Dyadic Parent-Adolescent Role Confusion Dimensions: Development and Validation of an Observational Coding Scale

When parents lack the psychological resources necessary to meet their own emotional and interpersonal needs, they may look to offspring to meet caregiving, social, or romantic needs, which may lead to deviation from typical parent-child roles. Subsequently, a child may attempt to fill this role to maintain significant caregiver attachment and engage in role confusion. Three dimensions of role confusion have been proposed: adolescent as parent, adolescent as peer, and adolescent as partner. Existing research demonstrates overall role confusion relates to offspring borderline features, however there is a lack of empirical understanding of how parent-adolescent role confusion dimensions relate to offspring outcomes, namely behavioral problems and borderline features (affective instability, identity disturbance, negative relationships, self-harm/impulsivity; Morey, 1991). There are no existing observational systems to assess all three dimensions among parent-adolescent dyads. Because offspring may internalize and transmit role-confused dynamics intergenerationally, it is important to investigate role confusion dimensions to inform family-based interventions to address problematic family relations. The current study validated a new observational coding scale (Dyadic Parent-Adolescent Role Confusion Scale, DPARCS) for assessing the three dimensions of dyadic parent-adolescent role confusion. We validated the DPARCS by establishing criterion and discriminant validity for overall role confusion and dimensions with known groups of maternal diagnostic status and known correlates of adolescent behavioral problems and borderline symptomatology. Specifically, adolescent as parent role confusion uniquely related to adolescent identity disturbance, and adolescent as peer role confusion to adolescent negative relationships. This scale validation provides empirical support for the importance of examining role confusion dimensions and offers implications for future research and treatment for role confusion, risk factors, and adolescent functioning

Observing Parenting in the Context of Maternal Borderline Personality Disorder and Adolescent Symptomatology

Borderline personality disorder (BPD) is a severe and chronic disorder characterized by a distorted sense of self, fear of abandonment, and difficulties forming and maintaining relationships. Two empirically supported developmental antecedents of offspring borderline features include invalidating parenting practices and maternal BPD. Recent research found that parental psychological control is one type of invalidating parenting behavior that is related to maternal borderline symptoms. The current study observed maternal psychologically controlling behaviors among a sample of 56 adolescents ages 14-18 and their mothers, who were divided into groups of those diagnosed with BPD (n = 28) and those who did not have the disorders (n = 28). Results revealed that maternal psychological control was positively associated with mothers’ borderline features. Further, mothers with BPD used more psychological control compared to normative mothers. Post-hoc findings also demonstrated that maternal psychological control used by mothers with BPD differed based on adolescent gender. Additionally, analyses investigated at adolescent outcomes and revealed a positive correlation between maternal psychological control and adolescent borderline features and internalizing and externalizing symptoms. The empirical and clinical implications of the associations of psychological control with both maternal BPD and adolescent outcomes are discussed

Risk factors for 30-day mortality in patients with methicillin-resistant Staphylococcus aureus bloodstream infections

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are a major health care problem accounting for a large percentage of nosocomial infections. The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI. METHODS: This was a retrospective study performed in Southeast Michigan. Over a 9- year period, a total of 1,168 patients were identified with MRSA BSI. Patient demographics and clinical data were retrieved and evaluated using electronic medical health records. RESULTS: 30-day mortality during the 9-year study period was 16%. Significant risk factors for 30-day mortality were age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score \u3e3 with Odds Ratio (OR) of 1.03 (CI 1.02-1.04), 2.29 (CI 1.40-3.75), 1.78 (CI 1.20-2.63), 1.65 (CI 1.08-2.25), 1.66 (CI 1.02 - 2.70) and 1.86 (CI 1.18 - 2.95) correspondingly. Diabetes mellitus, peripheral vascular disease (PVD), and readmission were protective factors for 30-day mortality with OR of 0.53 (CI 0.36-0.78), 0.46 (CI 0.26-0.84) and 0.13 (CI0.05 - 0.32) respectively. CONCLUSIONS: Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period

Diffusion and Transport Coefficients in Synthetic Opals

Opals are structures composed of the closed packing of spheres in the size range of nano-to-micro meter. They are sintered to create small necks at the points of contact. We have solved the diffusion problem in such structures. The relation between the diffusion coefficient and the termal and electrical conductivity makes possible to estimate the transport coefficients of opal structures. We estimate this changes as function of the neck size and the mean-free path of the carriers. The theory presented is also applicable to the diffusion problem in other periodic structures.Comment: Submitted to PR

Comparison of daptomycin and linezolid in the treatment of vancomycin-resistant enterococcus faecium in the absence of endocarditis

Background: Although linezolid and daptomycin are frequently used for the management of vancomycin-resistant Enterococcus (VRE) bloodstream infection, optimal treatment is undefined. Methods: We conducted a retrospective cohort study from January 2010 to December 2013 of patients with VRE faecium (VREF) bloodstream infection in the absence of endocarditis treated with daptomycin or linezolid at a single 802-bed teaching hospital in Detroit, Mich. Ninety-day all-cause mortality, length of stay, bacteremia duration, antibiotic duration, and recurrence at 30 days were evaluated. Multivariable analysis was performed to determine the effect of treatment selection on mortality. Results: One hundred eighteen patients were included. Seventy-four patients received daptomycin and 44 linezolid. There was no significant difference in baseline characteristics between the 2 groups with the exception of nursing home residence (P = 0.007), intensive care unit admission (P = 0.049), receipt of chemotherapy (P = 0.013), and neutropenia (P = 0.007). Ninety-day all-cause mortality was 46% and 27% (odds ratio = 2.27; 95% confidence interval, 1.1-5.07; P = 0.044) and mean bacteremia duration was 3.6 and 2.6 days (odds ratio = 2.52; 95% confidence interval, 1.17-5.42; P = 0.037) for daptomycin and linezolid, respectively. There was no significant difference in mean length of stay, mean antibiotic duration, and recurrence between the 2 groups. Moreover, there were no significant differences in mortality between the 2 groups after controlling for variables such as chemotherapy, neutropenia, and renal replacement therapy that were associated with increased mortality. Conclusions: Our study showed that there was no significant difference in mortality between linezolid and daptomycin for therapy of VRE bacteremia in the absence of endocarditis after controlling for other variables that were associated with increased mortality

Survival outcomes and patterns of failure in women with stage IIIC

Objectives Para-aortic lymph node involvement in women with endometrial carcinoma (EC) is a poor prognostic factor. Many studies have included women with stage IIIC 2 in cohorts of patients with advanced stage disease. The aim of this study was to analyze survival outcomes and patterns of failure in women with solely stage IIIC 2 EC. Methods We identified women with FIGO stage IIIC 2 EC who underwent surgical staging at our institution. In addition to descriptive analyses of patient demographics, tumor characteristics, and adjuvant treatment received, univariate log-rank analyses and Cox regression multivariate analyses (MVA) were performed to identify predictors of recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). Results A total of 72 women were included in this study cohort. The median follow-up time was 43 months. The median number of positive para -aortic lymph nodes was one. Of the 61 women (84.7%) who received adjuvant therapy, 40 women (65.6%) received chemotherapy and radiation therapy (CRT), 17 women (27.9%) received chemotherapy alone (CT), and only 4 women (6.6%) received radiation therapy alone. Thirty-seven women (51.4%) experienced disease recurrence. Distant metastasis was the most common pattern of failure (73%). Five-year RFS, DSS, and OS were 48%, 51%, and 48%, respectively. Due to small study size, our exploratory multivariate analysis demonstrated that histologic grade was the only significant prognostic factor for DSS ( p = 0.03) and OS ( p = 0.02). The type of adjuvant therapy did not sustain its independent predictive significance for RFS, DSS and OS. Conclusions Our findings suggest that almost half of women with stage IIIC 2 can be cured with surgical staging and adjuvant therapies. The most common pattern of failure was distant metastasis calling for further optimization of systemic therapy

Survival outcomes and patterns of failure in women with stage IIIC

OBJECTIVES: Para-aortic lymph node involvement in women with endometrial carcinoma (EC) is a poor prognostic factor. Many studies have included women with stage IIIC2 in cohorts of patients with advanced stage disease. The aim of this study was to analyze survival outcomes and patterns of failure in women with solely stage IIIC2 EC. METHODS: We identified women with FIGO stage IIIC2 EC who underwent surgical staging at our institution. In addition to descriptive analyses of patient demographics, tumor characteristics, and adjuvant treatment received, univariate log-rank analyses and Cox regression multivariate analyses (MVA) were performed to identify predictors of recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). RESULTS: A total of 72 women were included in this study cohort. The median follow-up time was 43 months. The median number of positive para-aortic lymph nodes was one. Of the 61 women (84.7%) who received adjuvant therapy, 40 women (65.6%) received chemotherapy and radiation therapy (CRT), 17 women (27.9%) received chemotherapy alone (CT), and only 4 women (6.6%) received radiation therapy alone. Thirty-seven women (51.4%) experienced disease recurrence. Distant metastasis was the most common pattern of failure (73%). Five-year RFS, DSS, and OS were 48%, 51%, and 48%, respectively. Due to small study size, our exploratory multivariate analysis demonstrated that histologic grade was the only significant prognostic factor for DSS (p=0.03) and OS (p=0.02). The type of adjuvant therapy did not sustain its independent predictive significance for RFS, DSS and OS. CONCLUSIONS: Our findings suggest that almost half of women with stage IIIC2 can be cured with surgical staging and adjuvant therapies. The most common pattern of failure was distant metastasis calling for further optimization of systemic therapy

Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit

BACKGROUND: Critically ill patients are vulnerable to the development of hospital-associated pressure ulcers (HAPUs). Positioning of patients is an essential component of pressure ulcer prevention because it off-loads areas of high pressure. However, the effectiveness of such positioning is debatable. A continuous bedside pressure mapping (CBPM) device can provide real-time feedback of optimal body position though a pressure-sensing mat that displays pressure images at a patient\u27s bedside, allowing off-loading of high-pressure areas and possibly preventing HAPU formation. METHODS: A prospective controlled study was designed to determine if CBPM would reduce the number of HAPUs in patients treated in our medical intensive care unit. In 2 months, 422 patients were enrolled and assigned to beds equipped with or without a CBPM device. Patients\u27 skin was assessed daily and weekly to determine the presence and progress of HAPUs. All patients were turned every 2 hours. CBPM patients were repositioned to off-load high-pressure points during turning, according to a graphic display. The number of newly formed HAPUs was the primary outcome measured. A χ(2) test was then used to compare the occurrence of HAPUs between groups. RESULTS: HAPUs developed in 2 of 213 patients in the CBPM group (0.9%; both stage II) compared with 10 of 209 in the control group (4.8%; all stage II; P = .02). CONCLUSION: Significantly fewer HAPUs occurred in the CBPM group than the control group, indicating the effectiveness of real-time visual feedback in repositioning of patients to prevent the formation of new HAPUs