Community and Clinical Epidemiology of Borderline Personality Disorder

Several studies of the prevalence of Borderline Personality Disorder (BPD) in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence of BPD is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, BPD prevalence is around 10-12% in outpatient psychiatric clinics and 20-22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of BPD in other clinical settings (e.g., primary care) and to investigate the impact of demographic variables on BPD prevalence

Does \u27Fear of Dying\u27 Indicate a More Severe Presentation of Panic Disorder?

Research suggests a relationship between the presence of fearful cognitions and panic disorder (PD) severity. With little existing evidence addressing the clinical significance of individual panic-cognitions, the current study examined presentation and impairment differences among 331 outpatients with PD according to whether they experience “fear of dying” (FOD) during panic attacks. Patients reporting FOD (n = 153) were compared to patients denying FOD (n = 178) on variables indicating PD severity (e.g., number of symptoms) and psychiatric impairment (e.g., hospitalizations). PD patients with FOD reported a greater number of panic symptoms, agoraphobia diagnoses, and were more likely to be seeking treatment primarily for PD. We found no clinical impairment or comorbidity differences between groups. Results suggest that panic attacks with FOD are related to a more acute presentation of PD. Such results substantiate past research connecting cognitive distress and PD severity and further suggest that FOD may be particularly relevant to this relationship

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

Although dimensional models of borderline personality disorder (BPD) are consistent with findings showing that minimal levels of pathology are associated with substantial increases in psychosocial impairment, it is still unclear whether different individual BPD criteria are each clinically significant on their own. The current study uses semistructured interview data from 1,870 adults presenting for outpatient psychiatric treatment to investigate whether the BPD criteria of impulsivity, affective instability, emptiness, and anger are each related to psychosocial morbidity when met in the absence of the other eight criteria. Analyses showed that each of these criteria was associated with dysfunction in comparison with a control group meeting zero BPD criteria, but only the emptiness criterion was a marker of impairment on all indices of psychosocial morbidity: suicidality, history of suicide attempts and psychiatric hospitalizations, social and work dysfunction, Axis I comorbidity, and global functioning. Implications for the study of borderline pathology are discussed

The ALMaQUEST survey – III. Scatter in the resolved star-forming main sequence is primarily due to variations in star formation efficiency

Using a sample of 11,478 spaxels in 34 galaxies with molecular gas, star formation and stellar maps taken from the ALMA-MaNGA QUEnching and STar formation (ALMaQUEST) survey, we investigate the parameters that correlate with variations in star formation rates on kpc scales. We use a combination of correlation statistics and an artificial neural network to quantify the parameters that drive both the absolute star formation rate surface density (Sigma_SFR), as well as its scatter around the resolved star forming main sequence (Delta Sigma_SFR). We find that Sigma_SFR is primarily regulated by molecular gas surface density (Sigma_H2) with a secondary dependence on stellar mass surface density (Sigma_*), as expected from an `extended Kennicutt-Schmidt relation'. However, Delta Sigma_SFR is driven primarily by changes in star formation efficiency (SFE), with variations in gas fraction playing a secondary role. Taken together, our results demonstrate that whilst the absolute rate of star formation is primarily set by the amount of molecular gas, the variation of star formation rate above and below the resolved star forming main sequence (on kpc scales) is primarily due to changes in SFE

The Role of Emotion Regulation Difficulties in the Connection Between Childhood Emotional Abuse and Borderline Personality Features

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the role of emotion dysregulation as a mediator between childhood abuse and borderline personality disorder (BPD) feature severity among a sample of 964 adults presenting for treatment at an outpatient clinic. A structural equation model suggested that emotional abuse relates to BPD features both directly and through difficulties with emotion regulation, whereas physical abuse showed only a weak indirect relation with BPD features. There was no link between sexual abuse and BPD feature severity in the model. Results add specificity to etiological theories of BPD and suggest that future research in treatment should focus on developing and strengthening emotion regulation strategies in clinical populations with a history of emotional abuse. Clinicians should be sure to assess the presence of childhood emotional abuse in addition to sexual and physical abuse

Cardiovascular disease in a cohort exposed to the 1940-45 Channel Islands occupation

BACKGROUND To clarify the nature of the relationship between food deprivation/undernutrition during pre- and postnatal development and cardiovascular disease (CVD) in later life, this study examined the relationship between birth weight (as a marker of prenatal nutrition) and the incidence of hospital admissions for CVD from 1997–2005 amongst 873 Guernsey islanders (born in 1923–1937), 225 of whom had been exposed to food deprivation as children, adolescents or young adults (i.e. postnatal undernutrition) during the 1940–45 German occupation of the Channel Islands, and 648 of whom had left or been evacuated from the islands before the occupation began. METHODS Three sets of Cox regression models were used to investigate (A) the relationship between birth weight and CVD, (B) the relationship between postnatal exposure to the occupation and CVD and (C) any interaction between birth weight, postnatal exposure to the occupation and CVD. These models also tested for any interactions between birth weight and sex, and postnatal exposure to the occupation and parish of residence at birth (as a marker of parish residence during the occupation and related variation in the severity of food deprivation). RESULTS The first set of models (A) found no relationship between birth weight and CVD even after adjustment for potential confounders (hazard ratio (HR) per kg increase in birth weight: 1.12; 95% confidence intervals (CI): 0.70 – 1.78), and there was no significant interaction between birth weight and sex (p = 0.60). The second set of models (B) found a significant relationship between postnatal exposure to the occupation and CVD after adjustment for potential confounders (HR for exposed vs. unexposed group: 2.52; 95% CI: 1.54 – 4.13), as well as a significant interaction between postnatal exposure to the occupation and parish of residence at birth (p = 0.01), such that those born in urban parishes (where food deprivation was worst) had a greater HR for CVD than those born in rural parishes. The third model (C) found no interaction between birth weight and exposure to the occupation (p = 0.43). CONCLUSION These findings suggest that the levels of postnatal undernutrition experienced by children, adolescents and young adults exposed to food deprivation during the 1940–45 occupation of the Channel Islands were a more important determinant of CVD in later life than the levels of prenatal undernutrition experienced in utero prior to the occupatio

The ALMaQUEST Survey - II. What drives central starbursts at z ∼ 0?

Starburst galaxies have elevated star formation rates (SFRs) for their stellar mass. In Ellison et al., we used integral field unit maps of SFR surface density (ΣSFR) and stellar mass surface density (Σ⋆) to show that starburst galaxies in the local universe are driven by SFRs that are preferentially boosted in their central regions. Here, we present molecular gas maps obtained with the Atacama Large Millimeter Array (ALMA) observatory for 12 central starburst galaxies at z ∼ 0 drawn from the Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) survey. The ALMA and MaNGA data are well matched in spatial resolution, such that the ALMA maps of molecular gas surface density (⁠ΣH2⁠) can be directly compared with MaNGA maps at kpc-scale resolution. The combination of ΣH2⁠, Σ⋆ and ΣSFR at the same resolution allow us to investigate whether central starbursts are driven primarily by enhancements in star formation efficiency (SFE) or by increased gas fractions. By computing offsets from the resolved Kennicutt-Schmidt relation (⁠ΣH2 versus ΣSFR) and the molecular gas main sequence (Σ⋆ versus ΣH2⁠), we conclude that the primary driver of the central starburst is an elevated SFE. We also show that the enhancement in ΣSFR is accompanied by a dilution in O/H, consistent with a triggering that is induced by metal poor gas inflow. These observational signatures are found in both undisturbed (9/12 galaxies in our sample) and recently merged galaxies, indicating that both interactions and secular mechanisms contribute to central starbursts

How Sales Taxes Affect Customer and Firm Behavior: The Role of Search on the Internet

When a multichannel retailer opens its first retail store in a state, the firm is obligated to collect sales taxes on all Internet and catalog orders shipped to that state. This article assesses how opening a store affects Internet and catalog demand. The authors analyze purchase behavior among customers who live far from the retail store but must now pay sales taxes on catalog and Internet purchases. A comparable group of customers in a neighboring state serves as a control. The results show that Internet sales decrease significantly, but catalog sales are unaffected. Further investigation indicates that the difference in these outcomes is partly attributable to the ease with which customers can search for lower prices at competing retailers. The authors extend the analysis to a panel of multichannel firms and show that retailers that earn a large proportion of their revenue from direct channels avoid opening a first store in high-tax states. They conclude that current U.S. sales taxes laws have significant effects on both customer and firm behavior

Latent class regression improves the predictive acuity and clinical utility of survival prognostication amongst chronic heart failure patients

The present study aimed to compare the predictive acuity of latent class regression (LCR) modelling with: standard generalised linear modelling (GLM); and GLMs that include the membership of subgroups/classes (identified through prior latent class analysis; LCA) as alternative or additional candidate predictors. Using real world demographic and clinical data from 1,802 heart failure patients enrolled in the UK-HEART2 cohort, the study found that univariable GLMs using LCA-generated subgroup/class membership as the sole candidate predictor of survival were inferior to standard multivariable GLMs using the same four covariates as those used in the LCA. The inclusion of the LCA subgroup/class membership together with these four covariates as candidate predictors in a multivariable GLM showed no improvement in predictive acuity. In contrast, LCR modelling resulted in a 18–22% improvement in predictive acuity and provided a range of alternative models from which it would be possible to balance predictive acuity against entropy to select models that were optimally suited to improve the efficient allocation of clinical resources to address the differential risk of the outcome (in this instance, survival). These findings provide proof-of-principle that LCR modelling can improve the predictive acuity of GLMs and enhance the clinical utility of their predictions. These improvements warrant further attention and exploration, including the use of alternative techniques (including machine learning algorithms) that are also capable of generating latent class structure while determining outcome predictions, particularly for use with large and routinely collected clinical datasets, and with binary, count and continuous variables

Vascular Manifestations of COVID-19 -Thromboembolism and Microvascular Dysfunction

The coronavirus pandemic has reportedly infected over 22 million individuals and caused over 778,000 deaths worldwide. This novel coronavirus, officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although primarily causes significant respiratory distress, can have significant deleterious effects on the cardiovascular system. Severe cases of the virus frequently result in respiratory distress requiring mechanical ventilation, often seen, but not confined to, individuals with pre-existing hypertension and cardiovascular disease, potentially due to the fact that the virus can enter the circulation via the lung alveoli. Here the virus can directly infect vascular tissues, via TMPRSS2 spike glycoprotein priming, thereby facilitating ACE-2-mediated viral entry. Clinical manifestations, such as vasculitis, have been detected in a number of vascular beds (e.g. lungs, heart, and kidneys), with thromboembolism being observed in patients suffering from severe coronavirus disease (COVID-19), suggesting the virus perturbs the vasculature, leading to vascular dysfunction. Activation of endothelial cells via the immune-mediated inflammatory response and viral infection of either endothelial cells or cells involved in endothelial homeostasis, are some of the multifaceted mechanisms potentially involved in the pathogenesis of vascular dysfunction within COVID-19 patients. In this review, we examine the evidence of vascular manifestations of SARS-CoV-2, the potential mechanism(s) of entry into vascular tissue and the contribution of endothelial cell dysfunction and cellular crosstalk in this vascular tropism of SARS-CoV-2. Moreover, we discuss the current evidence on hypercoagulability and how it relates to increased microvascular thromboembolic complications in COVID-19