognitive adaptation training group overall had higher levels of improvement, compared with those in the remaining treatment conditions. In addition, the three groups had significantly different relapse rates over the 9-month study: 13% for the cognitive adaptation training group, 69% for the group in which therapist time and environmental changes were controlled, and 33% for the group who received standard follow-up only. CONCLUSIONS: Compensatory strategies may improve outcomes for patients with schizophrenia.

Adult↗