Detection of regional blood perfusion changes in epileptic seizures with dynamic brain perfusion CT--a pilot study

BACKGROUND AND PURPOSE: Perfusion CT (P-CT) is used for acute stroke management, not, however, for evaluating epilepsy. To test the hypothesis that P-CT may identify patients with increased regional cerebral blood flow during subtle status epilepticus (SSE), we compared P-CT in SSE to different postictal conditions. METHODS: Fifteen patients (mean age 47 years, range 21-74) underwent P-CT immediately after evaluation in our emergency room. Asymmetry indices between affected and unaffected hemispheres were calculated for regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and mean transit time (MTT). Regional perfusion changes were compared to EEG findings. RESULTS: Three patients in subtle status epilepticus (group 1) had increased regional perfusion with electro-clinical correlate. Six patients showed postictal slowing on EEG corresponding to an area of regional hypoperfusion (group 2). CT and EEG were normal in six patients with a first epileptic seizure (group 3). Cluster analysis of asymmetry indices separated SSE from the other two groups in all three parameters, while rCBF helped to distinguish between chronic focal epilepsies and single events. CONCLUSION: Preliminary results indicate that P-CT may help to identify patients with SSE during emergency workup. This technique provides important information to neurologists or emergency physicians in the difficult clinical differential diagnosis of altered mental status due to subtle status epilepticus.

Geo-Locating the Knowledge Transfer in StackOverflow

By analyzing the transactions in Stack Overflow we can get a glimpse of the way in which the different geographical regions in the world contribute to the knowledge market represented by the website. In this paper we aggregate the knowledge transfer from the level of the users to the level of geographical regions and learn that Europe and North America are the principal and virtually equal contributors; Asia comes as a distant third, mainly represented by India; and Oceania contributes less than Asia but more than South America and Africa together.

Minderung physiologischer Reaktivität auf psychosozialen Stress durch Taiji-Training - wer profitiert besonders? Eine Untersuchung moderierender Effekte von selbstberichteter dispositioneller psychologischer Stressreaktivität und Achtsamkeit.

Theoretical background and objectives: Stress reducing effects of Taiji practice have been repeatedly reported. The aim of the present study was to investigate which persons benefit the most from Taiji practice in terms of reduced physiological stress reactivity. Methods: We conducted a secondary data analysis of a randomized controlled Taiji trial that significantly lowered stress reactivity of salivary cortisol and alpha-amylase in a Taiji group (n = 26) compared to a control group (n = 23). By using hierarchical regression analyses potential moderating influences of self-reported trait-mindfulness and trait values of general psychological stress reactivity on stress protective effects of a three months Taiji training were examined. Moderator variables were assessed at the beginning of the study using the Freiburg-Mindfulness-Inventory and the Perceived- Stress-Reactivity-Scale. Results: The interaction effect "study group x mindfulness" was significant for stress reactivity of salivary alpha-amylase (p = 0.050). Participants in the Taiji group with higher trait-mindfulness showed a lower salivary alpha-amylase stress reactivity, while in the control group higher trait-mindfulness was associated with higher alpha-amylase stress reactivity. In the control group (p = 0.042) but not in the Taiji group (p = 0.69) salivary cortisol stress reactivity was significantly increased in persons with higher trait-mindfulness scores. We could not find moderating effects of general psychological stress reactivity. Conclusion: Our results suggest that without intervention higher trait-mindfulness is associated with increased physiological stress reactivity. Persons with higher trait-mindfulness seem to benefit the most from practicing Taiji in terms of reduced sympathetic stress reactivity.

Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.

BACKGROUND Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition. OBJECTIVES To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults. SEARCH METHODS We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The comparator interventions considered for this review were: no treatment (NT), wait list (WL) and attention/psychological placebo (APP). For this review we considered four short-term (ST) outcomes (ST-remission, ST-response, ST-dropouts, ST-improvement on a continuous scale) and one long-term (LT) outcome (LT-remission/response). DATA COLLECTION AND ANALYSIS As a first step, we conducted a systematic search of all relevant papers according to the inclusion criteria. For each outcome, we then constructed a treatment network in order to clarify the extent to which each type of therapy and each comparison had been investigated in the available literature. Then, for each available comparison, we conducted a random-effects meta-analysis. Subsequently, we performed a network meta-analysis in order to synthesise the available direct evidence with indirect evidence, and to obtain an overall effect size estimate for each possible pair of therapies in the network. Finally, we calculated a probabilistic ranking of the different psychological therapies and control conditions for each outcome. MAIN RESULTS We identified 1432 references; after screening, we included 60 studies in the final qualitative analyses. Among these, 54 (including 3021 patients) were also included in the quantitative analyses. With respect to the analyses for the first of our primary outcomes, (short-term remission), the most studied of the included psychological therapies was CBT (32 studies), followed by BT (12 studies), PT (10 studies), CT (three studies), SP (three studies) and PD (two studies).The quality of the evidence for the entire network was found to be low for all outcomes. The quality of the evidence for CBT vs NT, CBT vs SP and CBT vs PD was low to very low, depending on the outcome. The majority of the included studies were at unclear risk of bias with regard to the randomisation process. We found almost half of the included studies to be at high risk of attrition bias and detection bias. We also found selective outcome reporting bias to be present and we strongly suspected publication bias. Finally, we found almost half of the included studies to be at high risk of researcher allegiance bias.Overall the networks appeared to be well connected, but were generally underpowered to detect any important disagreement between direct and indirect evidence. The results showed the superiority of psychological therapies over the WL condition, although this finding was amplified by evident small study effects (SSE). The NMAs for ST-remission, ST-response and ST-improvement on a continuous scale showed well-replicated evidence in favour of CBT, as well as some sparse but relevant evidence in favour of PD and SP, over other therapies. In terms of ST-dropouts, PD and 3W showed better tolerability over other psychological therapies in the short term. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these two treatments may be more stable with respect to other psychological therapies. However, all the mentioned differences among active treatments must be interpreted while taking into account that in most cases the effect sizes were small and/or results were imprecise. AUTHORS' CONCLUSIONS There is no high-quality, unequivocal evidence to support one psychological therapy over the others for the treatment of panic disorder with or without agoraphobia in adults. However, the results show that CBT - the most extensively studied among the included psychological therapies - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. In the only two studies available that explored PD, this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. Furthermore, PD appeared to be the best tolerated (in terms of ST-dropouts) among psychological treatments. Unexpectedly, we found some evidence in support of the possible viability of non-specific supportive psychotherapy for the treatment of panic disorder; however, the results concerning SP should be interpreted cautiously because of the sparsity of evidence regarding this treatment and, as in the case of PD, further research is needed to explore this issue. Behaviour therapy did not appear to be a valid alternative to CBT as a first-line treatment for patients with panic disorder with or without agoraphobia.

MOREMATA: Stata module (Mata) to provide various functions

This package includes various Mata functions. kern(): various kernel functions; kint(): kernel integral functions; kdel0(): canonical bandwidth of kernel; quantile(): quantile function; median(): median; iqrange(): inter-quartile range; ecdf(): cumulative distribution function; relrank(): grade transformation; ranks(): ranks/cumulative frequencies; freq(): compute frequency counts; histogram(): produce histogram data; mgof(): multinomial goodness-of-fit tests; collapse(): summary statistics by subgroups; _collapse(): summary statistics by subgroups; gini(): Gini coefficient; sample(): draw random sample; srswr(): SRS with replacement; srswor(): SRS without replacement; upswr(): UPS with replacement; upswor(): UPS without replacement; bs(): bootstrap estimation; bs2(): bootstrap estimation; bs_report(): report bootstrap results; jk(): jackknife estimation; jk_report(): report jackknife results; subset(): obtain subsets, one at a time; composition(): obtain compositions, one by one; ncompositions(): determine number of compositions; partition(): obtain partitions, one at a time; npartitionss(): determine number of partitions; rsubset(): draw random subset; rcomposition(): draw random composition; colvar(): variance, by column; meancolvar(): mean and variance, by column; variance0(): population variance; meanvariance0(): mean and population variance; mse(): mean squared error; colmse(): mean squared error, by column; sse(): sum of squared errors; colsse(): sum of squared errors, by column; benford(): Benford distribution; cauchy(): cumulative Cauchy-Lorentz dist.; cauchyden(): Cauchy-Lorentz density; cauchytail(): reverse cumulative Cauchy-Lorentz; invcauchy(): inverse cumulative Cauchy-Lorentz; rbinomial(): generate binomial random numbers; cebinomial(): cond. expect. of binomial r.v.; root(): Brent's univariate zero finder; nrroot(): Newton-Raphson zero finder; finvert(): univariate function inverter; integrate_sr(): univariate function integration (Simpson's rule); integrate_38(): univariate function integration (Simpson's 3/8 rule); ipolate(): linear interpolation; polint(): polynomial inter-/extrapolation; plot(): Draw twoway plot; _plot(): Draw twoway plot; panels(): identify nested panel structure; _panels(): identify panel sizes; npanels(): identify number of panels; nunique(): count number of distinct values; nuniqrows(): count number of unique rows; isconstant(): whether matrix is constant; nobs(): number of observations; colrunsum(): running sum of each column; linbin(): linear binning; fastlinbin(): fast linear binning; exactbin(): exact binning; makegrid(): equally spaced grid points; cut(): categorize data vector; posof(): find element in vector; which(): positions of nonzero elements; locate(): search an ordered vector; hunt(): consecutive search; cond(): matrix conditional operator; expand(): duplicate single rows/columns; _expand(): duplicate rows/columns in place; repeat(): duplicate contents as a whole; _repeat(): duplicate contents in place; unorder2(): stable version of unorder(); jumble2(): stable version of jumble(); _jumble2(): stable version of _jumble(); pieces(): break string into pieces; npieces(): count number of pieces; _npieces(): count number of pieces; invtokens(): reverse of tokens(); realofstr(): convert string into real; strexpand(): expand string argument; matlist(): display a (real) matrix; insheet(): read spreadsheet file; infile(): read free-format file; outsheet(): write spreadsheet file; callf(): pass optional args to function; callf_setup(): setup for mm_callf().