ABSTRACT
Planets open gaps in discs. Gap opening is typically modelled by considering the planetary Lindblad torque which repels disc gas away from the planet’s orbit. But gaps also clear because the ...planet consumes local material. We present a simple, easy-to-use, analytic framework for calculating how gaps deplete and how the disc’s structure as a whole changes by the combined action of Lindblad repulsion and planetary consumption. The final mass to which a gap-embedded gas giant grows is derived in tandem. The analytics are tested against 1D numerical experiments and calibrated using published multidimensional simulations. In viscous alpha discs, the planet, while clearing a gap, initially accretes practically all of the gas that tries to diffuse past, rapidly achieving super-Jupiter if not brown dwarf status. By contrast, in inviscid discs – that may still accrete on to their central stars by, say, magnetized winds – planets open deep, repulsion-dominated gaps. Then only a small fraction of the disc accretion flow is diverted on to the planet, which grows to a fraction of a Jupiter mass. Transitional disc cavities might be cleared by families of such low-mass objects opening inviscid, repulsion-dominated, overlapping gaps which allow most of the outer disc gas to flow unimpeded on to host stars.
It is widely accepted that interpersonal problems are a central area of difficulty for those with borderline personality disorder (BPD). However, empirical elucidation of the specific behaviors, or ...patterns of behaviors, characterizing interpersonal dysfunction or dissatisfaction with relationships in BPD is limited. In this paper, we review the literature on interpersonal functioning of individuals with BPD by focusing on studies that include some assessment of interpersonal functioning that is not solely self-report; that is, studies with either behavioral laboratory tasks or manipulation of interpersonal stimuli in a controlled laboratory setting were included. First, we review the literature relevant to social cognition, including perceptual biases, Theory of Mind/empathy, and social problem-solving. Second, we discuss research that assesses reactivity to interpersonal stressors and interpersonal aggression in BPD. Next, we review the literature on trust and cooperation among individuals with BPD and controls. Last, we discuss the behavior of mothers with BPD in interactions with their infants. In conclusion, we specify areas of difficulty that are consistently identified as characterizing the interpersonal behaviors of those with BPD and the relevant implications. We also discuss the difficulties in synthesizing this body of literature and suggest areas for future research.
•Interpersonal dysfunction is central in borderline personality disorder (BPD).•We highlight objective measures of areas of potential impairment in those with BPD.•Those with BPD have heightened emotional reactivity to interpersonal stressors.•Individuals with BPD show impairment in trust and cooperation.•We offer suggestions for future research.
This cross-sectional study was designed to add to the emerging empirical literature characterizing the psychiatric and audiologic features of misophonia. Because most research to date has not ...compared misophonia to clinical control groups, the present study used both participants who did not report any sound intolerance problems and a clinical control group of participants with auditory over-responsivity not formally meeting criteria for a diagnosis of misophonia using proposed diagnostic criteria by Schroeder et al. (2013). Severity of misophonia symptoms, frequency of current or lifetime psychiatric disorders, loudness discomfort, and hearing loss were compared across groups.
Structured interviews, questionnaires, and objective measures of audiologic functioning were administered to a sample of adult participants (N = 156). Measures included an interviewer-rated diagnostic assessment of misophonia, the MisoQuest, (Siepsiak et al., 2020), M.I.N·I (Sheehan et al., 1998), loudness discomfort level (LDL), and hearing loss (PTA).
Group differences in misophonia symptom severity among all three groups were observed: FWelch (2,50.57) = 149.92, p < .001, n2 = 0.64, validating group assignment. Psychiatric disorders were significantly more frequent in the misophonia group (71%) than in the auditory over-responsivity group (40%) and control group (40%): X2 (2, N = 142) = 14.3; p = .001; V = 0.317. A wide range of psychiatric disorders were observed in the misophonia group, (e.g., major depressive episode, suicidality and panic disorder were the most common). There were no significant differences between groups with regards to audiologic functioning.
Misophonia co-occurs with a variety of psychiatric disorders but does not appear to be associated with loudness discomfort or hearing impairments.
•Misophonia is related to a variety of psychiatric diagnoses.•The rate of psychiatric disorders is related to the operationalization of misophonia.•Misophonia is not related to loudness discomfort level and hearing loss.•No differences between auditory over-responsivity and controls were found.
Misophonia is a newly described condition characterized by sensory and emotional reactivity (e.g., anxiety, anger, disgust) to repetitive, pattern-based sounds (e.g., throat clearing, chewing, ...slurping). Individuals with misophonia report significant functional impairment and interpersonal distress. Growing research indicates ineffective coping and emotional functioning broadly (e.g., affective lability, difficulties with emotion regulation) are central to the clinical presentation and severity of misophonia. Preliminary evidence suggests an association between negative emotionality and deficits in emotion regulation in misophonia. Still, little is known about (a) the relationships among specific components of emotional functioning (e.g., emotion regulation, affective lability) with misophonia, and (b) which component(s) of misophonia (e.g., noise frequency, emotional and behavioral responses, impairment) are associated with emotional functioning. Further, despite evidence that mood and anxiety disorders co-occur with misophonia, investigation thus far has not controlled for depression and anxiety symptoms. Examination of these relationships will help inform treatment development for misophonia. The present study begins to disambiguate the relationships among affective lability, difficulties with emotion regulation, and components of misophonia. A sample of 297 participants completed questionnaires assessing misophonia, emotional functioning, depression, anxiety, and COVID-19 impact. Findings indicated that misophonia severity was positively associated with each of these constructs with small to medium effect sizes. When controlling for depression, anxiety, and COVID-19 impact, results from this preliminary study suggest that (a) difficulties with emotion regulation may be correlated with misophonia severity, and (b) misophonic responses, not number of triggers or perceived severity, are associated with difficulties with emotion regulation. Overall, these findings begin to suggest that emotion regulation is important to our understanding the risk factors and treatment targets for misophonia.
A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force was to ...review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment.
Task force members identified 24 questions relevant to the treatment of hypothyroidism. The clinical literature relating to each question was then reviewed. Clinical reviews were supplemented, when relevant, with related mechanistic and bench research literature reviews, performed by our team of translational scientists. Ethics reviews were provided, when relevant, by a bioethicist. The responses to questions were formatted, when possible, in the form of a formal clinical recommendation statement. When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. For clinical recommendations, the supporting evidence was appraised, and the strength of each clinical recommendation was assessed, using the American College of Physicians system. The final document was organized so that each topic is introduced with a question, followed by a formal clinical recommendation. Stakeholder input was received at a national meeting, with some subsequent refinement of the clinical questions addressed in the document. Consensus was achieved for all recommendations by the task force.
We reviewed the following therapeutic categories: (i) levothyroxine therapy, (ii) non-levothyroxine-based thyroid hormone therapies, and (iii) use of thyroid hormone analogs. The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones.
We concluded that levothyroxine should remain the standard of care for treating hypothyroidism. We found no consistently strong evidence for the superiority of alternative preparations (e.g., levothyroxine-liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. Some examples of future research needs include the development of superior biomarkers of euthyroidism to supplement thyrotropin measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including subgroup effects). Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile.
Abstract
Objective
To update the “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2009.
Participants
The ...participants include an Endocrine Society–appointed task force of nine experts, a methodologist, and a medical writer.
Evidence
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Consensus Process
Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.
Conclusion
Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person’s genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person’s affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments—appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)—should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
Gender affirmation is multidisciplinary treatment. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender.
The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association.
The Task Force ...identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document.
The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC.
The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
Abstract
We analyze the dust properties of 57 870
μ
m-selected dusty star-forming galaxies in GOODS-S using new deep Atacama Large Millimeter/Submillimeter Array 1.2, 2, and 3 mm continuum imaging ...together with other far-infrared through millimeter data. We fit the spectral energy distributions (SEDs) with optically thin modified blackbodies to constrain the emissivity indices and effective dust temperatures, finding a median emissivity index of
β
=
1.78
−
0.25
+
0.43
and a median temperature of
T
d
=
33.6
−
5.4
+
12.1
K. We observe a negative correlation between
β
and
T
d
. By testing several SED models, we determine that the derived emissivity indices can be influenced by opacity assumptions. Our temperature measurements are consistent with no evolution in dust temperature with redshift.
We apply an order-of-magnitude model of gas-assisted growth, known as pebble accretion, in a turbulent medium to suggest a reason why some systems form wide orbital separation gas giants while others ...do not. In contrast to traditional growth by ballistic collisions with planetesimals, growth by pebble accretion is not necessarily limited by doubling times at the highest core mass. Turbulence, in particular, can cause growth to bottleneck at lower core masses. We demonstrate how a combination of growth by planetesimal and pebble accretion limits the maximum semimajor axis where gas giants can form. We find that, for fiducial disk parameters, strong turbulence ( 10−2) restricts gas giant cores to form interior to a 40 au, while for weak turbulence, gas giants can form out to a 70 au. The correspondence between and semimajor axis depends on the sizes of small bodies available for growth. This dependence on turbulence and small-body size distribution may explain the paucity of wide orbital separation gas giants. We also show that while lower levels of turbulence ( 10−4) can produce gas giants far out in the disk, we expect these gas giants to be low-mass (M 1 MJ). These planets are not luminous enough to have been observed with the current generation of direct-imaging surveys, which could explain why wide orbital separation gas giants are currently observed only around A stars.
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