Nancy G. Bliwise

Rate of 24-hour blood pressure decline and mortality after spontaneous intracerebral hemorrhage: a retrospective analysis with a random effects regression model.

OBJECTIVE To study the effect of decline in blood pressure on mortality in patients with spontaneous intracerebral hemorrhage (ICH). DESIGN Retrospective chart review. SETTING University-affiliated teaching hospital. PATIENTS Consecutive patients admitted with spontaneous ICH over a 3-year period. MEASURES Blood pressure recordings were obtained from the first 24 hrs. Patients (n = 105) with more than five blood pressure recordings and on average greater than one measurement per 2 hrs were included (mean measurements per patient = 20.3). Mean arterial pressure (MAP) recordings over the first 24 hrs after presentation were regressed on time for each patient. Each patients MAP was calculated as a slope (change mm Hg/hr). We performed logistic regression analyses to determine the effect of MAP slope on mortality and functional outcome, adjusting for other predictive factors including Glasgow Coma Scale (GCS) score and hematoma volume. The effect of MAP slope on mortality was also evaluated in subsets of patients based on age, gender, initial GCS score, initial MAP, treatment status, hematoma volume, and presence of ventricular blood. MAIN RESULTS Mean slope of change in MAP was -2.0 mm Hg/hr (+/- 1.9, range -8.5 to +0.6). The slope of MAP (faster rate of decline) within the first 24 hrs was significantly associated with higher mortality (p =.04), independent of initial GCS score and hematoma volume. In subgroup analyses, MAP slope was significantly associated with mortality in men (p = .08), patients with hematoma volume <50 mm3 (p =.08), initial MAP < or = 146 mm Hg (p = .006), and those with initial GCS score > or = 10 (p= .07). MAP slope did not predict functional outcome among survivors. CONCLUSIONS A rapid decline in MAP within 24 hrs after presentation is independently associated with increased mortality in patients with ICH. A large, prospective, randomized trial is required to confirm these findings.

Parsing the heterogeneity of impulsivity: A meta-analytic review of the behavioral implications of the UPPS for psychopathology.

The construct of impulsivity is implicated in a wide variety of psychopathology. However, the heterogeneous factors or subcomponents that differentially predict outcomes are still in the process of being parsed. The present review and meta-analysis focuses on the psychopathological correlates of the Negative Urgency, (lack of) Premeditation, (lack of) perseverance, Sensation Seeking, and Positive Urgency (UPPS/UPPS-P; Whiteside & Lynam, 2001). which provides a relatively new model of impulsivity that posits 5 potentially overlapping pathways to impulsive action. The present meta-analysis included 115 studies that used the UPPS, with a total of 40,432 participants. Findings suggested that the Negative Urgency pathway to impulsivity demonstrated the greatest correlational effect sizes across all forms of psychopathology, with the Positive Urgency pathway demonstrating a pattern of correlations similar to that of Negative Urgency. These findings raise questions regarding the conceptual and practical separability of these pathways. Lack of Premeditation and Lack of Perseverance also demonstrated similar correlational patterns, suggesting that further investigation of the distinctiveness of these pathways is warranted.

Maturation of the hippocampal formation and amygdala in Macaca mulatta: A volumetric magnetic resonance imaging study

Malformations of the hippocampal formation and amygdala have been implicated in several neurodevelopmental disorders; yet relatively little is known about their normal structural development. The purpose of this study was to characterize the early developmental trajectories of the hippocampus and amygdala in the rhesus macaques (Macaca mulatta) using noninvasive MRI techniques. T1‐weighted structural scans of 22 infant and juvenile monkeys (11 male, 11 female) were obtained between 1 week and approximately 2 yrs of age. Ten animals (five males, five females) were scanned multiple times and 12 monkeys (six males, six females) were scanned once between 1 and 4 weeks of age. Both structures exhibited significant age‐related changes throughout the first 2 yrs of life that were not explained by overall brain development. The hippocampal formation increased 117.05% in males and 110.86% in females. No sex differences were evident, but the left hemisphere was significantly larger than the right. The amygdala increased 86.49% in males and 72.94% in females with males exhibiting a larger right than left amygdala. For both structures, the most substantial volumetric increases were seen within the first month, but the hippocampal formation appeared to develop more slowly than the amygdala with the rate of hippocampal maturation stabilizing around 11 months and that of amygdala maturation stabilizing around 8 months. Differences in volumetric developmental trajectories of the hippocampal formation and amygdala largely mirror differences in the timing of the functional development of these structures. The current results emphasize the importance of including early postnatal ages when assessing developmental trajectories of neuroanatomical structures and reinforces the utility of nonhuman primates in the assessment of normal developmental patterns.

Family Unpredictability, Parental Alcoholism, and the Development of Parentification

The current study sought to examine whether parental alcoholism and family unpredictability contribute to the development of parentification, when children take on parental roles within the family. Participants (N = 123) from 10 outpatient clinics completed surveys that included the Retrospective Family Unpredictability Scale (Ross, 1999), the Children of Alcoholics Screening Test (Jones, 1982) and the Parentification Questionnaire (Sessions & Jurkovic, 1986). Two hierarchical regression analyses confirmed that family unpredictability and parental alcoholism each made independent contributions to childhood parentification. We discuss clinical implications and suggestions for future research.

Interrelationship of Cytokines, Hypothalamic-Pituitary-Adrenal Axis Hormones, and Psychosocial Variables in the Prediction of Preterm Birth

Background/Aims: To examine the relationship of biological mediators (cytokines, stress hormones), psychosocial, obstetric history, and demographic factors in the early prediction of preterm birth (PTB) using a comprehensive logistic regression model incorporating diverse risk factors. Methods: In this prospective case-control study, maternal serum biomarkers were quantified at 9–23 weeks’ gestation in 60 women delivering at <37 weeks compared to 123 women delivering at term. Biomarker data were combined with maternal sociodemographic factors and stress data into regression models encompassing 22 preterm risk factors and 1st-order interactions. Results: Among individual biomarkers, we found that macrophage migration inhibitory factor (MIF), interleukin-10, C-reactive protein (CRP), and tumor necrosis factor-α were statistically significant predictors of PTB at all cutoff levels tested (75th, 85th, and 90th percentiles). We fit multifactor models for PTB prediction at each biomarker cutoff. Our best models revealed that MIF, CRP, risk-taking behavior, and low educational attainment were consistent predictors of PTB at all biomarker cutoffs. The 75th percentile cutoff yielded the best predicting model with an area under the ROC curve of 0.808 (95% CI 0.743–0.874). Conclusion: Our comprehensive models highlight the prominence of behavioral risk factors for PTB and point to MIF as a possible psychobiological mediator.

Web-Based Tutorials for Teaching Introductory Statistics.

Interactive Web-based tutorials were developed as a supplement to lectures in an introductory statistics class. A quasi-experimental design compared learning outcomes of students who attended one of two classes that offered the tutorials to students as an extra-credit course option to those who attended a lecture-only class. Analysis of critical items on five course exams revealed that students who attended the classes with tutorials scored higher on four out of five topics covered by the tutorials than students who attended the lecture-only class. Tutorial use leading to mastery of the concepts was associated with exam performance on the critical items. These findings suggest that Web-based tutorials can be an effective supplement to class lectures for enhancing student learning.

Toxoplasma gondii exposure affects neural processing speed as measured by acoustic startle latency in schizophrenia and controls

The prevalence of Toxoplasma gondii (TOXO) infection in schizophrenia (SCZ) is elevated compared to controls (odds ratio=2.73). TOXO infection is associated with psychomotor slowing in rodents and non-psychiatric humans. Latency of the acoustic startle response, an index of neural processing speed, is the time it takes for a startling stimulus to elicit the reflexive response through a three-synapse subcortical circuit. We report a significant slowing of latency in TOXO seropositive SCZ vs. seronegative SCZ, and in TOXO seropositive controls vs. seronegative controls. Latency was likewise slower in SCZ subjects than in controls. These findings indicate a slowing of neural processing speed with chronic TOXO infection; the slowest startle latency was seen in the TOXO seropositive SCZ group.

Interactions are critical.

Although we agree with Theobold and Freeman (2014) that linear models are the most appropriate way in which to analyze assessment data, we show the importance of testing for interactions between covariates and factors.