To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement, prior neurosurgery, and prior EVD placement.
To identify risk factors for EVD infections.
We reviewed all EVD insertions at our institution from March 2015 through May 2019 following implementation of a standardized infection control protocol for EVD insertion and maintenance. Cox regression was used to identify risk factors for EVD infections.
479 EVDs placed in 409 patients met inclusion criteria, and 9 culture-positive infections were observed during the study period. The risk of infection within 30 days of EVD placement was 2.2% (2.3 infections/1,000 EVD days). Coagulase-negative staphylococci were identified in 6 of the 9 EVD infections). EVD infection led to prolonged length of stay post–EVD-placement (23 days vs 16 days; P = .045). Cox regression demonstrated increased infection risk in patients with prior brain surgery associated with cerebrospinal fluid (CSF) diversion (HR, 8.08; 95% CI, 1.7–39.4; P = .010), CSF leak around the catheter (HR, 21.0; 95% CI, 7.0–145.1; P = .0007), and insertion site dehiscence (HR, 7.53; 95% CI, 1.04–37.1; P = .0407). Duration of EVD use >7 days was not associated with infection risk (HR, 0.62; 95% CI, 0.07–5.45; P = .669).
Risk factors associated with EVD infection include prior brain surgery, CSF leak, and insertion site dehiscence. We found no significant association between infection risk and duration of EVD placement.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
The purpose of this rejoinder is to emphasize several important areas of future research that were mentioned by one or both commentaries. First, the authors discuss issues related to multi-source assessment, such as the importance of further research on informant bias, and argue that the information gleaned from multiple sources is worth the added assessment burden. Second, they underscore the importance of longitudinal assessment both in capturing the treatment-relevant within-person processes through which personality pathology unfolds, as well as tracking therapeutic progress. They assert that a given measure’s ability to reliably and validly measure change over time should be considered when evaluating its clinical utility. Finally, they emphasize the need for greater attention to clinical utility of dimensional PD assessment measures.
The purpose of this chapter is to review the current state of the dimensional assessment of personality disorder (PD). The first part of the chapter serves as a review of the most well-established and commonly used measures of maladaptive personality traits. Measures that assess the psychosocial impairment associated with personality pathology also are reviewed. Areas of discontinuity among these measures (e.g., theoretical origin, method of scale construction, degree of correspondence with well-known trait dimensions, attention received in the empirical literature, degree of bipolarity of underlying dimensions) are emphasized, and the clinical utility of measures is evaluated. The second part of the chapter focuses on several controversial issues with which the field of dimensional PD assessment now is grappling. These issues include (a) the psychometric distinction of personality traits from personality functioning, (b) the incremental utility of adaptive trait assessment, (c) the question of maladaptive trait bipolarity, (d) facet-level differences versus domain-level similarity across competing PD trait models, and (e) the value of multi-source assessment.
Postnatal depression is a serious disorder affecting 10–20% of postpartum women. It has a negative impact on the whole family system and on the child's development.
It is important to identify possible risk factors for PND, due to its frequency and severity. It has been hypothesized that the hormonal fluctuatios of the immediate postpartum period could be a risk factor for the appearance of PND.
This study aimed at inquiring the possible correlation of hormonal parameters in the 1st week postpartum with the appearance of PND.
95 postpartum women were recruited, in the process of validating the Greek EPDS. Of them, 40 consented to give blood on the second postpartum day, so that the plasma levels of TSH, T4, T3, FSH, LH, Progesterone, Estradiol, Prolactin and Cortisol were measured. 81/95 women consented to be reassessed at 8 weeks postpartum, and 10/81 were diagnosed with depression, major or minor. Plasma levels of the hormones were correlated with the diagnosis of PND and with the EPDS.
Women who suffered from PND did not differ from the non-PND subjects in the levels of all measured hormones. There was a statistically significant negative correlation of the levels of prolactin with the EPDS on the second postpartum day (p < 0.001, correlation coefficient -0.56).
Our study failed to show a definite correlation of the hormonal levels in the immediate postpartum period with PND. In other studies the role of hormones in the appearance of PND remains as well questionable.
As in many sciences, description is an important component of theory, research, and practical applications in clinical psychology. Despite this, considerable disagreement exists regarding how to describe the diverse manifestations of psychopathology that clinicians and researchers have observed. The disagreements are such that translating research across descriptive psychopathology models can be difficult or impossible, impeding scientific progress. As this chapter reviews, at least four major descriptive psychopathology approaches exist – clinical theory, descriptive psychiatry, quantitative models, and biological models – each of which has unique goals, units of observation, theoretical concepts, and research traditions. Through reviewing these dominant approaches, it is illustrated how diverging language, concepts, and methods can impede communication between scientists and practitioners working within different descriptive approaches. Beyond this, specific emerging descriptive psychopathology models (i.e., HiTOP, RDoC, and transdiagnostic processes) are reviewed, which have primarily developed as a response to descriptive psychiatry’s limitations (e.g., DSM) and may advance clinical psychology. Despite the promise of these emerging descriptive models, each is still primarily rooted in one traditional descriptive approach and retains that approach’s limitations. Thus, the chapter concludes by discussing the need to integrate descriptive psychopathology approaches and the challenges associated with this task.
In this chapter, we review the current state of personality disorder (PD) assessment practices. The review includes both traditional measures that are rooted in categorical conceptualizations of PD and dimensional measures that have emerged in response to mounting evidence that has called into question the validity of traditional PD classification approaches. The scope of this chapter includes prominent and promising models and measures of PD. Moreover, our review is focused on omnibus measures that present a relatively “complete” picture of personality pathology rather than measures that focus on the features of only one or a limited set of PDs. Finally, we address two important topics relevant to PD assessment. First, we discuss the cross-cultural PD assessment literature, which is characterized by a relative lack of strong cross-cultural research on the manifestation and measurement of PD. Second, we address the disconnect between research and applied practice of PD assessment.
Wearable devices are fast evolving to address mobility and autonomy needs of elderly people who would benefit from physical assistance. Recent developments in soft robotics provide important opportunities to develop soft exoskeletons (also called exosuits) to enable both physical assistance and improved usability and acceptance for users. The XoSoft EU project has developed a modular soft lower limb exoskeleton to assist people with low mobility impairments. In this paper, we present the design of a soft modular lower limb exoskeleton to improve person’s mobility, contributing to independence and enhancing quality of life. The novelty of this work is the integration of quasi-passive elements in a soft exoskeleton. The exoskeleton provides mechanical assistance for subjects with low mobility impairments reducing energy requirements between 10% and 20%. Investigation of different control strategies based on gait segmentation and actuation elements is presented. A first hip–knee unilateral prototype is described, developed, and its performance assessed on a post-stroke patient for straight walking. The study presents an analysis of the human–exoskeleton energy patterns by way of the task-based biological power generation. The resultant assistance, in terms of power, was 10.9% ± 2.2% for hip actuation and 9.3% ± 3.5% for knee actuation. The control strategy improved the gait and postural patterns by increasing joint angles and foot clearance at specific phases of the walking cycle.
Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU admissions, and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes.
Depression and metabolic syndrome (MetS) are frequently comorbid disorders that are independently associated with premature mortality. Conversely, cardiorespiratory fitness (CRF) is associated with reduced mortality risk. These factors may interact to impact mortality; however, their effects have not been assessed concurrently. This analysis assessed the mortality risk of comorbid depression/MetS and the effect of CRF on mortality in those with depression/MetS.
Prospective study of 47 702 adults in the Cooper Center Longitudinal Study. Mortality status was attained from the National Death Index. History of depression was determined by patient response (yes or no) to a standardized medical history questionnaire. MetS was categorized using the American Heart Association/National Heart, Lung, and Blood Institute criteria. CRF was estimated from the final speed/grade of a treadmill graded exercise test.
13.9% reported a history of depression, 21.4% met criteria for MetS, and 3.0% met criteria for both MetS and history of depression. History of depression (HR = 1.24, p = 0.003) and MetS (HR = 1.28, p < 0.001) were independently associated with an increased mortality risk, with the greatest mortality risk among individuals with both a history of depression and MetS (HR = 1.59, p < 0.001). Higher CRF was associated with a significantly lower risk of mortality (p < 0.001) in all individuals, including those with MetS and/or a history of depression.
Those with higher levels CRF had reduced mortality risk in the context of depression/MetS. Interventions that improve CRF could have substantial impact on the health of persons with depression/MetS.
Oxtotitlán Cave paintings have been considered among the earliest in Mesoamerica on stylistic grounds, but confirmation of this hypothesis through absolute dating has not been attempted until now. We describe the application of advanced radiocarbon strategies developed for situations such as caves with high carbon backgrounds. Using a low-temperature plasma oxidation system, we dated both the ancient paint and the biogenic rock coatings that cover the paint layers at Oxtotitlán. Our research has significantly expanded the time frame for the production of polychrome rock paintings encompassing the Early Formative and Late Formative/Early Classic periods, statistically spanning a long era from before ca. 1500 cal B.C. to cal A.D. 600.
The bilayer pseudospin field effect transistor (BiSFET) is intended to enable much lower voltage and power operation than possible with complementary metal–oxide–semiconductor (CMOS) field effect transistor (FET)-based logic [1, 2]. The ultimate limits of CMOS are not due to fabrication technology limitations. Rather, they are intrinsic to its operating principles, defined by basic physics such as charge carrier thermionic emission over the channel barrier and quantum mechanical tunneling through it. New operating principles are required. The BiSFET relies on the possibility of room temperature excitonic (electron-hole) superfluid condensation in two dielectrically separated graphene layers [3, 4]. While the physics is interesting in its own right, from the device point of view this many-body physics brings with it the possibility of a strong sensitivity to sub-thermal voltages (sub-kBT/q voltages, where kB is Boltzmann’s constant, T is the temperature in Kelvin, and q is the magnitude of electron charge) in the current–voltage (I–V) characteristics [5–7]. With power consumption proportional to the square of voltage, use of voltages on the scale of or less than room temperature kBT/q ≈ 26 mV offers order of magnitude reductions in switching energies as compared to even end-of-the roadmap CMOS . Circuit simulation with 25 mV power supplies show switching energies on the scale of 10 zeptojoules (zJ) per BiSFET (where 1 zJ = 10–21 J = 10–3 aJ)! However, with this potential for voltage reduction also come I–V characteristics much different from those of MOSFETs that must be worked around at worst, and may provide new circuit opportunities at best. In terms of interconnects, information would continue to be passed via charge among devices. In this way, BiSFETs would also be compatible with existing electronic devices after voltage level shifts.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.