Studies have shown that patients with borderline personality disorder (BPD) have co-occurring disorders; literature has also suggested that BPD patients have impairments in neuropsychological ...functioning, as seen in a previous meta-analysis (Ruocco, 2005). This meta-analysis showed that neuropsychological functioning are marked areas of concern in BPD; however, this meta-analytic research did not assess the effects of co-occurring disorders on neuropsychological functioning in BPD patients. The current meta-analysis takes this into consideration and a systematic review of cross-sectional studies comparing neuropsychological performance of individuals with BPD with age-matched healthy comparison subjects was carried out. Potential moderators (i.e., age, gender, education level, and co-morbid mental disorders) were analyzed. Significant deficits were observed in the decision making, memory, executive functioning, processing speed, verbal intelligence, and visuospatial abilities. BPD patients with more education and with parents of a higher educational level had better neuropsychological functioning. Globally, BPD samples with a higher percentage of co-morbid personality disorders, major depression, eating disorders, or any substance abuse disorders performed worse than patients with a less percentage; however, anxiety disorders and PTSD co-morbidity did not affect the cognitive performance of the BPD group. Differences are seen dependent on neuropsychological domain and specific co-morbidity. These findings highlight the clinical relevance of characterizing cognitive functioning in BPD and the importance of considering demographic and clinical moderators in future analyses.
•This is a meta-analysis on neuropychological functioning in BPD and co-morbid mental disorders.•BPD patients have impairments in six neuropsychological domains.•BPD patients with co-morbid mental disorders are more impaired.•BPD patients with specific co-morbidites have specific neuropsychological impairments.
The accuracy of state‐of‐the‐art global barotropic tide models is assessed using bottom pressure data, coastal tide gauges, satellite altimetry, various geodetic data on Antarctic ice shelves, and ...independent tracked satellite orbit perturbations. Tide models under review include empirical, purely hydrodynamic (“forward”), and assimilative dynamical, i.e., constrained by observations. Ten dominant tidal constituents in the diurnal, semidiurnal, and quarter‐diurnal bands are considered. Since the last major model comparison project in 1997, models have improved markedly, especially in shallow‐water regions and also in the deep ocean. The root‐sum‐square differences between tide observations and the best models for eight major constituents are approximately 0.9, 5.0, and 6.5 cm for pelagic, shelf, and coastal conditions, respectively. Large intermodel discrepancies occur in high latitudes, but testing in those regions is impeded by the paucity of high‐quality in situ tide records. Long‐wavelength components of models tested by analyzing satellite laser ranging measurements suggest that several models are comparably accurate for use in precise orbit determination, but analyses of GRACE intersatellite ranging data show that all models are still imperfect on basin and subbasin scales, especially near Antarctica. For the M2 constituent, errors in purely hydrodynamic models are now almost comparable to the 1980‐era Schwiderski empirical solution, indicating marked advancement in dynamical modeling. Assessing model accuracy using tidal currents remains problematic owing to uncertainties in in situ current meter estimates and the inability to isolate the barotropic mode. Velocity tests against both acoustic tomography and current meters do confirm that assimilative models perform better than purely hydrodynamic models.
Key Points
Tide model accuracy assessmentImproved accuraciesTidal current estimates
Global comparisons of barotropic and internal tides generated in an eddy‐resolving ocean circulation model are made with tidal estimates obtained from altimetric sea surface heights and an ...altimetry‐constrained tide model. As far as we know, our Hybrid Coordinate Ocean Model (HYCOM) simulations shown here and in an earlier paper are the only published high‐resolution global simulations to contain barotropic tides, internal tides, the general circulation, and mesoscale eddies concurrently. Comparing the model barotropic tide with a global data‐assimilative shallow water tide model shows that the global tidal elevation differences are approximately evenly split between discrepancies in tidal amplitude and phase. Both the model and observations show strong generation of internal tides at a limited number of “hot spot” regions with propagation of beams of energy for thousands of kilometers away from the sources. The model internal tidal amplitudes compare well with observations near these energetic tidal regions. Averaged over these regions, the model and observation internal tide amplitude estimates agree to approximately 15% for the four largest semidiurnal constituents and 23% for the four largest diurnal constituents. Away from the hot spots, the comparison between the model and altimetric amplitude is not as good due, in part, to two problems, errors in the model barotropic tides and overestimation of the altimetric tides in regions of strong mesoscale eddy activity. Examining the general energy distribution of the simulated internal tide is an important first step in the evaluation of internal tides in HYCOM.
Key Points
Model and observations show generation of internal tides in limited regions
Our global model is able to generate internal waves consistent with observations
Barotropic phase errors are a major source of errors in the model internal tide
Hospital consolidation into health systems has mixed effects on surgical quality, potentially related to degree of surgical centralization at high-volume (hub) sites. We developed a novel measure of ...centralization and evaluated a hub and spoke framework.
Surgical centralization within health systems was measured using hospital surgical volumes (American Hospital Association) and health system data (Agency for Healthcare Research and Quality). Hub and spoke hospitals were compared using mixed effects logistic regression and system characteristics associated with surgical centralization were identified using a linear model.
Within 382 health systems containing 3022 hospitals, system hubs perform 63% of cases (IQR 40-84%). Hubs are larger, in metropolitan and urban areas, and more often academically affiliated. Degree of surgical centralization varies ten-fold. Larger, multistate, and investor-owned systems are less centralized. Adjusting for these factors, there is less centralization among teaching systems (p < 0.001).
A hub-spoke framework applies to most health systems but centralization varies significantly. Future studies of health system surgical care should assess the contributions of surgical centralization and teaching status on differential quality.
Major depression (MDD) and social anxiety (SAD) disorders are debilitating psychiatric conditions characterized by disturbed interpersonal relationships. Despite these impairments in social ...relationships, research has been limited in simultaneously evaluating the dysfunction in MDD or SAD within two aspects of theory of mind (ToM): decoding mental states (i.e., Affective ToM) and reasoning mental states (i.e., cognitive ToM). Taking this into consideration, the current study assesses both decoding and reasoning mental states abilities in MDD, SAD, and healthy controls (HC).
Subjects included 37 patients with MDD, 35 patients with SAD, and 35 HCs. ToM was measured with the Reading the Mind in the Eyes Test (RMET) and the Faux Pas Task, which assess decoding and reasoning mental states, respectively.
Results revealed that in decoding of mental states, both the SAD and MDD groups had lower scores than the HC group; there was no significant difference between the SAD and MDD groups in decoding mental states. Conversely, in reasoning mental states, the SAD and HC groups had higher scores than the MDD group; no differences were found between the SAD and HC groups.
Clinicians and researchers should further consider parsing generalized impairment in ToM into two aspects: decoding and reasoning of mental states by using the aforementioned measurements. By further understanding the two aspects, we can create a potentially new clinical profile for mental health disorders, such as in this context with both decoding and reasoning mental state impairment in MDD and just a decoding impairment in SAD.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
...gene-environment interactions are also easily studied in zebrafish by adding drugs to the water in fish with predisposing mutations. ...we are excited about the 2 drug therapy articles that rescue ...cleft palate in Pax9 mutant mice. ...discoveries reported in this excellent series of articles will lead to improvements in diagnosis and ultimately treatment of challenging craniofacial and dental anomalies.
Previous studies suggest the rate of positive surgical margin (PSM) after lumpectomy for breast cancer is approximately 20 %. The risk of PSM at time of resection is often a source of fear for ...patients, driving some to elect to undergo mastectomy. This study describes rates and predictors of positive margins for invasive breast cancers in the National Cancer Database (NCDB).
From 2004 to 2013, patients with non-metastatic invasive breast cancers who underwent breast conservation surgery were identified from the NCDB. Patients’ demographic, clinical, and facility of treatment characteristics were collected and compared. Per SSO-ASTRO-ASCO criteria, margin negative is defined as no gross or microscopic disease (i.e. no tumor on ink). Bivariate tests and multivariate logistic regression were conducted to identify independent predictors of patients with PSM at the time of resection.
A total of 707,798 patients were identified with non-metastatic invasive breast tumors who underwent lumpectomy. Rate of PSM across the entire cohort was 5.02 %. Over time, the rate of PSM decreased significantly from 6.54 % in 2004 to 3.91 % in 2013 (p < 0.001). Pure lobular histology predicted for the highest rate of PSM compared with IDC (8.63 vs 4.55 %; p < 0.001). In adjusted analysis, high grade, non-ductal histology and HER2 amplification were significantly associated with PSM with breast conservation while estrogen and progesterone status were not.
This study demonstrates a 5 % risk of PSM at time of breast conservation surgery using a large, modern national database. Patients with invasive lobular and mixed histology have a nearly two-fold risk of PSM compared to invasive ductal cancers. These results provide important data points to help appropriately counsel patients regarding the risk of PSM.
•Using the National Cancer Database (NCDB), trends in positive surgical margin (PSM) at time of lumpectomy for early stage invasive breast cancer are decreasing over time.•Observed rates of PSM in this analysis are approximately 5 % for the entire cohort.•Predictors of PSM are lobular histology, increasing T and N stage, grade, and Her2+ histology.
1 Cardiovascular Division, Department of
Internal Medicine, and Department of Molecular Physiology and
Biological Physics, and Cardiovascular Research Center, University of
Virginia Health Sciences ...Center, Charlottesville, Virginia 22908; and
2 Medical Automation Systems, Charlottesville,
Virginia 22903
Entropy, as it relates to
dynamical systems, is the rate of information production. Methods for
estimation of the entropy of a system represented by a time series are
not, however, well suited to analysis of the short and noisy data sets
encountered in cardiovascular and other biological studies. Pincus
introduced approximate entropy (ApEn), a set of measures of system
complexity closely related to entropy, which is easily applied to
clinical cardiovascular and other time series. ApEn statistics,
however, lead to inconsistent results. We have developed a new and
related complexity measure, sample entropy (SampEn), and have compared ApEn and SampEn by using them to analyze sets of random numbers with
known probabilistic character. We have also evaluated cross-ApEn and
cross-SampEn, which use cardiovascular data sets to measure the
similarity of two distinct time series. SampEn agreed with theory much
more closely than ApEn over a broad range of conditions. The improved
accuracy of SampEn statistics should make them useful in the study of
experimental clinical cardiovascular and other biological time series.
probability; nonlinear dynamics
To determine the prevalence and incidence of epilepsy among U.S. Medicare beneficiaries aged 65 years old and over, and to compare rates across demographic groups.
We performed a retrospective ...analysis of Medicare administrative claims for 2001-2005, defining prevalent cases as persons with ≥1 claim with diagnosis code 345.xx (epilepsy) or 2 or more with diagnosis code 780.3x (convulsion) ≥1 month apart, and incident cases as prevalent cases with 2 years immediately before diagnosis without such claims. Prevalence and incidence rates were calculated for the years 2003-2005 using denominators estimated from a 5% random sample of Medicare beneficiaries. Results were correlated with gender, age, and race.
We identified 282,661 per year on average during 2001-2005 (a total of 704,243 unique cases overall), and 62,182 incident cases per year on average during 2003-2005. Average annual prevalence and incidence rates were 10.8/1,000 and 2.4/1,000. Overall, rates were higher for black beneficiaries (prevalence 18.7/1,000, incidence 4.1/1,000), and lower for Asians (5.5/1,000, 1.6/1,000) and Native Americans (7.7/1,000, 1.1/1,000) than for white beneficiaries (10.2/1,000, 2.3/1,000). Incidence rates were slightly higher for women than for men, and increased with age for all gender and race groups.
Epilepsy is a significant public health problem among Medicare beneficiaries. Efforts are necessary to target groups at higher risk, such as minorities or the very old, and to provide the care necessary to reduce the negative effects of epilepsy on quality of life.
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