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This chapter focuses on advancements in the understanding of personality pathology gained from structural and functional neuroimaging studies. It draws from the literature on the most widely researched personality disorders including schizotypal, borderline, and antisocial personality disorder. Prominent findings in schizotypal personality disorder include abnormalities in temporal and frontal lobe volumes, decreased structural connectivity of temporal lobe regions, and inefficient recruitment of brain areas during task performance. In borderline personality disorder, neuroimaging findings are characterized by aberrant volume and activity of limbic and prefrontal brain areas that suggest diminished top-down control of affective responsivity. Studies in antisocial personality disorder reveal reduced volume in prefrontal and temporal lobe structures, white matter structure compromise, and altered brain network functional connectivity. Significant challenges in studying this complex population and limitations of current methodology are discussed. Suggestions for future directions of research in this field are provided.
This rejoinder uses the neuroimaging literature on affect regulation to exemplify how integration of complementary methods suggested by the commentaries could advance neurobiological understanding of personality disorders. It illustrates progressive insights gained from incorporating multiple sources of evidence including neuroimaging, genetics, and behavioral data associated with affect regulation. It also demonstrates the use of brain pattern activation analysis in addition to studying individual regions of interest to better understand the complex relationships between biological genotype, brain activity, and behavioral phenotype. The ways in which neuroimaging can serve as an endophenotype to bridge the gap between genes and distant phenotypes are highlighted.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
We argue that general social psychological mechanisms (e.g., common group identity) can account for prosocial behavior and cooperative norms without the need for punishing Big Gods. Moreover, prosocial religions often do not prevent conflict within their religious groups. Hence, we doubt whether Big Gods and prosocial religions are more effective than alternative identities in enhancing high-level cooperation.
In this article, we report results from a new study that surveyed a large, national sample of American adults about their willingness to pay for health reform. As in previous work, we find that self-identified Republicans, older Americans, and high-income Americans are less supportive of reform. However, these basic findings mask three important features of public opinion. First, income has a substantial effect on support for reform, even holding political affiliation constant. Indeed, income is the most important determinant of support for reform. Second, the negative effects of income on support for reform begin early in the income distribution, at annual family income levels of $25,000 to $50,000. Third, although older Americans have a less favorable view of reform than the young, much of their opposition is due to dislike of large policy changes than to reform per se.
Poly(methylsilsesquioxane) (PMSSQ) based hybrid materials are promising candidates to produce substrate-independent stable and adherent surface coatings. Usually these materials are synthesized by controlled radical polymerization from inorganic precursors. The presented synthetic pathway in here demonstrates how to graft PMSSQ networks from an endgroup-functionalized organic polymer and thus enlarges the range of accessible inorganic/organic hybrid coating materials.
David J. Becker, assistant professor, University of Alabama Birmingham's Department of Health Care Organization and Policy.,
Daniel P. Kessler, professor, Stanford University Graduate School of Business
In theory, the medical malpractice liability system operates according to the “negligence rule”: Doctors are responsible for the costs of injuries that they negligently cause. The negligence rule should lead doctors' private decisions about whether and how to practice medicine to reflect society's overall interests, by leading them to balance the benefits of medical care, the costs of precaution, and the costs of negligence.
Imperfections in markets for health care and the liability system, however, mean that the negligence rule may not provide incentives for appropriate medical care in practice. It may lead doctors to take insufficient precautions against medical injuries or may lead to “defensive medicine” – medical practice based on fear of legal liability rather than on patients' best interests.
This indeterminacy has led to an extensive empirical debate over tort policy. What are the effects of the medical liability system on the cost and quality of care? What reforms to the system have the potential to reduce cost and improve quality?
This chapter reviews existing research on these questions. The first section outlines why understanding the effects of the liability system on the cost and quality of care is an important empirical issue. The second section summarizes the empirical evidence about the effects of the system and the effects of conventional “tort reforms” – changes to state law that seek to reduce liability. In brief, the empirical evidence supports the hypothesis that the existing system encourages defensive medicine, and that tort reforms reduce its prevalence.
Phase-field models, the simplest of which is Allen–Cahn's
problem, are characterized by a small parameter ε that dictates
the interface thickness. These models naturally call for mesh adaptation
techniques, which rely on a posteriori error control.
However, their error analysis usually deals with the
underlying non-monotone nonlinearity via a Gronwall argument which
leads to an exponential dependence on ε-2. Using an energy argument
combined with a
topological continuation argument and a spectral estimate, we
establish an a posteriori error control result with only a low order
polynomial dependence in ε-1. Our result is applicable to
any conforming discretization technique that allows for a
posteriori residual estimation. Residual estimators for an
adaptive finite element scheme are derived to illustrate the theory.
Pilón Lajas Biosphere Reserve and Communal Lands (Pilón Lajas) ranges from 300 m to 1,400 m altitude in the
departments of Beni and La Paz, Bolivia. It is located in the Bolivian and Peruvian lower yungas Endemic Bird Area
(054) and within one of the regions of highest conservation priority in the Neotropics. Pilón Lajas includes primary
evergreen tropical lowland forest, foothill forest, and lower montane forest. Vegetation heterogeneity forms the basis
for the high species richness of the area. A population of approximately 600 Chiman, Moseten and Tacana indigenous
people live within the reserve. Little has been published regarding the avifauna of Pilón Lajas. Here we present the
results of visual observations and tape recordings of 22 ornithological surveys, recording 502 bird species. Serranía
Pilón is the most intensively studied and species-rich mountain range with 332 species, 48 of which have been recorded
only in this area within Pilón Lajas. We present 26 new departmental records and evidence of breeding for 42 species.
The reserve protects three globally Vulnerable and three globally Near Threatened species, four species of High
Conservation Priority and 32 of Medium Conservation Priority. Together with Madidi National Park and the adjacent
Bahuaja Sonene National Park in south-eastern Peru, Pilón Lajas forms a unique protected area system of more than
3.5 million ha and plays an important role in the establishment of biological corridors along the eastern Andean slope
Electoral-connection theories of legislative politics view bill cosponsorship as low-cost position taking by rational legislators who communicate with target audiences (e.g., constituents) external to the legislature. Legislative signaling games suggest a view of bill cosponsorship in which early cosponsors attempt to communicate to target audiences (e.g., the median voter) within the legislature. Using data from the 103rd U.S. House of Representatives, we show that the timing of legislators' cosponsorship decisions are more supportive of cosponsorship as intralegislative signaling than as extralegislative position taking. First, policy extremists on both sides of the political spectrum are more likely than moderates to be initial endorsers of legislative initiatives. Second, extremist-moderate differences diminish over the course of bill histories.
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