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The search for mechanisms in personality disorders (PDs) is of growing importance, because PDs are prevalent, costly, and challenging to treat. Unfortunately, there is a dearth of compelling mechanistic research on PDs and psychopathology more broadly, due to equivocal definitions of a “mechanism” and study designs that are atheoretical and/or ill-suited for causal inferences.This chapter defines mechanisms as elements of possible causal sequence, which not only increase the probability of observed outcomes but also reveal how the outcomes occur. In addition, the authors argue that it is not always necessary to break down a mechanism to its most elemental physical parts; rather, it is important to consider how mechanisms act as complex, interacting components of a causal chain, with a focus on those that could serve as viable targets for prevention and intervention. Considering this broader definition of a “mechanism,” it is crucial that PD researchers ground their work in testable theories, such as those considering dimensional, transdiagnostic precursors to PDs. In this chapter, the authors also address various design and statistical considerations in PD mechanistic research and highlight promising developments in identifying mechanisms of PDs across multiple levels of measurement (e.g., biological, contextual, environmental) and across the lifespan.
This rejoinder addresses commentaries by Markon and Bornovalova and colleagues. Markon highlighted challenges associated with determining cause and effect in mechanistic research. He theorized that “weak emergence” may account, in part, for the complex development of personality pathology. Bornovalova and colleagues addressed transactional relations between various phenomena that may influence development of personality pathology over time. In this rejoinder, the authors build upon these commentaries to further highlight challenges associated with identifying true mechanisms in psychopathology. They hypothesize that dynamical systems models, which conceptualize people as systems open to incalculable environmental influences, may provide an alternative approach through which researchers can examine complex mechanisms more accurately. Although such models are nascent in clinical research, particularly in the context of personality disorders, these approaches may provide more nuanced interpretations of mechanisms and may ultimately enrich our understanding of processes underlying the emergence of personality disorders.
This chapter provides an insight into the role of systems science for sustainability assessment. In the first part, we present seven axioms that have been derived from system-theoretical perspectives and show their relevance for sustainability assessment. Following these axioms, we propose a way to structure and analyze systems following four system characteristics: (1) system boundary and interactions with the external environment; (2) purpose, goals, and associated decision-making drivers and criteria for the system; (3) system structure (subsystems, elements, and their interactions), dynamics, and emerging behavior; and (4) system information, outcomes monitoring, and learning. These four characteristics were applied to study, first, the historical development of the energy system analysis and, second, an Australian urban systems-transformation initiative. The systems-analysis framework presented provides a good basis for putting the elements of a system analysis into their broader context, and designing purposeful interventions. Especially for more transformational change, the alignment of stakeholder values, institutional arrangements, and available knowledge become key leverage points.
No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment.
From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment.
Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043).
Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.
To establish whether a dementia intensive support (DIS) service that is part of a crisis resolution and home treatment team for older people is preventing admissions to acute hospital and psychiatric wards. The number of referrals in 2017 to the DIS service was established and those admitted to hospital ascertained. Senior doctors examined 30 sets of notes in detail and reached a conclusion on whether DIS had contributed to admission prevention. This information was then re-examined in two meetings with at least eight senior psychiatrists present. A consensus opinion was then reached as to whether DIS had contributed to admission prevention in each case.
Over 12 months, 30/171 patients (18%) referred were admitted to hospital. For the subset of 30 referrals examined in detail, DIS contributed to admission avoidance in 21 cases (70%).
Our evaluation demonstrates that the DIS service is an effective way of preventing admission.
Radar sounding is a powerful geophysical approach for characterizing the subsurface conditions of terrestrial and planetary ice masses at local to global scales. As a result, a wide array of orbital, airborne, ground-based, and in situ instruments, platforms and data analysis approaches for radioglaciology have been developed, applied or proposed. Terrestrially, airborne radar sounding has been used in glaciology to observe ice thickness, basal topography and englacial layers for five decades. More recently, radar sounding data have also been exploited to estimate the extent and configuration of subglacial water, the geometry of subglacial bedforms and the subglacial and englacial thermal states of ice sheets. Planetary radar sounders have observed, or are planned to observe, the subsurfaces and near-surfaces of Mars, Earth's Moon, comets and the icy moons of Jupiter. In this review paper, and the thematic issue of the Annals of Glaciology on ‘Five decades of radioglaciology’ to which it belongs, we present recent advances in the fields of radar systems, missions, signal processing, data analysis, modeling and scientific interpretation. Our review presents progress in these fields since the last radio-glaciological Annals of Glaciology issue of 2014, the context of their history and future prospects.
The mechanism through which developmental programming of offspring overweight/obesity following in utero exposure to maternal overweight/obesity operates is unknown but may operate through biologic pathways involving offspring anthropometry at birth. Thus, we sought to examine to what extent the association between in utero exposure to maternal overweight/obesity and childhood overweight/obesity is mediated by birth anthropometry. Analyses were conducted on a retrospective cohort with data obtained from one hospital system. A natural effects model framework was used to estimate the natural direct effect and natural indirect effect of birth anthropometry (weight, length, head circumference, ponderal index, and small-for-gestational age [SGA] or large-for-gestational age [LGA]) for the association between pre-pregnancy maternal body mass index (BMI) category (overweight/obese vs normal weight) and offspring overweight/obesity in childhood. Models were adjusted for maternal and child socio-demographics. Three thousand nine hundred and fifty mother–child dyads were included in analyses (1467 [57.8%] of mothers and 913 [34.4%] of children were overweight/obese). Results suggest that a small percentage of the effect of maternal pre-pregnancy BMI overweight/obesity on offspring overweight/obesity operated through offspring anthropometry at birth (weight: 15.5%, length: 5.2%, head circumference: 8.5%, ponderal index: 2.2%, SGA: 2.9%, and LGA: 4.2%). There was a small increase in the percentage mediated when gestational diabetes or hypertensive disorders were added to the models. Our study suggests that some measures of birth anthropometry mediate the association between maternal pre-pregnancy overweight/obesity and offspring overweight/obesity in childhood and that the size of this mediated effect is small.
Addressing rural health disparities has unique challenges that require cross-sector collaborations to address social determinants of health and help those in need to get connected to care continuum. We brought the Clinical and Translational Science Award, Institutional Development Award Program Infrastructure for Clinical and Translational Research, and Cooperative Extension System Programs together for a one-day semi-structured meeting to discuss collaborative opportunities to address rural health disparities. Session notes and event materials were analyzed for themes to facilitate collaboration such as defining rural, critical issues, and organizational strengths in support of collaboration. Across 16 sessions, there were 26 broad topics of discussion. The most frequent topics included “barriers and challenges,” “strategies and opportunities,” and “defining rural.” There is a growing understanding of the opportunity that collaboration between these large programs provides in addressing rural health disparities.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
The middle (Wuliuan Stage) Cambrian Burgess Shale is famous for its exceptional preservation of diverse and abundant soft-bodied animals through the “thick” Stephen Formation. However, with the exception of the Walcott Quarry (Fossil Ridge) and the stratigraphically older Tulip Beds (Mount Stephen), which are both in Yoho National Park (British Columbia), quantitative assessments of the Burgess Shale have remained limited. Here we first provide a detailed quantitative overview of the diversity and structure of the Marble Canyon Burgess Shale locality based on 16,438 specimens. Located 40 km southeast of the Walcott Quarry in Kootenay National Park (British Columbia), Marble Canyon represents the youngest site of the “thick” Stephen Formation. We then combine paleoecological data sets from Marble Canyon, Walcott Quarry, Tulip Beds, and Raymond Quarry, which lies approximately 20 m directly above the Walcott Quarry, to yield a combined species abundance data set of 77,179 specimens encompassing 234 species-level taxa. Marble Canyon shows significant temporal changes in both taxonomic and ecological groups, suggesting periods of stasis followed by rapid turnover patterns at local and short temporal scales. At wider geographic and temporal scales, the different Burgess Shale sites occupy distinct areas in multivariate space. Overall, this suggests that the Burgess Shale paleocommunity is far patchier than previously thought and varies at both local and regional scales through the “thick” Stephen Formation. This underscores that our understanding of Cambrian diversity and ecological networks, particularly in early animal ecosystems, remains limited and highly dependent on new discoveries.
Healthcare-facility–onset C.difficile LabID events are defined as positive stool samples collected >3 days after hospitalization. Using a definition of >72 hours, we found that 84 of 1013 cases (8.3%) identified as C. difficile LabID events were collected between 48 and 72 hours after admission.
A collaborative research model was developed and tested to enable regional healthcare systems to join multisite clinical trials emanating from the Clinical and Translational Science Award (CTSA) Trial Innovation Network (TIN) by the Institute of Translational Health Sciences at the University of Washington and the Northwest Participant and Clinical Interactions (NW PCI) Network. The NW PCI is a collaborative group of regional research programs located at medical centers, healthcare systems, and universities across Washington, Wyoming, Alaska, Montana, and Idaho. This article describes the purpose, development, barriers, and initial experience with feasibility assessment for TIN-supported studies in the NW PCI. The tools and processes of the NW PCI Network were adapted to enable network sites to assess studies for clinical relevance and feasibility. Seven of seventeen TIN-supported studies were reviewed for consideration; three of which resulted in successful completion of study documentation for site selection by NW PCI sites. The NW PCI/TIN model can be adapted by other CTSAs to increase involvement of regional research programs in national multisite clinical research studies. Barriers to expanding TIN-supported trials to regional networks include short timelines for study document submissions, insufficient site reimbursement rates, and non-feasible study designs.
The prenatal detection of structural cardiac malformations has greatly benefited from the advances in echo Doppler technology and the in-depth training of specialists in this area. This opens up new possibilities, now and in the future, for developing in utero therapies. It also allows a better knowledge of the underlying mechanisms and developmental timing that lead to structural congenital heart disease (CHD), based on a marked progress involving genetic and epigenetic causes. Gene mutations are discovered in the fetus and parents, and pathways can be unraveled using mouse transgene technology. Epigenetic causes are also receiving attention, but have thus far been underestimated as approximately 85% of CHD is determined to have a multifactorial background that combines a genetic susceptibility with epigenetic influences. Studies in animal models, including chicken, quail, zebrafish, and even more primitive Chordates, contribute relevant data. In essence, cardiac development shows basic similarities of the major processes involved between species. Therefore mechanisms unraveled in animal models can be reliably used in understanding normal human cardiac development and CHD .
Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India.
We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression.
We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98–1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small.
Geographic accessibility – as measured by travel distance – is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.
The “resource-rational” approach is ambitious and worthwhile. A shortcoming of the proposed approach is that it fails to constrain what counts as a constraint. As a result, constraints used in different cognitive domains often have nothing in common. We describe an alternative framework that satisfies many of the desiderata of the resource-rational approach, but in a more disciplined manner.
The detection of fireballs streaks in astronomical imagery can be carried out by a variety of methods. The Desert Fireball Network uses a network of cameras to track and triangulate incoming fireballs to recover meteorites with orbits and to build a fireball orbital dataset. Fireball detection is done on-board camera, but due to the design constraints imposed by remote deployment, the cameras are limited in processing power and time. We describe the processing software used for fireball detection under these constrained circumstances. Two different approaches were compared: (1) A single-layer neural network with 10 hidden units that were trained using manually selected fireballs and (2) a more traditional computational approach based on cascading steps of increasing complexity, whereby computationally simple filters are used to discard uninteresting portions of the images, allowing for more computationally expensive analysis of the remainder. Both approaches allowed a full night’s worth of data (over a thousand 36-megapixel images) to be processed each day using a low-power single-board computer. We distinguish between large (likely meteorite-dropping) fireballs and smaller fainter ones (typical ‘shooting stars’). Traditional processing and neural network algorithms both performed well on large fireballs within an approximately 30 000-image dataset, with a true positive detection rate of 96% and 100%, respectively, but the neural network was significantly more successful at smaller fireballs, with rates of 67% and 82%, respectively. However, this improved success came at a cost of significantly more false positives for the neural network results, and additionally the neural network does not produce precise fireball coordinates within an image (as it classifies). Simple consideration of the network geometry indicates that overall detection rate for triangulated large fireballs is calculated to be better than 99.7% and 99.9%, by ensuring that there are multiple double-station opportunities to detect any one fireball. As such, both algorithms are considered sufficient for meteor-dropping fireball event detection, with some consideration of the acceptable number of false positives compared to sensitivity.
Propagating inhomogeneous electromagnetic waves called surface plasmon polaritons (SPPs) can be excited by free-space beams on corrugated conducting surfaces at resonance angles determined by corrugation period, permittivity, and optical frequency. SPPs are coupled to and co-propagate with surface charge displacements. Complete electrical isolation of individual conducting corrugations prevents the charge displacement necessary to sustain an SPP, such that excitation resonances of traveling SPPs are absent. However, SPPs can be excited via electric induction if a smooth conducting surface exists below and nearby the isolated conducting corrugations. The dependence of SPP excitation resonances on that separation is experimentally investigated here at long-wave infrared wavelengths. We find that excitation resonances for traveling SPPs broaden and disappear as the dielectric’s physical thickness is increased beyond ∼1% of the free-space wavelength. The resonance line width increases with refractive index and optical thickness of the dielectric.
The Minnesota Center for Twin and Family Research (MCTFR) comprises multiple longitudinal, community-representative investigations of twin and adoptive families that focus on psychological adjustment, personality, cognitive ability and brain function, with a special emphasis on substance use and related psychopathology. The MCTFR includes the Minnesota Twin Registry (MTR), a cohort of twins who have completed assessments in middle and older adulthood; the Minnesota Twin Family Study (MTFS) of twins assessed from childhood and adolescence into middle adulthood; the Enrichment Study (ES) of twins oversampled for high risk for substance-use disorders assessed from childhood into young adulthood; the Adolescent Brain (AdBrain) study, a neuroimaging study of adolescent twins; and the Siblings Interaction and Behavior Study (SIBS), a study of adoptive and nonadoptive families assessed from adolescence into young adulthood. Here we provide a brief overview of key features of these established studies and describe new MCTFR investigations that follow up and expand upon existing studies or recruit and assess new samples, including the MTR Study of Relationships, Personality, and Health (MTR-RPH); the Colorado-Minnesota (COMN) Marijuana Study; the Adolescent Brain Cognitive Development (ABCD) study; the Colorado Online Twins (CoTwins) study and the Children of Twins (CoT) study.